A systematic review and meta-analysis published in Sleep Medicine Reviews found that patients with presurgical sleep disturbances and disorders may be at increased risk for chronic postsurgical pain.
Chronic postsurgical pain, or pain that develops or intensifies following surgery and lasts for 3 or more months, is associated with detriments to quality of life. Chronic postsurgical pain is common (3%-56%) and is often undermanaged. There is a well-established relationship between sleep and pain, however, it remains unclear how sleep factors into chronic postsurgical pain.
For this review, researchers with Catholic University of Milan in Italy searched publication databases through August 2021 for studies of postoperative pain which evaluated sleep. A total of 18 studies comprising 8408 patients were included in this analysis.
Most studies (n=16) were of prospective designs and follow-up ranged from 3 to 12 months. The patient populations were biased toward middle-aged (mean, 60.7 years) women (68%). The most common surgical intervention was total knee arthroplasty, followed by breast surgery, total hip arthroplasty, thoracotomy, hip surgery, and rotator cuff repair.
A significant relationship was observed between sleep disturbances and disorders with chronic postsurgical pain (r, 0.13; 95% CI, 0.06-0.20; P<.01). This comparison had moderate heterogeneity (I2, 66.81%; P<.01).
In a subgroup analysis, significant relationships between sleep and CPSP were found for studies using continuous outcomes (r, 0.13; 95% CI, 0.03-0.23; P <.05) but not dichotomous outcomes (r, 0.15; 95% CI, – 0.01 to 0.31); both studies measuring sleep disturbance (r, 0.12; 95% CI, 0.04-0.20; P <.05) or disorders, specifically insomnia (r, 0.19; 95% CI, 0.12-0.26; P <.05); and surgical interventions of total knee arthroplasty (r, 0.12; 95% CI, 0.01-0.23; P<.05) and other surgery (r, 0.08; 95% CI, 0.00-0.16; P<.05) but not for total hip arthroplasty (r, 0.19; 95% CI, -0.41 to 0.78) or breast surgery (r, 0.15; 95% CI, -0.37 to 0.68).
In the meta-regression analysis, a significant effect was observed for follow-up duration (0.02; 95% CI, 0.01-0.03; P<.05), not for methodological quality, age, or gender.
This analysis was limited by the lack of clear and consistent definitions of sleep disturbances and disorders across the studies.
The review authors concluded that poor preoperative sleep quality may contribute to the development and intensity of chronic postsurgical pain. “Early detection of sleep disturbances and sleep disorders in patients undergoing surgical intervention considered in this study could lead to more tailored medications,” the researchers concluded.
Varallo G, Giusti EM, Manna C, et al. Sleep disturbances and sleep disorders as risk factors for chronic postsurgical pain: a systematic review and meta-analysis. Sleep Med Rev. 2022;63:101630. doi:10.1016/j.smrv.2022.101630