Perioperative insomnia trajectories and functional outcomes after total knee arthroplasty.

ABSTRACT 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 = 173; Mage = 65 ± 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.

[1]  D. Dunlop,et al.  Pain Sensitization as a Potential Mediator of the Relationship Between Sleep Disturbance and Subsequent Pain in Rheumatoid Arthritis , 2022, Arthritis care & research.

[2]  M. Irwin,et al.  Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty , 2021, European journal of pain.

[3]  L. Salmon,et al.  Improvement in Sleep Patterns After Hip and Knee Arthroplasty: A Prospective Study in 780 Patients. , 2020, The Journal of arthroplasty.

[4]  R. M. N. Fatah,et al.  A sleep disturbance after total knee arthroplasty , 2020, Journal of family medicine and primary care.

[5]  Ling-li Li,et al.  Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study , 2019, Journal of Orthopaedic Surgery and Research.

[6]  M. Koken,et al.  The Effects of Total Knee Arthroplasty on Sleep Quality , 2019, Malaysian orthopaedic journal.

[7]  A. Stone,et al.  PROMIS® Adult Health Profiles: Efficient Short-Form Measures of Seven Health Domains. , 2019, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[8]  M. Irwin,et al.  Sex differences in measures of central sensitization and pain sensitivity to experimental sleep disruption: implications for sex differences in chronic pain , 2018, Sleep.

[9]  Zhe Feng,et al.  A general introduction to adjustment for multiple comparisons. , 2017, Journal of thoracic disease.

[10]  D. Bohl,et al.  Prospective Assessment of Sleep Quality Before and After Primary Total Joint Replacement. , 2017, Orthopedics.

[11]  Madhu Mazumdar,et al.  Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative , 2017, British Medical Journal.

[12]  A. Lerdal,et al.  Factors that can predict pain with walking, 12 months after total knee arthroplasty , 2016, Acta orthopaedica.

[13]  A. Althouse.  Adjust for Multiple Comparisons? It's Not That Simple. , 2016, The Annals of thoracic surgery.

[14]  P. Lavand'homme,et al.  Dynamic view of postoperative pain evolution after total knee arthroplasty: a prospective observational study. , 2016, Minerva anestesiologica.

[15]  R. Deyo,et al.  Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) Short Form in Older Adults with Chronic Musculoskeletal Pain. , 2015, Pain medicine.

[16]  J. Giesinger,et al.  WOMAC, EQ-5D and Knee Society Score Thresholds for Treatment Success After Total Knee Arthroplasty. , 2015, The Journal of arthroplasty.

[17]  R. Edwards,et al.  Sleep, Pain Catastrophizing, and Central Sensitization in Knee Osteoarthritis Patients With and Without Insomnia , 2015, Arthritis care & research.

[18]  P. Noble,et al.  Patient-reported outcome measures after total knee arthroplasty , 2015, Bone & joint research.

[19]  J. Haythornthwaite,et al.  Cognitive–Behavioral Therapy for Insomnia in Knee Osteoarthritis: A Randomized, Double‐Blind, Active Placebo–Controlled Clinical Trial , 2015, Arthritis & rheumatology.

[20]  G. Lewis,et al.  Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. , 2015, British journal of anaesthesia.

[21]  Janiece L. Walker,et al.  (350) Pre- and post-operative sleep is associated with post-operative pain and functioning following total knee replacements , 2015 .

[22]  R. Edwards,et al.  (201) Pre-surgical Quantitative Sensory Testing predicts persistent postoperative pain in total knee replacement patients , 2015 .

[23]  E. Senba.  A key to dissect the triad of insomnia, chronic pain, and depression , 2015, Neuroscience Letters.

[24]  T. Roth,et al.  Correlation between Sleep Disruption on Postoperative Pain , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[25]  A. Harvey,et al.  Insomnia before and after treatment for anxiety and depression. , 2014, Journal of affective disorders.

[26]  J. Callaghan,et al.  Preoperative predictors of pain following total knee arthroplasty. , 2014, The Journal of arthroplasty.

[27]  T. Roth,et al.  Increasing preoperative sleep reduces postoperative pain and analgesic use , 2014 .

[28]  G. Lavigne,et al.  Postoperative sleep disruptions: a potential catalyst of acute pain? , 2014, Sleep medicine reviews.

[29]  S. Kurtz,et al.  Mortality, cost, and health outcomes of total knee arthroplasty in Medicare patients. , 2013, The Journal of arthroplasty.

[30]  T. Sculco,et al.  Predictors for moderate to severe acute postoperative pain after total hip and knee replacement , 2012, International Orthopaedics.

[31]  C. Morin,et al.  The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. , 2011, Sleep.

[32]  Yinglin Xia,et al.  The efficacy of cognitive-behavioral therapy for insomnia in patients with chronic pain. , 2010, Sleep medicine.

[33]  C. Morin,et al.  Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference , 2009, Current medical research and opinion.

[34]  B. Rybarczyk,et al.  Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. , 2009, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[35]  J. Katz,et al.  Catastrophizing and depressive symptoms as prospective predictors of outcomes following total knee replacement. , 2009, Pain research & management.

[36]  Robert R. Edwards,et al.  Duration of sleep contributes to next-day pain report in the general population , 2008, PAIN®.

[37]  Christian Guilleminault,et al.  Sleep and rheumatologic disorders. , 2008, Sleep medicine reviews.

[38]  A. Kreicbergs,et al.  Prediction of persistent pain after total knee replacement for osteoarthritis. , 2008, The Journal of bone and joint surgery. British volume.

[39]  S. Kurtz,et al.  Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. , 2007, The Journal of bone and joint surgery. American volume.

[40]  Philipp E. Scherer,et al.  Visceral Fat Adipokine Secretion Is Associated With Systemic Inflammation in Obese Humans , 2007, Diabetes.

[41]  K. Greene,et al.  Sleep Disruptions Mediate the Relationship Between Early Postoperative Pain and Later Functioning Following Total Knee Replacement Surgery , 2006, Journal of Behavioral Medicine.

[42]  E. Badley,et al.  Pain as a mediator of sleep problems in arthritis and other chronic conditions. , 2005, Arthritis and rheumatism.

[43]  M. Ohayon.  Relationship between chronic painful physical condition and insomnia. , 2005, Journal of psychiatric research.

[44]  A. Davis,et al.  The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. , 2001, Arthritis and rheumatism.

[45]  C. Morin,et al.  Validation of the Insomnia Severity Index as an outcome measure for insomnia research. , 2001, Sleep medicine.

[46]  C. Cooper,et al.  Knee osteoarthritis and obesity , 2001, International Journal of Obesity.

[47]  S. Lange,et al.  Adjusting for multiple testing--when and how? , 2001, Journal of clinical epidemiology.

[48]  M. Sevick,et al.  Factors Related to Sleep Disturbance in Older Adults Experiencing Knee Pain or Knee Pain with Radiographic Evidence of Knee Osteoarthritis , 2000, Journal of the American Geriatrics Society.

[49]  Hermann Brenner,et al.  Obesity, overweight and patterns of osteoarthritis: the Ulm Osteoarthritis Study. , 2000, Journal of clinical epidemiology.

[50]  N. Bellamy.  Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index. , 1989, Seminars in arthritis and rheumatism.

[51]  G. Long,et al.  Analysis of patients' sleep disorder after total knee arthroplasty-A retrospective study. , 2019, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[52]  C. Deirmengian,et al.  Prospective Evaluation of Sleep Disturbances After Total Knee Arthroplasty. , 2016, The Journal of arthroplasty.