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Updated: Aug 13, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Psychological predictors of postoperative sleep in children undergoing outpatient surgery
Alison A Caldwell-Andrews1, Zeev N Kain
1The Center for the Advancement of Perioperative Health, Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA. alison.caldwell-andrews@yale.edu
Insights
Parental anxiety and children's aggressive behavior significantly predict postoperative sleep difficulties in children undergoing surgery, impacting sleep quality beyond pain and prior sleep patterns.
Area of Science:
- Pediatric Psychology
- Sleep Medicine
- Behavioral Science
Background:
- Postoperative sleep disturbances are common in children.
- Identifying predictors of sleep issues is crucial for improving recovery.
- Psychological factors may play a significant role in pediatric postoperative sleep.
Purpose of the Study:
- To investigate psychological predictors of postoperative sleep in children undergoing outpatient surgery.
- To determine the impact of parental and child psychological variables on children's sleep after surgery.
Main Methods:
- Hierarchical multivariate regression analysis was employed.
- Variables included parental anxiety (NEO-PI-R Neuroticism), coping style, child aggressive behavior (CBCL externalizing), and temperament.
- Objective sleep assessment was conducted using actigraphy in 52 healthy children.
Main Results:
- 22% of children experienced postoperative sleep difficulties.
- A regression model explained 82% of the variance in postoperative sleep efficiency.
- Key predictors were preoperative sleep patterns (60%), postoperative pain (8.2%), parental anxiety (9%), and child aggressive behavior (5%).
Conclusions:
- Parental anxiety and children's aggressive behavior are significant psychological predictors of postoperative sleep.
- These psychological factors influence children's sleep independently of preoperative sleep and postoperative pain.
Background:
The purpose of this study was to examine psychological predictors of postoperative sleep in children undergoing outpatient surgery.
Methods:
We used hierarchical multivariate regression to examine the impact of demographic and personality variables such as parental worry/anxiety [NEO-personality inventory, revised (NEO-PI-R) Neuroticism], parental coping style (Miller Behavioral Style Scale), children's aggressive behavior [child behavior checklist (CBCL) externalizing], and children's temperament (emotionality, activity, sociability, and impulsivity) on postoperative sleep in 52 consecutive, healthy, children undergoing outpatient surgery. Sleep was assessed using actigraphy, a valid, reliable and objective measure of sleep quality. All perioperative protocols were strictly controlled and standardized.
Results:
We found that 22% of the children experienced difficulty with postoperative sleep as defined by actigraphy. A hierarchical multiple regression model that was constructed to identify predictors of postoperative sleep efficiency in children accounted for 82% of the variance (R = 0.906, F = 19.42, P = 0.0001). Significant predictors in this model included preoperative sleep patterns (60%), postoperative pain (8.2%), parental anxiety/worry (NEO-PI-R Neuroticism scale; 9%), and children's aggressive behavior (CBCL externalizing; 5%).
Conclusions:
We conclude that psychological factors such as parental anxiety/worry and children's aggressive behavior are predictive of children's postoperative sleep above and beyond the influence of preoperative sleep patterns and postoperative pain.
