Increasing presurgery sleep reduces postsurgery pain and analgesic use following joint replacement: a feasibility study

Study Objectives: To determine whether presurgery sleep extension in short-sleeping volunteers scheduled for total knee/hip replacement surgery would reduce postsurgery pain and analgesic use. Methods: Eighteen short sleepers, defined by sleep times below the national mean (ie, <= 7 h) nightly, were randomized to one week of a 2-h nightly extension of their time in bed (EXT) or maintenance of their habitual time in bed (HAB) prior to knee or hip replacement surgery. Compliance was monitored by wrist actigraphy. Outcomes were the postsurgery daily dose of opiates (converted to morphine milligram equivalents) and the daily pain ratings (acquired 3-4 times across the day) on a 0-10 rating scale (0 = no pain to 10 = worst pain experienced) over the three to four day inpatient recovery. Results: On a diary before the presurgery time in bed (TIB) manipulation, there were no significant differences in reported nightly sleep times between those randomized to the EXT group [6.0 (+/- 0.78) h] and the HAB group [6.5 (+/- 0.50) h]. During the one-week presurgery TIB manipulation, three participants failed to extend their TIB. Among those extending TIB (n = 7), compared to the HAB group, the EXT group spent significantly more nightly TIB (8.0 vs. 6.9 h, p < 0.05), which resulted in 1 h of more sleep (6.8 vs. 5.8 h, p < 0.04). On the three- to four-day postsurgery inpatient recovery, the EXT group reported significantly less average daily pain (4.4 vs. 5.6, p < 0.04) and less daily morphine milligram equivalent intake (20.3 vs. 38.6 mg, p < 0.02) than those by the HAB group. Conclusions: In this feasibility study, we found that a presurgery extended TIB and associated increase in sleep time in short-sleeping patients scheduled for undergoing joint replacement results in reduced postsurgery pain ratings and opiate use. (C) 2017 Elsevier B.V. All rights reserved.