Sleep disturbance is a modifiable risk factor that, when reduced, may improve subacute postsurgical outcomes (e.g., pain-related impact). Evidence also indicates that pain and sleep may have a bidirectional longitudinal relationship before to (sub) acutely after surgery. The objective of the present study is to examine the degree to which sleep disturbances and pain behavior have uni- or bidirectional relationships in a sample of patients undergoing sports orthopedic surgery. In this observational, longitudinal cohort study, participants ( = 296) were adult (ages 18+) active duty service members who underwent open or arthroscopic shoulder or knee surgery at Walter Reed National Military Medical Center. Participants were asked to complete PROMIS Sleep Disturbance and Pain Behavior computer adaptive testing item banks before surgery, 6 weeks postsurgery, and 3 months postsurgery. Patient-level covariates were analyzed for interrelationships using nonparametric bivariate statistics. Autoregressive and cross-lagged structural equation modeling examined the bidirectional relationships of patient-level covariates and PROMIS outcomes. When controlling for patient-level covariates, sleep disturbance at presurgical and 2-week postsurgical timepoints were positively associated with both sleep disturbance and pain behavior at the subsequent timepoint. Sleep disturbance may contribute to pain-related functioning and quality of life after sports orthopedic surgery. Future studies utilizing multidimensional patient report outcomes and robust analytics are needed to better understand whether sleep-targeted interventions can improve subacute and long-term orthopedic sports surgery outcomes.

中文翻译：

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患者报告结果测量信息系统 (PROMIS) 睡眠障碍对亚急性术后 PROMIS 疼痛行为的滞后效应

睡眠障碍是一个可改变的风险因素，当减少时，可能会改善亚急性术后结果（例如，疼痛相关的影响）。证据还表明，疼痛和睡眠可能在手术前到（亚）急性后具有双向纵向关系。本研究的目的是检查睡眠障碍和疼痛行为在接受运动骨科手术的患者样本中具有单向或双向关系的程度。在这项观察性纵向队列研究中，参与者 (= 296) 是成人（18 岁以上）现役军人，他们在沃尔特里德国家军事医疗中心接受了开放式或关节镜下肩部或膝部手术。参与者被要求在手术前完成 PROMIS 睡眠障碍和疼痛行为计算机自适应测试项目库，术后 6 周，术后 3 个月。使用非参数双变量统计分析患者水平协变量的相互关系。自回归和交叉滞后结构方程模型检查了患者水平协变量和 PROMIS 结果的双向关系。当控制患者水平的协变量时，术前和术后 2 周时间点的睡眠障碍与随后时间点的睡眠障碍和疼痛行为呈正相关。睡眠障碍可能会影响运动骨科手术后与疼痛相关的功能和生活质量。未来需要利用多维患者报告结果和强大的分析进行研究，以更好地了解以睡眠为目标的干预措施是否可以改善亚急性和长期骨科运动手术的结果。