title: Postoperative sleep disturbance: influences of opioids and pain in humans.
abstract: OBJECTIVE
  To test the hypothesis that opioids and pain contribute independently to postoperative sleep disturbance, 10 women undergoing surgery requiring a low abdominal incision for treatment of benign gynecologic conditions were randomized to receive either epidural opioid (fentanyl) (n=6) or epidural local anesthetic (bupivacaine) (n=4) for intraoperative and postoperative analgesia.
  
  
  METHODS
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  METHODS
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  METHODS
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  METHODS
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  METHODS
  Polysomnography was performed in a standard patient room on the preoperative and first three postoperative nights. Pain at rest and with coughing was evaluated using a visual-analogue pain scale each evening and morning.
  
  
  RESULTS
  On the first postoperative night, rapid eye movement (REM) sleep was abolished in all patients. On the third postoperative night, the mean +/- SE REM sleep time increased significantly (p=.003) to 9.8% +/- 3.1% in the fentanyl group, and 12.9% +/- 3.8% in the bupivacaine group. Conversely, light non-REM (NREM) sleep (%stage 1 + %stage 2) was higher on the first postoperative night and significantly lower on the third postoperative night (p=0.011). Between group comparison revealed only that the mean % slow-wave sleep (SWS) in the fentanyl group (6.0%, 2.0%, and 14.7%) was different from the bupivacaine group (7.8%, 9.1%, and 10.6%) in the postoperative period after adjusting for the preoperative night % SWS (p=0.021). Pain was well controlled in all patients, but was slightly better controlled in the fentanyl group than in the bupivacaine group on postoperative night 2 (p=0.024). There was no statistically significant association between pain score and any polysomnographically defined stage.
  
  
  CONCLUSIONS
  Postoperative patients suffer a profound sleep disturbance even when opioids are avoided and pain is well controlled.
authors.affiliation: Department of Anesthesiology, The Pennsylvania State University, Hershey 17033-0850, USA. acronin@psu.edu
authors.forename: A J
authors.initials: AJ
authors.lastname: Cronin
authors.forename: J C
authors.initials: JC
authors.lastname: Keifer
authors.forename: M F
authors.initials: MF
authors.lastname: Davies
authors.forename: T S
authors.initials: TS
authors.lastname: King
authors.forename: E O
authors.initials: EO
authors.lastname: Bixler
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000494:pharmacology; D002045:Bupivacaine / Q000494:pharmacology; D021081:Chronobiology Disorders / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000494:pharmacology*; D006801:Humans; D007430:Intraoperative Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control*; D017286:Polysomnography; D011446:Prospective Studies; D012894:Sleep Stages / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology*; D012895:Sleep, REM / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine