Zhong Zhenyu, Lu Xian, Zhang Qian, Zhang Yueying
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.
Department of Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
J Pain Res. 2025 Sep 2;18:4527-4538. doi: 10.2147/JPR.S508324. eCollection 2025.
Postoperative hyperalgesia (POH) is a common clinical phenomenon that will increase the experience of patients' pain. Previous studies have confirmed that surgical site, opioid analgesics, gender, and age were risk factors of POH. Limited research has been investigated to prove the association between obstructive sleep apnea (OSA) and POH. This study investigated the relationship between severity of OSA and POH in patients undergoing bariatric surgery.
We conducted a single-center prospective observational study in the Affiliated Hospital of Xuzhou Medical University from April 2022 to September 2022. Patients were stratified for OSA risk according to their scores of STOP-Bang questionnaire. Postoperative pain was assessed using a 100 mm Visual Analogue Scale (VAS). Mechanical pain threshold was measured with Von Frey filaments in order to determine whether patients developed POH. Characteristic variables were selected by means of least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was used to identify the independent risk factors associated with POH.
Postoperative hyperalgesia was diagnosed in 69.1% of all patients, and the risk factors for POH were: male(OR, 2.43; 95% CI, 1.04-6.10), age(OR, 2.03;95% CI, 1.28-3.31), BMI≥35 kg·m(OR, 3.13;95% CI, 1.46-6.83), high risk of moderate to severe OSA (OR, 6.43;95% CI, 2.71-15.52), preoperative mechanical pain thresholds(OR, 4.05;95% CI, 2.35-9.14).
Our study found that patients with high risk of moderate to severe OSA were more likely to have postoperative hyperalgesia than those in the low-risk group, and the hyperalgesia was more severe in patients with high risk of moderate to severe OSA within 24 hours after surgery. These results highlight the need for OSA screening in preoperative assessments to mitigate postoperative hyperalgesia.
术后痛觉过敏（POH）是一种常见的临床现象，会增加患者的疼痛体验。既往研究证实，手术部位、阿片类镇痛药、性别和年龄是POH的危险因素。关于阻塞性睡眠呼吸暂停（OSA）与POH之间关联的研究较少。本研究探讨了肥胖手术患者中OSA严重程度与POH之间的关系。
2022年4月至2022年9月，我们在徐州医科大学附属医院进行了一项单中心前瞻性观察研究。根据患者的STOP-Bang问卷得分对OSA风险进行分层。使用100mm视觉模拟量表（VAS）评估术后疼痛。用von Frey细丝测量机械痛阈，以确定患者是否发生POH。通过最小绝对收缩和选择算子（LASSO）回归选择特征变量。采用多因素logistic回归确定与POH相关的独立危险因素。
所有患者中69.1%被诊断为术后痛觉过敏，POH的危险因素为：男性（OR，2.43；95%CI，1.04-6.10）、年龄（OR，2.03；95%CI，1.28-3.31）、BMI≥35kg·m（OR，3.13；95%CI，1.46-6.83）、中重度OSA高风险（OR，6.43；95%CI，2.71-15.52）、术前机械痛阈（OR，4.05；95%CI，2.35-9.14）。
我们的研究发现，中重度OSA高风险患者比低风险组患者更易发生术后痛觉过敏，且术后24小时内，中重度OSA高风险患者的痛觉过敏更严重。这些结果凸显了在术前评估中进行OSA筛查以减轻术后痛觉过敏的必要性。
