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Mark A. Lumley


The association of sleep and pain has become very prominent in the research literature, both with chronic pain populations and with experimental manipulations of sleep and pain. This study sought to extend the literature and examine how sleep impacts acute pain in a surgical population. Patients who were scheduled to have either knee (n = 64) or hip (n = 43) replacement surgery completed a sleep questionnaire prior to surgery that assessed sleep duration, frequency and severity of sleep difficulties, daytime sleepiness, and the number of symptoms associated with sleep problems. After surgery, patients used a patient controlled analgesia (PCA) machine to self-administer an opioid analgesic. Only one dose could be administered during each physician-prescribed lockout period, but all requests that were not administered as well as actual injections were measured for the first 10 hours post-surgery. Correlation analyses indicated that there was not a significant relationship between the sleep-related predictor variables and PCA outcome variables (injections, denials, and total requests) for the entire sample. When the sample was divided by the moderator of type of surgery, the knee population had a significant positive correlation between the predictor of sleep duration and the number of PCA denials and total requests. However, there was no correlation between sleep duration and number of injections, or for the hip population. Since the knee group was also found to be more obese than the hip group, the entire sample was split by presence of obesity and there were significant correlations between sleep duration and PCA denials and total requests for the obese group only. The entire sample was then divided into four groups, accounting for type of surgery and obesity. Analyses indicated that knee surgery was a greater predictor of the relationship between sleep duration and PCA use than the presence of obesity. Measuring variables such as personality, psychological factors, pre-surgical pain and drug use may provide a clearer picture of why the significant positive correlation was found only within the knee population.

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