Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Eur J Pain. 2021 Aug;25(7):1482-1492. doi: 10.1002/ejp.1761. Epub 2021 Mar 23.
Sleep disturbance is thought to aggravate acute postoperative pain. The influence of preoperative sleep problems on pain control in the long-term and development of chronic postsurgical pain is largely unknown.
This prospective, observational study aimed to examine the links between preoperative sleep disturbance (Pittsburgh Sleep Quality Index, PSQI) and pain severity (Brief Pain Inventory, BPI) 6 months postoperative (primary outcome), objective measures of pain and postoperative pain control variables (secondary outcomes). Patients (n = 52) with disabling osteoarthritis (OA) pain undergoing total hip arthroplasty (THA) were included. Quantitative sensory testing (QST) was performed preoperatively on the day of surgery to evaluate pain objectively. Clinical data, as well as measures of sleep quality and pain, were obtained preoperatively and longitudinally over a 6-month period.
Preoperatively, sleep disturbance (i.e., PSQI score >5) occurred in 73.1% (n = 38) of THA patients, and pain severity was high (BPI pain severity 5.4 ± 1.3). Regression models, adjusting for relevant covariates, showed that preoperative PSQI score predicted pain severity 6 months postoperative (β = 0.091 (95% CI 0.001-0.181), p = .048, R = 0.35). Poor sleep quality was associated with increased pressure pain sensitivity and impaired endogenous pain inhibitory capacity (R range 0.14-0.33, all p's < 0.04). Moreover, preoperative sleep disturbance predicted increased opioid treatment during the first 24 hr after surgery (unadjusted β = 0.009 (95% CI 0.002-0.015) mg/kg, p = .007, R = 0.15).
Preoperative sleep disturbance is prevalent in THA patients, is associated with objective measures of pain severity, and independently predicts immediate postoperative opioid treatment and poorer long-term pain control in patients who have undergone THA.
Poor sleep quality and impaired sleep continuity are associated with heightened pain sensitivity, but previous work has not evaluated whether preoperative sleep problems impact long-term postoperative pain outcomes. Here, we show that sleep difficulties prior to total hip arthroplasty adversely predict postoperative pain control 6 months after surgery. Given sleep difficulties robustly predict pain outcomes, targeting and improving sleep may have salutary effects on postoperative pain reports and management.
睡眠障碍被认为会加重急性术后疼痛。术前睡眠问题对长期疼痛控制和慢性术后疼痛发展的影响在很大程度上尚不清楚。
这项前瞻性、观察性研究旨在研究术前睡眠障碍（匹兹堡睡眠质量指数，PSQI）与术后 6 个月时疼痛严重程度（简明疼痛量表，BPI）之间的联系（主要结果），客观疼痛测量和术后疼痛控制变量（次要结果）。纳入了患有致残性骨关节炎（OA）疼痛的接受全髋关节置换术（THA）的患者（n=52）。在手术当天进行定量感觉测试（QST），以客观地评估疼痛。在 6 个月的时间内，在术前和纵向获得临床数据以及睡眠质量和疼痛测量值。
术前，73.1%（n=38）的 THA 患者出现睡眠障碍（即 PSQI 评分>5），疼痛严重程度较高（BPI 疼痛严重程度 5.4±1.3）。调整相关协变量的回归模型显示，术前 PSQI 评分可预测术后 6 个月的疼痛严重程度（β=0.091（95%CI 0.001-0.181），p=0.048，R2=0.35）。睡眠质量差与压力痛觉敏感性增加和内源性疼痛抑制能力受损相关（R 范围 0.14-0.33，所有 p 值均<0.04）。此外，术前睡眠障碍预测术后 24 小时内阿片类药物治疗增加（未调整的β=0.009（95%CI 0.002-0.015）mg/kg，p=0.007，R2=0.15）。
THA 患者中术前睡眠障碍很常见，与客观的疼痛严重程度指标相关，并且独立预测接受 THA 手术后的即时术后阿片类药物治疗和较差的长期疼痛控制。
睡眠质量差和睡眠连续性受损与疼痛敏感性增加有关，但以前的研究尚未评估术前睡眠问题是否会影响长期术后疼痛结果。在这里，我们表明，全髋关节置换术前的睡眠困难会对术后 6 个月的术后疼痛控制产生不利影响。鉴于睡眠困难可强有力地预测疼痛结果，因此针对并改善睡眠可能对术后疼痛报告和管理具有有益作用。
