Postoperative sleep disturbance: Influences of opioids and pain in humans

A. J. Cronin, J. C. Keifer, M. F. Davies, T. S. King, E. O. Bixler

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Study Objectives: To test the hypothesis that opioids and pain contribute independently to postoperative sleep disturbance, 10 women undergoing surgery requiring a low abdominal incision for treatment of benign gynecologic conditions were randomized to receive either epidural opioid (fentanyl) (n=6) or epidural local anesthetic (bupivacaine) (n=4) for intraoperative and postoperative analgesia. Design: N/A Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements: Polysomnography was performed in a standard patient room on the preoperative and first three postoperative nights. Pain at rest and with coughing was evaluated using a visual-analogue pain scale each evening and morning. Results: On the first postoperative night, rapid eye movement (REM) sleep was abolished in all patients. On the third postoperative night, the mean±SE REM sleep time increased significantly (p=.003) to 9.8%±3.1% in the fentanyl group, and 12.9%±3.8% in the bupivacaine group. Conversely, light non-REM (NREM) sleep (%stage 1 + %stage 2) was higher on the first postoperative night and significantly lower on the third postoperative night (p=0.011). Between group comparison revealed only that the mean % slow-wave sleep (SWS) in the fentanyl group (6.0%, 2.0%, and 14.7%) was different from the bupivacaine group (7.8%, 9.1%, and 10.6%) in the postoperative period after adjusting for the preoperative night % SWS (p=0.021). Pain was well controlled in all patients, but was slightly better controlled in the fentanyl group than in the bupivacaine group on postoperative night 2 (p=0.024). There was no statistically significant association between pain score and any polysomnographically defined stage. Conclusion: Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled.

Original languageEnglish (US)
Pages (from-to)39-44
Number of pages6
JournalSleep
Volume24
Issue number1
DOIs
StatePublished - Feb 1 2001

Fingerprint

Opioid Analgesics
Sleep
Bupivacaine
Fentanyl
Pain
REM Sleep
Patients' Rooms
Polysomnography
Sleep Stages
Pain Measurement
Eye Movements
Local Anesthetics
Postoperative Period
Analgesia
Light

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Physiology (medical)

Cite this

Cronin, A. J. ; Keifer, J. C. ; Davies, M. F. ; King, T. S. ; Bixler, E. O. / Postoperative sleep disturbance : Influences of opioids and pain in humans. In: Sleep. 2001 ; Vol. 24, No. 1. pp. 39-44.
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abstract = "Study Objectives: To test the hypothesis that opioids and pain contribute independently to postoperative sleep disturbance, 10 women undergoing surgery requiring a low abdominal incision for treatment of benign gynecologic conditions were randomized to receive either epidural opioid (fentanyl) (n=6) or epidural local anesthetic (bupivacaine) (n=4) for intraoperative and postoperative analgesia. Design: N/A Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements: Polysomnography was performed in a standard patient room on the preoperative and first three postoperative nights. Pain at rest and with coughing was evaluated using a visual-analogue pain scale each evening and morning. Results: On the first postoperative night, rapid eye movement (REM) sleep was abolished in all patients. On the third postoperative night, the mean±SE REM sleep time increased significantly (p=.003) to 9.8{\%}±3.1{\%} in the fentanyl group, and 12.9{\%}±3.8{\%} in the bupivacaine group. Conversely, light non-REM (NREM) sleep ({\%}stage 1 + {\%}stage 2) was higher on the first postoperative night and significantly lower on the third postoperative night (p=0.011). Between group comparison revealed only that the mean {\%} slow-wave sleep (SWS) in the fentanyl group (6.0{\%}, 2.0{\%}, and 14.7{\%}) was different from the bupivacaine group (7.8{\%}, 9.1{\%}, and 10.6{\%}) in the postoperative period after adjusting for the preoperative night {\%} SWS (p=0.021). Pain was well controlled in all patients, but was slightly better controlled in the fentanyl group than in the bupivacaine group on postoperative night 2 (p=0.024). There was no statistically significant association between pain score and any polysomnographically defined stage. Conclusion: Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled.",
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Postoperative sleep disturbance : Influences of opioids and pain in humans. / Cronin, A. J.; Keifer, J. C.; Davies, M. F.; King, T. S.; Bixler, E. O.

In: Sleep, Vol. 24, No. 1, 01.02.2001, p. 39-44.

Research output: Contribution to journalArticle

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T1 - Postoperative sleep disturbance

T2 - Influences of opioids and pain in humans

AU - Cronin, A. J.

AU - Keifer, J. C.

AU - Davies, M. F.

AU - King, T. S.

AU - Bixler, E. O.

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N2 - Study Objectives: To test the hypothesis that opioids and pain contribute independently to postoperative sleep disturbance, 10 women undergoing surgery requiring a low abdominal incision for treatment of benign gynecologic conditions were randomized to receive either epidural opioid (fentanyl) (n=6) or epidural local anesthetic (bupivacaine) (n=4) for intraoperative and postoperative analgesia. Design: N/A Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements: Polysomnography was performed in a standard patient room on the preoperative and first three postoperative nights. Pain at rest and with coughing was evaluated using a visual-analogue pain scale each evening and morning. Results: On the first postoperative night, rapid eye movement (REM) sleep was abolished in all patients. On the third postoperative night, the mean±SE REM sleep time increased significantly (p=.003) to 9.8%±3.1% in the fentanyl group, and 12.9%±3.8% in the bupivacaine group. Conversely, light non-REM (NREM) sleep (%stage 1 + %stage 2) was higher on the first postoperative night and significantly lower on the third postoperative night (p=0.011). Between group comparison revealed only that the mean % slow-wave sleep (SWS) in the fentanyl group (6.0%, 2.0%, and 14.7%) was different from the bupivacaine group (7.8%, 9.1%, and 10.6%) in the postoperative period after adjusting for the preoperative night % SWS (p=0.021). Pain was well controlled in all patients, but was slightly better controlled in the fentanyl group than in the bupivacaine group on postoperative night 2 (p=0.024). There was no statistically significant association between pain score and any polysomnographically defined stage. Conclusion: Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled.

AB - Study Objectives: To test the hypothesis that opioids and pain contribute independently to postoperative sleep disturbance, 10 women undergoing surgery requiring a low abdominal incision for treatment of benign gynecologic conditions were randomized to receive either epidural opioid (fentanyl) (n=6) or epidural local anesthetic (bupivacaine) (n=4) for intraoperative and postoperative analgesia. Design: N/A Setting: N/A Patients or Participants: N/A Interventions: N/A Measurements: Polysomnography was performed in a standard patient room on the preoperative and first three postoperative nights. Pain at rest and with coughing was evaluated using a visual-analogue pain scale each evening and morning. Results: On the first postoperative night, rapid eye movement (REM) sleep was abolished in all patients. On the third postoperative night, the mean±SE REM sleep time increased significantly (p=.003) to 9.8%±3.1% in the fentanyl group, and 12.9%±3.8% in the bupivacaine group. Conversely, light non-REM (NREM) sleep (%stage 1 + %stage 2) was higher on the first postoperative night and significantly lower on the third postoperative night (p=0.011). Between group comparison revealed only that the mean % slow-wave sleep (SWS) in the fentanyl group (6.0%, 2.0%, and 14.7%) was different from the bupivacaine group (7.8%, 9.1%, and 10.6%) in the postoperative period after adjusting for the preoperative night % SWS (p=0.021). Pain was well controlled in all patients, but was slightly better controlled in the fentanyl group than in the bupivacaine group on postoperative night 2 (p=0.024). There was no statistically significant association between pain score and any polysomnographically defined stage. Conclusion: Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled.

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