Sleep deficiency and opioid use/misuse in adolescents following surgery

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PROJECT SUMMARY Prescription opioid misuse is a significant burden on adolescent public health in the United States. Opioid misuse often starts with prescribed opioids, with surgery representing a key pathway by which adolescents are first prescribed opioids for the management of acute pain. Yet, little is known about the critical period following surgery during which adolescents initiate prescription opioid misuse or the modifiable behavioral mechanisms contributing to this process. These are critical gaps in our knowledge impeding our ability to identify adolescents at increased risk for opioid misuse and to develop interventions aimed at reducing prescription opioid misuse. Sleep deficiency (including sleep deprivation, noncircadian sleep, sleep disorders, and poor sleep quality) is an important proximal risk factor for prescription opioid misuse. Sleep is often disturbed during the perioperative period, a time when many adolescents are exposed to their first opioid prescription. Indeed, in our own preliminary study, we found that sleep deficiency present both before surgery and during the immediate postsurgical period was associated with increased opioid use. However, this pilot study did not allow us to characterize aspects of sleep most strongly related to opioid use and did not allow us to evaluate mechanisms, such as pain and psychological factors, underlying the sleep – opioid use relationship. Furthermore, data are urgently needed to determine how sleep deficiency prospectively predicts the development of opioid misuse behaviors in the context of other putative factors, such as a history of substance use, pain intensity, psychosocial (e.g., depression), peer, and family factors. Given that sleep deficiency is modifiable, it is a critical focus of research aimed at reducing the development of adolescent opioid misuse behaviors. Therefore, this project aims to 1) test the direct and mediation pathways of sleep deficiency, pain, psychological factors, and opioid use following sports-injury surgery, and 2) develop and validate a multivariable prediction model to identify adolescents at increased risk of prescription opioid misuse over the 24 months following surgery. To address these aims, we propose a prospective, observational study of N= 400 adolescents (10-19 years) who receive their first ever opioid following sports injury surgery. Presurgery, participants will undergo comprehensive multimodal sleep assessments (surveys and actigraphy monitoring) to measure sleep deficiency. Participants will also report on previous substance use, pain intensity, psychosocial, peer, and family factors. Adolescents will then be followed over the first 14 days after surgery using ecological momentary assessment to capture real-time daily data on sleep, pain, psychological factors, and opioid use. We will use an innovative electronic medication monitoring methodology to accurately measure opioid use (total number of doses and duration) following surgery. Follow-up assessments at 3-months, 6-months, 12- months, and 24-months will track opioid misuse developing over time. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse.