Perioperative insomnia trajectories and functional outcomes after total knee arthroplasty.
Perioperative insomnia trajectories and functional outcomes after total knee arthroplasty.
复制标题
全膝关节置换术后围手术期失眠轨迹和功能结果。
DOI：
10.1097/j.pain.0000000000002977
复制
发表时间：
2023
期刊：
影响因子：
7.4
通讯作者：
Smith,MichaelT
中科院分区：
文献类型：
--
作者：
Hamilton,KatrinaR;Hughes,AbbeyJ;Campbell,ClaudiaM;Owens,MichaelA;Pester,BethanyD;Meints,SamanthaM;Taylor,JanieceL;Edwards,RobertR;Haythornthwaite,JenniferA;Smith,MichaelT
纵向全膝关节置换术（TKA）研究表明，相当大比例的患者在术后继续经历临床显著疼痛和功能障碍。失眠与较差的手术结果有关;然而，以前的工作主要集中在长期术后失眠。这项研究建立在以前的工作，通过检查睡眠和疼痛的结果围手术期失眠轨迹。急性围手术期（TKA前2周至TKA后6周）期间的失眠症状（使用失眠严重程度指数）用于将参与者分为围手术期失眠轨迹：（1）无失眠（ISI，8），（2）新发失眠（基线，8;术后$8或$6分增加），（3）改善失眠（基线$8，术后，8或$6分减少）和（4）持续性失眠（ISI $8）。在5个时间点（TKA前2周、TKA后：6周、3个月、6个月和12个月）对膝关节骨关节炎参与者（n 5 173;法师5 65 6 8.3，57.8%女性）的肌力、疼痛和身体功能进行了评估。观察到失眠轨迹和时间的显著主效应，以及术后失眠、疼痛严重程度和身体功能的时间交互作用（P <0.05）。在所有随访中，持续性不稳定轨迹的术后疼痛最严重，TKA术后失眠和身体功能受损明显（P <0.05）。New Incentive轨迹具有显著的长期失眠（6周至6个月）和急性（6周）术后疼痛和身体功能（P，0.05）。研究结果表明，围手术期失眠轨迹和术后结局之间存在显着关系。本研究的结果表明，针对术前失眠和预防急性术后失眠的发展可能会改善长期术后结局，重点是由于相关结局较差而导致的持续性围手术期失眠。
Longitudinal total knee arthroplasty (TKA) studies indicate that a substantial percentage of patients continue to experience clinically significant pain and functional impairment after surgery. Insomnia has been associated with poorer surgical outcomes; however, previous work has largely focused on long-term postsurgical insomnia. This study builds on previous work by examining sleep and pain outcomes about perioperative insomnia trajectories. Insomnia symptoms (using the Insomnia Severity Index) during the acute perioperative period (2 weeks pre-TKA to 6 weeks post-TKA) were used to classify participants into perioperative insomnia trajectories:(1) No Insomnia (ISI, 8),(2) New Insomnia (baseline, 8; postoperative $8 or $6-point increase),(3) Improved Insomnia (baseline $8, postoperative, 8 or $6-point decrease), and (4) Persistent Insomnia (ISI $8). Insomnia, pain, and physical functioning were assessed in participants with knee osteoarthritis (n 5 173; Mage 5 65 6 8.3, 57.8% female) at 5 time points: 2 weeks pre-TKA, post-TKA: 6 weeks, 3 months, 6 months, and 12 months. Significant main effects were seen for insomnia trajectory and time, and trajectory-by-time interactions for postoperative insomnia, pain severity, and physical functioning (P’s, 0.05). The Persistent Insomnia trajectory had the worst postoperative pain at all follow-ups and marked insomnia and physical functioning impairment post-TKA (P’s, 0.05). The New Insomnia trajectory had notable long-term insomnia (6 weeks to 6 months) and acute (6 weeks) postoperative pain and physical functioning (P’s, 0.05). Findings indicated a significant relationship between perioperative insomnia trajectory and postoperative outcomes. Results of this study suggest that targeting presurgical insomnia and preventing the development of acute postoperative insomnia may improve long-term postoperative outcomes, with an emphasis on persistent perioperative insomnia due to poorer associated outcomes.