TITLE: PREOPERATIVE SLEEP DEPRIVATION INFLUENCES RECOVERY AND POSTOPERATIVE ANALGESIC REQUIREMENTS

AUTHORS: Abdus S. Arif, MD, Corey E. Scher, MD, Alan D. Kaye, MD, PhD
AFFILIATION: Tulane/Texas Tech, Lubbock, TX.

INTRODUCTION: Normal sleep is essential for all body functions especially the central nervous system (CNS). Sleeping patterns can alter CNS neurotransmission, in fact, sleep deprivation has been associated with many neurobehavioral changes. Animal and human studies have demonstrated that there is significant lowering of threshold to painful stimulation by sleep deprivation. Inadequate sleep has been shown to induce super sensitivity in brain dopamine receptors while adequate post operative sleep was associated with less nausea and vomiting after ENT surgery. Since most anesthetic agents modulate CNS neurotransmission, reduction of regular sleep preoperatively should influence postoperative course.
METHODS: Twenty-three adult patients (17-58 years) scheduled for outpatient surgery under similar general anesthesic technique were evaluated with regard to age, weight, ASA status, type of surgery, medications, regular sleep in hours and sleep on preoperative night. Hours of sleep preoperatively and time to attain Aldrete discharge score were evaluated. Associated postoperative events were evaluated including nausea, vomiting, delirium, restlessness, and amount of pain medications.
RESULTS: Twenty-three patients received general anesthesia. One patient received regional anesthesia in addition to general anesthesia and was excluded from the survey. Eleven patients were determined to have inadequate sleep as defined as less than 80% of regular sleep hours per night. Nine of the eleven patients (81.8%) required pain medications (4-20 mg. morphine; 10-75 mg. meperidine) in the post anesthesia care unit as compared to four out of eleven patients (36.3%) in the control group (10-20 mg. morphine; 50 mg. meperidine). Each group had two patients who suffered from nausea. The average recovery time was seventy-nine minutes in the inadequate sleep group as compared to fifty-eight minutes in the control group (27% greater). None of the patients manifested delirium or restlessness.
CONCLUSION: The result of this brief study suggest that there may be a correlation between sleep deprivation and postoperative analgesic requirements and recovery time. Future studies are warranted with regard to preoperative sleep, recovery time, and postoperative pain medication.