title: Longitudinal and Temporal Associations Between Daily Pain and Sleep Patterns After Major Pediatric Surgery.
abstract: Approximately 20% of children develop persistent pain after major surgery. Sleep disruption has been implicated as a predictor of children's acute postsurgical pain. However, perioperative sleep patterns have not been longitudinally assessed, and the role of sleep in persistence of postsurgical pain has not been explored. We aimed to examine sleep patterns over 4 months in children having major surgery, and temporal relationships between daily sleep and pain. Sixty children age 10 to 18 (mean = 14.7) years having major surgery completed 7 days of actigraphy sleep monitoring (sleep duration, efficiency), twice daily electronic diaries (sleep quality, pain intensity, medication use), and validated questionnaires at presurgery, 2 weeks, and 4 months postsurgery. Generalized linear models, controlling for age, sex, naps, and medication, showed sleep quality (β [B] = -.88, P < .001) and efficiency (B = -1.50, P = .036) were significantly reduced at 2 weeks compared with presurgery, and returned to baseline by 4 months. Poorer night-time sleep quality was significantly associated with greater next day pain intensity (B = -.15, P = .005). Sleep duration and efficiency were not associated with subsequent pain; daytime pain was not associated with subsequent sleep. Findings suggest sleep quality may be an important target for intervention after surgery in children; research is needed to understand how other sleep parameters may relate to recovery.
  
  
  
  This study assessed longitudinal sleep patterns over 4 months after major pediatric surgery using actigraphy, diaries, and validated measures. Sleep quality and efficiency were significantly reduced at 2 weeks. Poorer sleep quality was associated with greater next day pain intensity suggesting that sleep quality may be an important target for intervention.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington. Electronic address: jennifer.rabbitts@seattlechildrens.org.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Rabbitts
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington; Department of School of Public Health, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Departments of Neuroscience and Sociology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Arthi
authors.initials: A
authors.lastname: Narayanan
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Tonya M
authors.initials: TM
authors.lastname: Palermo
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008499:Medical Records; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications / Q000503:physiopathology; D057566:Self Report; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology; D013131:Spine / Q000601:surgery; D035441:Thoracic Wall / Q000601:surgery; D013997:Time Factors
keywords: Postoperative pain; pediatric pain; perioperative sleep; scoliosis surgery; spine fusion