Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study

Ze-Yu Luo, Ling-Li Li, Duan Wang, Hao-Yang Wang, Fu-Xing Pei, Zong-Ke Zhou, Ze-Yu Luo, Ling-Li Li, Duan Wang, Hao-Yang Wang, Fu-Xing Pei, Zong-Ke Zhou

Abstract

Background: The relationship between preoperative sleep quality and postoperative clinical outcomes after total joint arthroplasty (TJA) is unclear. We performed a prospective cohort study to determine whether preoperative sleep quality was correlated with postoperative outcomes after TJA.

Methods: In this prospective cohort study, 994 patients underwent TJA. Preoperative sleep measures included scores on the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and a ten-point sleep quality scale. The primary study outcome measured was the visual analog scale (VAS) pain score to 12 weeks postoperation. The consumption of analgesic rescue drugs (oxycodone and parecoxib) and postoperative length of stay (LOS) were recorded. We also measured functional parameters, including range of motion (ROM), Knee Society Score (KSS), and Harris hip score (HHS).

Results: The mean age for total knee and hip arthroplasties was 64.28 and 54.85 years, respectively. The PSQI scores were significantly correlated with nocturnal and active pain scores and ROM and functional scores from postoperative day 1 (POD1) to POD3. In addition, significant correlation was noted between the correlation between the active pain scores and ESS scores in the TKA group at postoperative 3 months. The consumption of analgesics after joint arthroplasty was significantly correlated with the PSQI scores. Moreover, significant correlations were noted between the sleep parameters and postoperative length of hospital stay (LOS).

Conclusion: Preoperative sleep parameters were correlated with clinical outcomes (i.e., pain, ROM, function, and LOS) after TJA. Clinicians should assess the sleep quality and improve it before TJA.

Keywords: Clinical function; Pain; Sleep; Total joint arthroplasty.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin N Am. 2004;42(1):1–9. doi: 10.1016/S0033-8389(03)00161-1.
    1. Murphy SL, et al. Relationship between fatigue and subsequent physical activity among older adults with symptomatic osteoarthritis. Arthritis Care Res (Hoboken) 2013;65(10):1617–1624.
    1. Murphy SL, et al. Association between pain, radiographic severity, and centrally-mediated symptoms in women with knee osteoarthritis. Arthritis Care Res. 2011;63(11):1543–1549. doi: 10.1002/acr.20583.
    1. Parmelee PA, Tighe CA, Dautovich ND. Sleep disturbance in osteoarthritis: linkages with pain, disability, and depressive symptoms. Arthritis Care Res. 2015;67(3):358–365. doi: 10.1002/acr.22459.
    1. Redeker NS. Sleep in acute care settings: an integrative review. J Nurs Scholarsh. 2000;32(1):31–38. doi: 10.1111/j.1547-5069.2000.00031.x.
    1. Luo ZY, et al. Monobloc implants in cementless total hip arthroplasty in patients with Legg-Calve-Perthes disease: a long-term follow-up. BMC Musculoskelet Disord. 2017;18(1):386. doi: 10.1186/s12891-017-1748-1.
    1. Bourne RB, et al. Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res. 2010;468(2):542–546. doi: 10.1007/s11999-009-1046-9.
    1. Chen AF, et al. Prospective evaluation of sleep disturbances after total knee arthroplasty. J Arthroplast. 2016;31(1):330–332. doi: 10.1016/j.arth.2015.07.044.
    1. Krenk L, Jennum P, Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement. J Clin Sleep Med. 2014;10(3):321–326.
    1. Gong L, Wang Z, Fan D. Sleep quality effects recovery after total knee arthroplasty (TKA)--a randomized, double-blind, controlled study. J Arthroplasty. 2015;30(11):1897–1901. doi: 10.1016/j.arth.2015.02.020.
    1. Kirksey MA, et al. Impact of melatonin on sleep and pain after total knee arthroplasty under regional anesthesia with sedation: a double-blind, randomized, placebo-controlled pilot study. J Arthroplasty. 2015;30(12):2370–2375. doi: 10.1016/j.arth.2015.06.034.
    1. Smith MT, et al. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494–505. doi: 10.1093/sleep/30.4.494.
    1. Roehrs T, et al. Sleep loss and REM sleep loss are hyperalgesic. Sleep. 2006;29(2):145–151. doi: 10.1093/sleep/29.2.145.
    1. Onen SH, et al. The effects of total sleep deprivation, selective sleep interruption and sleep recovery on pain tolerance thresholds in healthy subjects. J Sleep Res. 2001;10(1):35–42. doi: 10.1046/j.1365-2869.2001.00240.x.
    1. Roehrs TA, Roth T. Increasing presurgery sleep reduces postsurgery pain and analgesic use following joint replacement: a feasibility study. Sleep Med. 2017;33:109–113. doi: 10.1016/j.sleep.2017.01.012.
    1. Parvizi J, Miller AG, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93(11):1075–1084. doi: 10.2106/JBJS.J.01095.
    1. Lei Yi-ting, Xu Bin, Xie Xiao-wei, Xie Jin-wei, Huang Qiang, Pei Fu-xing. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial. International Orthopaedics. 2017;42(3):499–505. doi: 10.1007/s00264-017-3537-8.
    1. Luo ZY, et al. Oral vs intravenous vs topical tranexamic acid in primary hip arthroplasty: a prospective, randomized, double-blind, controlled study. J Arthroplasty. 2018;33(3):786–793. doi: 10.1016/j.arth.2017.09.062.
    1. Yi Z, et al. Tranexamic acid administration in primary total hip arthroplasty: a randomized controlled trial of intravenous combined with topical versus single-dose intravenous administration. J Bone Joint Surg Am. 2016;98(12):983–991. doi: 10.2106/JBJS.15.00638.
    1. Wang D, et al. Effect of multiple doses of oral tranexamic acid on haemostasis and inflammatory reaction in total hip arthroplasty: a randomized controlled trial. Thromb Haemost. 2019;119(1):92–103. doi: 10.1055/s-0038-1676625.
    1. Healy WL, et al. Complications of total knee arthroplasty: standardized list and definitions of the knee society. Clin Orthop Relat Res. 2013;471(1):215–220. doi: 10.1007/s11999-012-2489-y.
    1. Healy WL, et al. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop Relat Res. 2016;474(2):357–364. doi: 10.1007/s11999-015-4341-7.
    1. Buysse DJ, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–545. doi: 10.1093/sleep/14.6.540.
    1. Uchmanowicz I, et al. The relationship between sleep disturbances and quality of life in elderly patients with hypertension. Clin Interv Aging. 2019;14:155–165. doi: 10.2147/CIA.S188499.
    1. Huang Z, et al. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplast. 2014;29(12):2342–2346. doi: 10.1016/j.arth.2014.05.026.
    1. Coelho PS, Esteves SP. The choice between a five-point and a ten-point scale in the framework of customer satisfaction measurement. Int J Mark Res. 2007;49(3):313–339. doi: 10.1177/147078530704900305.
    1. Hawker GA, et al. Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative. Osteoarthr Cartil. 2008;16(4):415–422. doi: 10.1016/j.joca.2007.12.017.
    1. Simpson NS, et al. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2018;159(1):33–40. doi: 10.1097/j.pain.0000000000001053.
    1. Haack M, et al. Activation of the prostaglandin system in response to sleep loss in healthy humans: potential mediator of increased spontaneous pain. Pain. 2009;145(1–2):136–141. doi: 10.1016/j.pain.2009.05.029.
    1. Weingarten JA, et al. Polysomnographic measurement of sleep duration and bodily pain perception in the sleep heart health study. Sleep. 2016;39(8):1583–1589. doi: 10.5665/sleep.6026.
    1. Odegard SS, et al. The effect of sleep restriction on laser evoked potentials, thermal sensory and pain thresholds and suprathreshold pain in healthy subjects. Clin Neurophysiol. 2015;126(10):1979–1987. doi: 10.1016/j.clinph.2014.12.011.
    1. Long G, et al. Analysis of patients’ sleep disorder after total knee arthroplasty-a retrospective study. J Orthop Sci. 2019;24(1):116–120. doi: 10.1016/j.jos.2018.07.019.
    1. Sibia US, MacDonald JH, King PJ. Predictors of hospital length of stay in an enhanced recovery after surgery program for primary total hip arthroplasty. J Arthroplast. 2016;31(10):2119–2123. doi: 10.1016/j.arth.2016.02.060.
    1. Halawi MJ, et al. Preoperative pain level and patient expectation predict hospital length of stay after total hip arthroplasty. J Arthroplast. 2015;30(4):555–558. doi: 10.1016/j.arth.2014.10.033.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere