Preoperative Sleep Quality And Adverse Pain Outcomes After Total Hip Arthroplasty.

Bjurström, Martin F; Irwin, Michael R; Bodelsson, Mikael; Smith, Michael T; Mattsson-Carlgren, Niklas

BACKGROUND 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. METHODS 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 six-month period. RESULTS 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=0.048, R2 =0.35). Poor sleep quality was associated with increased pressure pain sensitivity and impaired endogenous pain inhibitory capacity (R2 range 0.14-0.33, all p´s <0.04). Moreover, preoperative sleep disturbance predicted increased opioid treatment during the first 24 hours after surgery (unadjusted β=0.009 (95% CI 0.002-0.015) mg/kg, p=0.007, R2 =0.15). CONCLUSIONS 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.