Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Re
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Recovery After Surgery concept YuZhu Wang 1 & Ying Liu 1 & XiaoYu Li 1 & QianZhou LV 1 & Qing Xia 2 & XiaoFeng Wang 2 & YunChao Shao 2 Received: 6 July 2020 / Revised: 17 September 2020 / Accepted: 2 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose This study aimed to examine sleep quality and risk factors associated with sleep disturbance in patients undergoing total joint arthroplasty (TJA) managed with an enhanced recovery protocol from preoperatively until 12 weeks postoperatively in order to provide suggestions for improving the prevention and treatment of sleep disturbance in these patients. Methods The Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI) and Epworth Sleepiness Scale (CESS) were used to evaluate sleep quality. Pain was measured by a visual analog scale (VAS). Neuropsychological status was also assessed, using the Center for Epidemiological Studies Depression Scale (CESD) and Zung Self-Rating Anxiety Scale (ZSAS). Results Of 107 patients (66% women), the prevalence of sleep disturbance was as high as 60% preoperatively. CPSQI score significantly increased postoperatively from baseline to 2 weeks before decreasing rapidly to a lower level than preoperative baseline. CESS scores of postoperative weeks 1 and 2 increased significantly compared with baseline and decreased significantly after 4 weeks, and a positive correlation was found between CESS and CPSQI score. VAS score significantly decreased from baseline over all time points in the postoperative period. A good sleeper group was more likely to suffer from severe sleep disturbance after surgery than a poor sleeper group with a bigger increase of CPSQI score. Multivariate logistic regression analysis indicated that pain and anxiety were risk factors associated with postoperative sleep disturbance. Conclusions Sleep disturbance is highly prevalent among patients undergoing TJA. More attention and multimodal approaches with well-controlled pain, mental counseling, and possibly preemptive use of sleep medication may improve sleep quality in TJA patients to promote recovery. Keywords Sleep disturbance . Enhanced recovery after surgery . Total hip arthroplasty . Total knee arthroplasty . Risk factor
Introduction In recent years, under the promotion of a series of expert consensus, enhanced recovery after surgery (ERAS) has been widely applied in the field of arthroplasty surgery in China [1]. YuZhu Wang and Ying Liu contributed equally to this work. * XiaoFeng Wang [email protected] * YunChao Shao [email protected] 1
Department of Pharmacy, Zhongshan Hospital Fudan University, Shanghai, China
2
Department of Orthopedics, Zhongshan Hospital Fudan University, 180# Feng Lin Road, Shanghai 200032, Republic of China
Many traditional management methods have been challenged and improved clinical results have been achieved. Periop
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