Development and validation of a nomogram for postoperative sleep disturbance in adults: a prospective survey of 640 patients undergoing spinal surgery

Abstract

Background Postoperative sleep disturbance (PSD) is a prevalent clinical complication that may arise due to various factors. The purpose of this investigation is to identify the risk factors for PSD in spinal surgery and establish a risk prediction nomogram. Methods The clinical records of individuals who underwent spinal surgery from January 2020 to January 2021 were gathered prospectively. The least absolute shrinkage and selection operator (LASSO) regression, along with multivariate logistic regression analysis, was employed to establish independent risk factors. A nomogram prediction model was devised based on these factors. The nomogram’s effectiveness was evaluated and verified via the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). Results A total of 640 patients who underwent spinal surgery were analyzed in this investigation, among which 393 patients experienced PSD with an incidence rate of 61.4%. After conducting LASSO regression and logistic regression analyses using R software on the variables in training set, 8 independent risk factors associated to PSD were identified, including female, preoperative sleep disorder, high preoperative anxiety score, high intraoperative bleeding volume, high postoperative pain score, dissatisfaction with ward sleep environment, non-use of dexmedetomidine and non-use of erector spinae plane block (ESPB). The nomogram and online dynamic nomogram were constructed after incorporating these variables. In the training and validation sets, the area under the curve (AUC) in the receiver operating characteristic (ROC) curves were 0.806 (0.768–0.844) and 0.755 (0.667–0.844), respectively. The calibration plots indicated that the mean absolute error (MAE) values in both sets were respectively 1.2% and 1.7%. The decision curve analysis demonstrated the model had a substantial net benefit within the range of threshold probabilities between 20% and 90%. Conclusions The nomogram model proposed in this study included eight frequently observed clinical factors and exhibited favorable accuracy and calibration. Trial registration The study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2200061257, 18/06/2022).

Perioperative Sleep Disturbance in Surgical Patients: A Concept Analysis

“…Numerous studies have demonstrated that preoperative anxiety and depression adversely affect sleep quality both before and after surgery. Higher levels of psychological distress correlate with poorer sleep quality during the perioperative period, leading to a higher incidence of PSD (Du et al, 2023;Gu et al, 2023;Huang et al, 2021;Mansano-Schlosser et al, 2017;S. J.Wang et al, 2022;Z.Wang et al, 2023;Wright et al, 2010).…”

“…Postoperative pain has been consistently identified as a risk factor for postoperative SD in surgical patients (Long et al, 2019;Miller et al, 2015;Özkan et al, 2023). Moreover, the type of surgery, high intraoperative bleeding, and postoperative passive positioning also elevate the risk of postoperative SD (Du et al, 2023;H. F.Zhang et al, 2018).…”

Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial

“…Postoperative sleep disturbance (PSD) can occur after surgery for various reasons, such as pain from the surgical incision site on the back and dysfunction of the autonomic nervous system. The incidence of PSD can be as high as 40% to 60% [ 9 , 10 ].…”

Melanin-Concentrating Hormone Is Associated With Delayed Neurocognitive Recovery in Older Adult Patients With Preoperative Sleep Disorders Undergoing Spinal Anesthesia

“…8,9 Therefore, it is clinically significant to conduct early cognitive risk prediction, focusing on older adult patients with preoperative sleep disorders. Studies have explored the risk factors for perioperative sleep disorders, 10,11 while other studies have also explored the risk factors affecting postoperative cognitive outcomes. 2,12,13 However, no study has explored the specific risk factors for DNR in patients with preoperative sleep disorders.…”