• ➤ There is increasing evidence that patient-reported outcomes following total knee arthroplasty (TKA) are associated with psychosocial factors and pain catastrophizing. Sleep disturbance, pain, and mental health have a complex interaction, which, if unrecognized, can be associated with impaired patient-reported outcomes and dissatisfaction following TKA.
• ➤ The gold standard of objective sleep assessment is polysomnography, which is not feasible to use routinely for TKA patients. Wearable devices are a validated and less costly alternative.
• ➤ Subjective sleep measures, such as the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, or Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive test sleep domains, are simple to administer and provide additional insight into sleep disturbance. Although objective and subjective measures do not correlate precisely, they can be informative together.
• ➤ Sleep disturbances in the elderly population are common and multifactorial in etiology, stemming from the interplay of sleep disorders, medication side effects, and pain. Commonly prescribed medications following TKA as well as postoperative pain can exacerbate underlying sleep disturbances.
• ➤ Obstructive sleep apnea (OSA) is prevalent in patients seeking TKA. In the setting of OSA, postoperative opioids can cause respiratory depression, resulting in consequences as severe as death. A standardized multimodal pain protocol including anti-inflammatories and gamma-aminobutyric acid (GABA) analogues may allow for decreased reliance on opioids for pain control.
• ➤ Surgeons should reassure patients that postoperative sleep disturbance is common and transient, collaborate with the patient’s primary care doctor to address sleep disturbance, and avoid prescription of pharmaceutical sleep aids.

中文翻译：

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膝关节骨性关节炎和全膝关节置换术患者的睡眠障碍和障碍

• ➤ 越来越多的证据表明，全膝关节置换术 (TKA) 后患者报告的结果与心理社会因素和灾难性疼痛有关。睡眠障碍、疼痛和心理健康具有复杂的相互作用，如果未被识别，可能与 TKA 后患者报告的结果受损和不满意有关。
• ➤ 客观睡眠评估的金标准是多导睡眠图，常规用于 TKA 患者是不可行的。可穿戴设备是一种经过验证且成本较低的替代品。
• ➤ 主观睡眠测量，例如匹兹堡睡眠质量指数、Epworth 嗜睡量表或患者报告结果测量信息系统 (PROMIS) 计算机化自适应测试睡眠域，易于管理并提供对睡眠障碍的额外洞察。尽管客观和主观测量不精确相关，但它们可以一起提供信息。
• ➤ 老年人群中的睡眠障碍是常见的，病因是多因素的，源于睡眠障碍、药物副作用和疼痛的相互作用。TKA 后常用的处方药以及术后疼痛会加剧潜在的睡眠障碍。
• ➤ 阻塞性睡眠呼吸暂停 (OSA) 在寻求 TKA 的患者中很普遍。在 OSA 的情况下，术后阿片类药物可导致呼吸抑制，导致严重的后果，如死亡。包括抗炎药和 γ-氨基丁酸 (GABA) 类似物在内的标准化多模式疼痛方案可以减少对阿片类药物的疼痛控制依赖。
• ➤ 外科医生应让患者放心，术后睡眠障碍是常见且短暂的，与患者的初级保健医生合作解决睡眠障碍，避免使用药物助眠剂。