A recent study found that sleep quality deteriorated in patients whose pain levels increased while in the preoperative period.
Women, those who had sleep problems before hospitalization, and those who had sleep problems in the preoperative period had worse sleep quality during the preoperative period, according to a study published in Journal of PeriAnesthesia Nursing. This study found that the amount of pain was greater in patients who had worse sleep quality.
The aim of this study was to identify the sleep quality and pain intensity of patients prior to surgery. The study also aimed to identify the relationship between sleep quality and pain intensity and any influencing factors.
The researchers performed a cross-sectional study among preoperative patients who were hospitalized in the surgical services of Eskisehir Osmangazi University Health Practice and Research Hospital in Turkey between March 1, 2019, and July 31, 2019.
A total of 139 patients participated in this study. The patients were included if they were 18 years or older, agreed to participate in the research, had the ability to communicate, were in the preoperative period, and had no prior surgery experience. Patients were excluded if they had a cognitive, affective, or verbal impairment or were undergoing an urgent surgery.
Data were collected from patients on the morning of the surgery through face-to-face interviews. The researchers used the Visual Analog Scale for Pain (VASP) to evaluate pain intensity and the Visual Analog Sleep Scale (VASS) to measure sleep quality. Patients were asked to indicate the amount of pain they had using the VASP, which was on a scale of 10, with 0 being no pain and 10 being the worst pain. The VASS has 15 items that consist of 3 subdimensions: sleep disturbance, effective sleep, and daytime sleep. A higher score indicated a decrease in sleep quality where a max score was 1000.
The Sociodemographic Characteristics and Data Form was given to all participants to evaluate for age, gender, level of education, number of people sharing room with patient, body mass index, sleeping problem before hospitalization, sleeping problem in the preoperative period, diagnosed chronic disease, regular drug use, regular exercise, tea or coffee consumption, and drinking alcohol.
Of the patients, 59.7% were male and the mean (SD) age of the participants was 54.64 (17.83) years. When patients were asked which way they preferred to sleep, 43.2% said that they preferred lying on their right side and 36.0% said they preferred to sleep in the supine position.
In the preoperative period, 20.1% of patients with sleep problems said that pain was the cause, 6.5% said that it was the hospital environment, 6.5% said they suffered from sleep disturbances, 5.8% said they had discomfort, 4.3% had anxiety, and 2.2% suffered from sleep problems due to their lying position.
Patients had a mean (SD) score of 484.98 (204.53) on the VASS and 3.95 (3.02) on the VASP. The mean scores on the VASS and VASP were worse in women, those who had sleep problems before hospitalization, and those who had sleep problems in the preoperative period. Patients who had a companion in their room and had sleep problems in the preoperative period were in more pain. The researchers found a correlation between pain levels and sleep quality, in which the sleep quality of the patient deteriorated as pain levels increased.
Being a woman and having sleep problems were significant contributors to the variance in the VASS score. Having a sleep problem in the preoperative period was a significant contributor to the variance in VASP score.
There were some limitations to this study. The data were based on self-reported information using a subjective assessment. This study was also a single-center study, which limits the widespread applicability. The study was also conducted with patients about to receive very different surgical operations.
The researchers concluded that sleep quality and pain intensity were interrelated. A female participant was more likely to have affected sleep quality compared with her male counterpart. Patients who had a companion in their room were more affected by the severity of pain they felt.
“Preoperative surgery patients should be evaluated for sleep quality and pain severity, and appropriate service provision should be planned, considering suitability to the institution,” the researchers wrote. They also recommended programs to increase sleep quality in patients and more detailed studies are needed to solve the deterioration in sleep structure.
Sara Y, Orsal O, Duru P, Kosgeroglu N. Evaluation of preoperative sleep quality and factors affecting pain intensity of patients hospitalized in surgical services. J Perianesth Nurs. Published online March 14, 2022. doi:10.1016/j.jopan.2021.10.004