Pettit Robert J, Gregory Brandon, Stahl Stephanie, Buller Leonard T, Deans Christopher
Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska School of Medicine, Omaha, NE, USA.
Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA.
Arthroplast Today. 2024 Apr 24;27:101383. doi: 10.1016/j.artd.2024.101383. eCollection 2024 Jun.
As the number of total hip and knee arthroplasties (TJA) performed increases, there is heightened interest in perioperative optimization to improve outcomes. Sleep is perhaps one of the least understood perioperative factors that affects TJA outcomes. The purpose of this article is to review the current body of knowledge regarding sleep and TJA and the tools available to optimize sleep perioperatively.
A manual search was performed using PubMed for articles with information about sleep in the perioperative period. Articles were selected that examined: sleep and pain in the perioperative period; the effect of surgery on sleep postoperatively; the relationship between sleep and TJA outcomes; risk factors for perioperative sleep disturbance; the effect of anesthesia on sleep; and the efficacy of interventions to optimize sleep perioperatively.
Sleep and pain are intimately associated; poor sleep is associated with increased pain sensitivity. Enhanced sleep is associated with improved surgical outcomes, although transient sleep disturbances are normal postoperatively. Risk factors for perioperative sleep disturbance include increasing age, pre-existing sleep disorders, medical comorbidities, and type of anesthesia used. Interventions to improve sleep include optimizing medical comorbidities preoperatively, increasing sleep time perioperatively, appropriating sleep hygiene, using cognitive behavioral therapy, utilizing meditation and mindfulness interventions, and using pharmacologic sleep aids.
Sleep is one of many factors that affect TJA. As we better understand the interplay between sleep, risk factors for suboptimal sleep, and interventions that can be used to optimize sleep, we will be able to provide better care and improved outcomes for patients.
随着全髋关节和膝关节置换术（TJA）实施数量的增加，人们对围手术期优化以改善手术效果的关注度日益提高。睡眠可能是影响TJA手术效果的最不为人所了解的围手术期因素之一。本文旨在综述目前关于睡眠与TJA的知识体系以及围手术期优化睡眠的可用工具。
通过手动检索PubMed数据库，查找有关围手术期睡眠信息的文章。入选的文章探讨了以下内容：围手术期睡眠与疼痛；手术对术后睡眠的影响；睡眠与TJA手术效果之间的关系；围手术期睡眠障碍的危险因素；麻醉对睡眠的影响；以及围手术期优化睡眠干预措施的疗效。
睡眠与疼痛密切相关；睡眠不佳与疼痛敏感性增加有关。改善睡眠与更好的手术效果相关，尽管术后短暂的睡眠障碍是正常现象。围手术期睡眠障碍的危险因素包括年龄增长、既往存在的睡眠障碍、内科合并症以及所使用的麻醉类型。改善睡眠的干预措施包括术前优化内科合并症、围手术期增加睡眠时间、采用睡眠卫生措施、使用认知行为疗法、运用冥想和正念干预措施以及使用助眠药物。
睡眠是影响TJA的众多因素之一。随着我们更好地理解睡眠、睡眠不佳的危险因素以及可用于优化睡眠的干预措施之间的相互作用，我们将能够为患者提供更好的护理并改善手术效果。
