<p>Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery</p>

Abstract

Purpose: Studies have reported that preoperative poor sleep quality could decrease the pain threshold in patients undergoing noncardiac surgery. However, the risk of postoperative hyperalgesia (HA) in cardiac surgery patients with preoperative poor sleep quality remains unclear. Patients and Methods: We retrospectively collected clinical data from patients undergoing open-heart valve surgery between May 1 and October 31, 2019, in Fuwai Hospital (Beijing). We assessed preoperative sleep quality and postoperative pain severity using the Pittsburgh sleep quality index (PSQI) and numerical pain rating scale (NPRS), respectively. A PSQI of six or greater was considered to indicate poor sleep quality, and a NPRS of four or greater was considered to indicate HA. Multivariable logistic regression analysis was used to study the risk of postoperative HA in patients with preoperative poor sleep quality. Results: We divided 214 eligible patients into two groups based on postoperative HA; HA group: n=61 (28.5%) and nonHA group: n=153 (71.5%). Compared with nonHA patients, patients with postoperative HA showed a higher percentage of history of smoking, 17 (11.1%) vs 15 (24.6%) and alcohol abuse, 5 (3.3%) vs 6 (9.8%), higher intraoperative dose of sufentanil (median, 1.02 vs 1.12 μg/kg/h), and longer duration of ventilation with tracheal catheter (median, 760 vs 934 min). Preoperative poor sleep quality was associated independently with an increased risk of postoperative HA (adjusted odds ratio [AOR]: 2.66; 95%CI: 1.31-5.39, P=0.007). Stratification by history of smoking revealed a stronger risk of postoperative HA in nonsmoking patients with preoperative poor sleep quality (AOR: 3.40; 95%CI: 1.51-7.66, P=0.003). No risk was found in patients who had history of smoking (AOR: 0.83; 95%CI: 0.14-4.75, P=0.832). Conclusion: Preoperative poor sleep quality is an independent risk factor for postoperative HA in adult patients undergoing open-heart valve surgery who had no history of smoking.

Lagged effect of Patient‐Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance on subacute postsurgical PROMIS Pain Behavior

“…The present findings are consistent with previous literature regarding the role of sleep in both acute and persistent postsurgical pain, 6,8,18 but extends previous studies by specifically utilizing PROMIS Pain Behavior, SEM, and a sample of patients undergoing sports orthopedic surgery. Ongoing assessments of pain behaviors and factors that contribute to higher symptom severity (e.g., sleep) are vital to understanding patient‐centered coping efforts, both adaptive and maladaptive ones, that can be targeted with additional interventions 2 …”

Intranasal Dexmedetomidine for the Treatment of Pre-operative Anxiety and Insomnia: A Prospective, Randomized, Controlled, and Clinical Trial

“…It was reported that 38.2% of patients mainly suffered from insomnia due to anxiety on the day before surgery ( 6 ). Pre-operative sleep quality has an important influence on post-operative recovery of patients, and poor sleep may increase the incidence of surgical complications ( 16 , 17 ). Studies have reported the association of insufficient sleep with the increased risk of a variety of human diseases, including heart disease, immune disorders, anxiety, and depression, leading to incurable neurodegenerative diseases (e.g., Alzheimer's disease) ( 9 , 10 , 15 , 29 ).…”

“…Poor pre-operative sleep quality has shown to significantly increase the risk of severe peak pain during exercise after surgery ( 30 ). It also increases the incidence of post-operative hyperalgesia ( 17 ). Leung et al ( 13 ) revealed the relationship between pre-operative sleep disruption and post-operative delirium.…”

“…Insomnia can damage immune function ( 8 ), and it is related to a high blood pressure (BP) and other cardiovascular risk factors ( 9 , 10 ), a poor blood sugar control ( 11 , 12 ), cognitive impairment ( 13 , 14 ), and mental health ( 15 ). In addition, pre-operative insomnia causes patients' poor medical experience, while increases the incidence of disease complications ( 16 , 17 ).…”

Prevalence of Preoperative Anxiety and Level of Fatigue Among Patients Undergoing Coronary Artery Bypass Surgery: A Descriptive Cross-Sectional Study

“…8 Kalp ameliyatı olacak hastalarda görülen yetersiz uyku kalitesi, fiziksel yaşam kalitesinde azalma ve ameliyat öncesi anksiyete ve ağrı şiddetinde artma ile sonuçlanan fizyolojik ve emosyonel önemli bir stresördür. 2,18,19 Bu nedenle cerrahi girişim uygulanacak olan kalp hastalarında uyku kalitesini artırmaya yönelik uyku hijyeni eğitimi gibi hemşirelik girişimlerinin hastaların ameliyat öncesi yorgunluk ve anksiyete düzeylerinin azaltılmasında yararlı olabileceği söylenebilir.…”