A sleep disturbance after total knee arthroplasty

Fatah, Rebar M. Noori; Abdulrahman, Binar Burhan

doi:10.4103/jfmpc.jfmpc_595_19

Cited by 7 publications

(13 citation statements)

References 24 publications

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“…Other investigators have noted small, yet clinically meaningful, effects PNB can have on postoperative sleep in the subsequent days after surgery. 3,4,17,25 Although, the preponderance of research, largely retrospective, has focused primarily on correlational associations between PNB exposure and more proximal surgical outcomes, less attention has been paid to changes in sleep in the weeks following surgery. 3,4,17,25 Therefore, the ability to detect any association between perioperative pain management approaches and sleep outcomes of significant magnitude weeks after surgery, as was done in the present study, provides indication that further and rigorous research is needed to elucidate this potential effect.…”

Section: Discussionmentioning

confidence: 99%

“…2 For example, over 40% of patients undergoing knee arthroplasty report a desire for better sleep quality, even months after surgery. 3 Yet much of the research to date has focused on postoperative sleep outcomes in the days immediately following surgery or months later after total knee and hip arthroplasty. [3][4][5][6] Less research has examined the dynamic interplay between sleep and pain outcomes in the weeks immediately following surgery.…”

mentioning

confidence: 99%

“…Up to 20% of patients report that they are dissatisfied due to insufficient pain relief, inadequate functional improvement, or failure to meet their preoperative expectations following total knee or hip arthroplasty procedures 2. For example, over 40% of patients undergoing knee arthroplasty report a desire for better sleep quality, even months after surgery 3. Yet much of the research to date has focused on postoperative sleep outcomes in the days immediately following surgery or months later after total knee and hip arthroplasty 3–6.…”

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confidence: 99%

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Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Giordano

Kent

Andersen

et al. 2021

The Clinical Journal of Pain

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Objectives: Despite substantial research showing the bidrectional relationship between sleep and pain, there remains a dearth of research examining the role of perioperative pain management interventions in mitigating postoperative sleep disturbances. This secondary analysis of a prospective observational multisite study examined the association between peripheral nerve block (PNB) use during total knee or total hip arthroplasty (TKA/THA) procedures and postoperative pain and sleep outcomes.Materials and Methods: Adult patients undergoing TKA or THA procedures were recruited from 2 tertiary care facilities. Average pain and sleep disturbance scores were collected preoperatively and at 1-and 2-week postoperatively. Participants were not randomized to receive PNB. Postoperative outcomes were compared based on receipt of PNB during surgery. Structural equation modeling path analysis was utilized to model multiple co-occurring relationships, including mediation pathways between perioperative pain management approaches, pain, and postoperative sleep outcomes.Results: Of the 197 participants, 53% received PNB. Mediation analyses indicated that PNB was indirectly associated with 1-week sleep disturbance via its effects on 1-week pain intensity (β = −0.02, 95% confidence interval [CI] −0.04, −0.001, P = 0.04). In addition, PNB was indirectly associated with 2-week sleep disturbance, via its effects on 1-week pain intensity and 1-week sleep disturbance (β = −0.04, 95% CI −0.07, −0.02, P = 0.04). Lastly, PNB was indirectly associated with 2-week pain intensity via its effects on 1-week pain intensity (β = −0.10, 95% CI −0.19, −0.02, P = 0.02).Conclusions: Receipt of PNB during TKA or THA was found to be associated with improved 1-week postoperative pain intensity, which in turn was found to be associated with lower sleep disturbances at both 1-and 2-week postoperative time points. Multimodal opioid sparing pain management interventions, capable of improving postoperative sleep, are vital to improving recovery and rehabilitation following arthroplasty.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Giordano

Kent

Andersen

et al. 2021

The Clinical Journal of Pain

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“…Patients commonly report poor sleep in the 6-week period after a TKA, noting an inability to fall asleep, nighttime arousals, and sleep disruptions 45,63 . By 3 to 6 months, most patients have recovered sleep back to the preoperative levels with improvements beyond the preoperative baseline at the 1-year mark 45,64,65 .…”

Section: Sleep Disturbance After Tka Epidemiology and Durationmentioning

confidence: 97%

“…In a small cohort of 24 patients who underwent TKA, greater pain intensity and level of disability after TKA were correlated with worse sleep quality 90 . Interestingly, despite pain consistently decreasing over all time points following TKA, the PSQI scores worsened until 4 to 6 weeks postoperatively and required 3 months to improve past baseline 13,65 .…”

Section: Painmentioning

confidence: 99%

Sleep Disturbances and Disorders in Patients with Knee Osteoarthritis and Total Knee Arthroplasty

Bartosiak

Schwabe

Lucey

et al. 2022

Journal of Bone and Joint Surgery

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There is increasing evidence that patient-reported outcomes following total knee arthroplasty (TKA) are associated with psychosocial factors and pain catastrophizing. Sleep disturbance, pain, and mental health have a complex interaction, which, if unrecognized, can be associated with impaired patient-reported outcomes and dissatisfaction following TKA.The gold standard of objective sleep assessment is polysomnography, which is not feasible to use routinely for TKA patients. Wearable devices are a validated and less costly alternative.Subjective sleep measures, such as the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, or Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive test sleep domains, are simple to administer and provide additional insight into sleep disturbance. Although objective and subjective measures do not correlate precisely, they can be informative together.Sleep disturbances in the elderly population are common and multifactorial in etiology, stemming from the interplay of sleep disorders, medication side effects, and pain. Commonly prescribed medications following TKA as well as postoperative pain can exacerbate underlying sleep disturbances.Obstructive sleep apnea (OSA) is prevalent in patients seeking TKA. In the setting of OSA, postoperative opioids can cause respiratory depression, resulting in consequences as severe as death. A standardized multimodal pain protocol including anti-inflammatories and gamma-aminobutyric acid (GABA) analogues may allow for decreased reliance on opioids for pain control.Surgeons should reassure patients that postoperative sleep disturbance is common and transient, collaborate with the patient’s primary care doctor to address sleep disturbance, and avoid prescription of pharmaceutical sleep aids.

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How do patients sleep after orthopaedic surgery? Changes in objective sleep parameters and pain in hospitalized patients undergoing hip and knee arthroplasty

Vitale

Banfi

Viganò

et al. 2023

International Orthopaedics (SICOT)

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Purpose The aim of this observational cohort study was to assess actigraphy-based sleep characteristics and pain scores in patients undergoing knee or hip joint replacement and hospitalized for ten days after surgery. Methods N=20 subjects (mean age: 64.0±10.39 years old) wore the Actiwatch 2 actigraph (Philips Respironics, USA) to record sleep parameters for 11 consecutive days. Subjective scores of pain, by a visual analog scale (VAS), were constantly monitored and the following evaluation time points were considered for the analysis: pre-surgery (PRE), the first (POST1), the fourth (POST4), and the tenth day (POST10) after surgery. Results Sleep quantity and timing parameters did not differ from PRE to POST10, during the hospitalization whereas sleep efficiency and immobility time significantly decreased at POST1 compared to PRE by 10.8% (p=0.003; ES: 0.9, moderate) and 9.4% (p=0.005; ES: 0.86, moderate) respectively, and sleep latency increased by 18.7 min (+320%) at POST1 compared to PRE (p=0.046; ES: 0.70, moderate). Overall, all sleep quality parameters showed a trend of constant improvement from POST1 to POST10. VAS scores were higher in the first day post-surgery (4.58 ± 2.46; p=0.0011 and ES: 1.40, large) compared to POST10 (1.68 ± 1.58). During the time, mean VAS showed significant negative correlations with mean sleep efficiency (r = −0.71; p=0.021). Conclusion Sleep quantity and timing parameters were stable during the entire hospitalization whereas sleep quality parameters significantly worsened the first night after surgery compared to the pre-surgery night. High scores of pain were associated with lower overall sleep quality.

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A sleep disturbance after total knee arthroplasty

Cited by 7 publications

References 24 publications

Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Postoperative Pain Mediates the Association Between Peripheral Nerve Blocks and Postoperative Sleep Following Lower Extremity Arthroplasty

Sleep Disturbances and Disorders in Patients with Knee Osteoarthritis and Total Knee Arthroplasty

How do patients sleep after orthopaedic surgery? Changes in objective sleep parameters and pain in hospitalized patients undergoing hip and knee arthroplasty

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