Prospective assessment and risk factors of sleep disturbances in total hip and knee arthroplasty based on an Enhanced Recovery After Surgery concept

This study aimed to examine sleep quality and risk factors associated with sleep disturbance in patients undergoing total joint arthroplasty (TJA) managed with an enhanced recovery protocol from preoperatively until 12 weeks postoperatively in order to provide suggestions for improving the prevention and treatment of sleep disturbance in these patients.

The Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI) and Epworth Sleepiness Scale (CESS) were used to evaluate sleep quality. Pain was measured by a visual analog scale (VAS). Neuropsychological status was also assessed, using the Center for Epidemiological Studies Depression Scale (CESD) and Zung Self-Rating Anxiety Scale (ZSAS).

Of 107 patients (66% women), the prevalence of sleep disturbance was as high as 60% preoperatively. CPSQI score significantly increased postoperatively from baseline to 2 weeks before decreasing rapidly to a lower level than preoperative baseline. CESS scores of postoperative weeks 1 and 2 increased significantly compared with baseline and decreased significantly after 4 weeks, and a positive correlation was found between CESS and CPSQI score. VAS score significantly decreased from baseline over all time points in the postoperative period. A good sleeper group was more likely to suffer from severe sleep disturbance after surgery than a poor sleeper group with a bigger increase of CPSQI score. Multivariate logistic regression analysis indicated that pain and anxiety were risk factors associated with postoperative sleep disturbance.

Sleep disturbance is highly prevalent among patients undergoing TJA. More attention and multimodal approaches with well-controlled pain, mental counseling, and possibly preemptive use of sleep medication may improve sleep quality in TJA patients to promote recovery.