| Background:Surgical trauma and narcotic analgesics may result in increased postoperative pain sensitivity,termed postoperative hyperalgesia(POH).POH is a common cause of severe postoperative pain.Previous studies have shown that sleep disturbance before surgery may reduce the pain threshold and increase the incidence of moderate to severe pain after non-cardiac surgery.However,for patients undergoing cardiac surgery,whether preoperative sleep disturbance is associated with the incidence of POH with moderate to severe postoperative pain remains unclear.Therefore,the purpose of this study was to explore the correlation between preoperative sleep disturbance and the risk of POH with moderate to severe pain in patients undergoing cardiac surgery in order to implement evidence-based intervention measures in the future.Methods:Patients who underwent open-heart surgical valve replacement or repair with cardiopulmonary bypass at Fuwai Hospital from May to October 2019 were screened and included consecutively according to inclusion and exclusion criteria,taking into account sample size calculations.Epidemiological data and perioperative clinical data of patients included were collected retrospectively,including preoperative sleep quality assessment data and postoperative pain assessment data.The preoperative sleep quality data was obtained from the Pittsburgh sleep quality index(PSQI).Patients with a PSQI score ≥ 6 were considered to suffer preoperative sleep disturbance.The postoperative pain data was obtained from the numerical pain rating scale(NPRS).If the NPRS score≥4 and meeting the POH screening criteria,POH with moderate to severe pain was assumed.For statistical analysis,these patients were grouped according to POH occurrence into either a case group(POH group)or a control group(non-POH group).POH with moderate to severe pain was defined as the main outcome,and preoperative sleep disturbance as the main exposure factor.A multivariable Logistic regression model was used to analyze the correlation between preoperative sleep disturbance and the risk of POH with moderate to severe pain.Receiver operating characteristic(ROC)curve analysis and the Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and calibration of the multivariable Logistic regression model.Results:1.A total of 238 patients who underwent cardiac valve surgery met the inclusion criteria,and 24 of them were removed before statistical analysis according to the exclusion criteria.Thus,a total of 214 patients were included in the analysis:61 patients(28.5%)were in the POH group,and 153(71.5%)were in the non-POH group;121 patients(56.5%)had preoperative sleep disturbance;117 patients(54.7%)were male and 97(45.3%)were female;the body mass index of 26 patients reached the standard of obesity;the minimum and maximum ages were 18 and 76 years,respectively.2.Patients in the POH group had a higher proportion of smoking history(11.1%vs.24.6%)and drinking history(3.3%vs.9.8%),more intraoperative sufentanil dosage(1.02 vs.1.12 μg/kg/h),and longer duration of mechanical ventilation(760 vs.934 min)than those in the non-POH group.Univariate analysis showed a significant difference in the proportion of preoperative sleep disturbance between the POH and the non-POH groups(χ2:8.438,P=0.004).After adjustment for sex,age,smoking history,drinking history,intraoperative sufentanil dosage,and duration of mechanical ventilation,preoperative sleep disturbance was independently associated with increased risk of POH with moderate to severe pain(adjusted odds ratio[OR]:2.66,95%confidence interval[CI]:1.31-5.39,P=0.007)in the Logistic regression model.3.In the subgroup of patients without a smoking history,a Logistic regression model adjusted for sex,age,drinking history,intraoperative sufentanil dosage,and duration of mechanical ventilation revealed a greater risk of POH with moderate to severe pain in patients with preoperative sleep disturbance(adjusted OR:3.40,95%CI:1.51-7.66,P＝0.003).In the subgroup of patients with a smoking history,a Logistic regression model adjusted for sex,age,drinking history,intraoperative sufentanil dosage,and duration of mechanical ventilation showed that preoperative sleep disturbance was not associated with the risk of POH(adjusted OR:0.83,95%CI:0.14-4.75,P=0.832).4.ROC curve analysis showed that the multivariable Logistic regression model displayed reasonable predictive ability for POH with moderate to severe pain in patients who underwent cardiac valve surgery without a smoking history(area under the ROC curve:0.708,95%CI:0.622-0.794,P<0.001).The Hosmer-Lemeshow goodness of fit test of the multivariable Logistic regression model ensured the accuracy of the probability estimation of POH with moderate to severe pain(χ2:6.138,P=0.632).Conclusions:Preoperative sleep disturbance is associated with a considerably increased risk of POH with moderate to severe pain in non-smoking patients undergoing cardiac valve surgery.The risk prediction model for POH with moderate to severe pain should be constructed for the prediction and management of postoperative pain in patients undergoing cardiac surgery. |
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