Actigraphy-based differences in sleep in those receiving opioid versus non-opioid therapy postsurgical removal of...

Opioid medications are routinely used for short-term pain management after surgery. However, data on the effects of postsurgical opioid use on sleep is limited. The goal of this pilot study was to examine differences in objective sleep metrics between those on opioid versus non-opioid therapy for pain management in the immediate postsurgical period using participants in the pilot study from the Opioid Analgesic Reduction Study (OARS) and to determine if sex modifies the association.

The OARS study is a randomized, multisite study designed for people undergoing surgical removal of impacted third molars. Adult participants were stratified by sex and randomized to a treatment group. Participants wore an actigraph monitor for three days post-surgery. Actigraph-derived outcomes included total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Subjective survey data, including the Brief Pain Inventory (BPI) and Pain and Sleep Questionnaire (PSQ-3), were collected.

Data from 41 of the 50 pilot study participants who had full actigraphy data was included. The opioid group (n = 19) experienced more WASO on nights 1 and 3 than the nonopioid group (n = 22). The difference between the nonopioid and opioid groups was -22.3 min [90%CI:-42.8,-1.9] and -21.5 min [90%CI -41.9,-1.0], respectively. The noted difference was driven by men in the opioid group. In contrast, differences between treatment groups with regards to subjective surveys was driven by women. Women in the opioid group had worse mean PSQ-3 scores (p = 0.09): mean difference = -1.3 [90%CI:-2.4,-0.2] and -1.3 [90%CI:-2.3,-0.3] after nights 1 and 2, respectively.

Postsurgical opioid therapy is associated with worse objective and subjective sleep compared to non-opioid therapy. The associations are modified by sex.