Rogers Andrew H, Rabbitts Jennifer A, Saper Michael G, Schmale Gregory A, Palermo Tonya M, Groenewald Cornelius B
Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA.
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Sleep Adv. 2024 Jun 17;5(1):zpae039. doi: 10.1093/sleepadvances/zpae039. eCollection 2024.
Opioids are effective for acute pain management following surgery among adolescents, yet are associated with significant negative consequences, including respiratory depression and opioid misuse. Sleep deficiency is common following surgery and extant research indicates strong cross-sectional associations between sleep deficiency and increased problematic opioid use.
This study examined longitudinal associations between postsurgical sleep deficiency and opioid use among adolescents undergoing outpatient surgery. We also examined daily pain and mood as mechanisms linking previous night's sleep deficiency and next day prescription opioid use.
This prospective, observational study enrolled 106 adolescents (11-19 years) who underwent orthopedic outpatient surgery and collected pre-surgery and longitudinal measurements. Participants were 52% female, African-American (7%), American Indian/Alaska Native (7%), Hispanic (9%), Native Hawaiian or Other Pacific Islander (4%), or white, non-Hispanic (66%). Using ecological momentary assessment methods, participants reported sleep, pain, and mood in real time over the first 14 days following surgery. Postsurgical opioid use was measured using an electronic medication cap monitoring device, eCAP. Associations between variables were measured using multilevel structural equation modeling.
Using multi-level mediation models, pain, but not mood-mediated associations between postsurgical sleep deficiency (sleep quality, total sleep time, sleep onset latency, and wake after sleep onset) and opioid use, at both the within-person and between-person levels. Results highlight that greater previous night's sleep deficiency (both generally and greater than a person's mean level) was associated with higher next day pain (both generally and greater than a person's mean level), which, in turn, was associated with higher opioid use. Furthermore, between-person total effect models provide support for sleep deficiency predicting higher opioid use.
Our findings should be considered preliminary yet underscore the need for a comprehensive and personalized approach to postsurgical pain management and opioid use, potentially implementing interventions targeting sleep quality and quantity to reduce pain and opioid use.
阿片类药物对青少年术后急性疼痛管理有效，但会带来严重的负面后果，包括呼吸抑制和阿片类药物滥用。术后睡眠不足很常见，现有研究表明睡眠不足与阿片类药物使用问题增加之间存在很强的横断面关联。
本研究探讨了接受门诊手术的青少年术后睡眠不足与阿片类药物使用之间的纵向关联。我们还研究了每日疼痛和情绪作为连接前一晚睡眠不足与次日处方阿片类药物使用的机制。
这项前瞻性观察性研究招募了106名接受骨科门诊手术的青少年（11 - 19岁），并收集了术前和纵向测量数据。参与者中52%为女性，非裔美国人占7%，美洲印第安人/阿拉斯加原住民占7%，西班牙裔占9%，夏威夷原住民或其他太平洋岛民占4%，白人非西班牙裔占66%。使用生态瞬时评估方法，参与者在术后的前14天实时报告睡眠、疼痛和情绪。术后阿片类药物使用通过电子药物瓶盖监测设备eCAP进行测量。变量之间的关联使用多层次结构方程模型进行测量。
使用多层次中介模型，在个体内和个体间水平上，疼痛而非情绪介导了术后睡眠不足（睡眠质量、总睡眠时间、入睡潜伏期和睡眠中觉醒时间）与阿片类药物使用之间的关联。结果表明，前一晚睡眠不足更严重（总体上以及高于个人平均水平）与次日疼痛更严重（总体上以及高于个人平均水平）相关，而这又与更高的阿片类药物使用相关。此外，个体间总效应模型支持睡眠不足预测更高的阿片类药物使用。
我们的研究结果应被视为初步的，但强调了对术后疼痛管理和阿片类药物使用采取全面和个性化方法的必要性，可能实施针对睡眠质量和数量的干预措施以减轻疼痛和减少阿片类药物使用。
