Quantifying postoperative sleep loss associated with increased pain in children undergoing a modified Nuss operation

Benjamin T Many; Yazan K Rizeq; Soyang Kwon; Jonathan C Vacek; Seth D Goldstein; Catherine J Hunter; Hassan Ghomrawi; Fizan Abdullah

doi:10.1016/j.jpedsurg.2019.12.003

Quantifying postoperative sleep loss associated with increased pain in children undergoing a modified Nuss operation

J Pediatr Surg. 2020 Sep;55(9):1846-1849. doi: 10.1016/j.jpedsurg.2019.12.003. Epub 2020 Jan 7.

Authors

Benjamin T Many¹, Yazan K Rizeq², Soyang Kwon², Jonathan C Vacek³, Seth D Goldstein³, Catherine J Hunter³, Hassan Ghomrawi⁴, Fizan Abdullah³

Affiliations

¹ Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA. Electronic address: bmany@luriechildrens.org.
² Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA.
³ Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Surgery, Chicago, IL, USA; Department of Surgery, Northwestern University, Chicago, IL, USA.
⁴ Department of Surgery, Northwestern University, Chicago, IL, USA; Department of Pediatrics, Northwestern University, Chicago, IL, USA.

PMID: 31982091
DOI: 10.1016/j.jpedsurg.2019.12.003

Abstract

Purpose: The presence of pain may interrupt sleep and impede normal postoperative recovery; however, no prior studies have quantified sleep loss due to pain in children undergoing inpatient surgery. Wearable accelerometers objectively measure sleep patterns in children. We aimed to quantify sleep loss associated with patient reported pain scores after a Modified Nuss operation.

Methods: Ten patients undergoing Modified Nuss operations were recruited during their inpatient stay. Children wore an Actigraph GT3X-BT accelerometer postoperatively during their hospital stay. Hourly sleep minutes were recorded using the Actigraph between 10 pm and 6 am. Patient reported pain scores were abstracted from patient charts. Mixed linear regression models, adjusting for within-subject random effects, were estimated to quantify the association between hourly sleep minutes and patient reported pain scores.

Results: Patients were 30% female, with an average age of 15.7 years (range 13-22). The majority (70%) of patients were white non-Hispanic. All patients received a patient controlled analgesic pump. Average postoperative length of stay was 4.8 days (range 4.0-6.0; SD = 0.8). A total of 240 sleep hours and associated pain scores were analyzed. Patients slept on average 48 min per hour. Mixed model analysis predicted that a 1-point increase in pain score was associated with 2.5 min per hour less sleep time.

Conclusion: Increases in patient-reported pain scores are associated with sleep loss after a Modified Nuss operation. Objectively quantifying sleep loss associated with postoperative pain using accelerometer data may help clinicians better understand their patient's level of pain control. Our findings provide the basis for future studies aimed at more accurately titrating pain medication to optimize sleep and speed up recovery.

Level of evidence: Case Series Without Comparison Group, Level IV.

Keywords: Accelerometers; Children; Pain; Pectus excavatum; Pediatric surgery; Sleep; Wearable telemetry.

MeSH terms

Actigraphy
Adolescent
Adult
Analgesics / therapeutic use
Female
Funnel Chest / surgery
Humans
Male
Pain, Postoperative* / complications
Pain, Postoperative* / diagnosis
Pain, Postoperative* / drug therapy
Plastic Surgery Procedures / adverse effects*
Sleep / physiology
Sleep Wake Disorders* / diagnosis
Sleep Wake Disorders* / etiology
Treatment Outcome
Young Adult

Substances

Analgesics