Fragmented Sleep And Opioid Medication Utilization During Hospitalization Following Orthopaedic Trauma

To objectively characterize inpatient sleep patterns following orthopaedic trauma and evaluate their association with opioid medication utilization while hospitalized.

This was a retrospective analysis of a prospective randomized clinical trial (NCT04154384).

An Urban, Level 1 Trauma Center.

Adult patients with isolated orthopaedic injuries treated surgically were eligible to participate in the original trial if they could consent, comprehend English, were not pregnant or incarcerated, and had a cell phone. Participants were enrolled within 12 hours of surgery and provided with wrist worn actigraphy devices, which are non-invasive devices that measure activity and rest, for the duration of hospitalization thereafter. Participants who wore the actigraphy device for ≥70% of their hospitalization were included in the analysis; those who did not meet this threshold were excluded.

Total sleep time while participants were admitted to the hospital recorded by actigraphy devices. Linear mixed-effects models examined associations between inpatient sleep and inpatient opioid use, measured in morphine milligram equivalents daily.

The final sample of N=99 participants was predominantly Black (71.7%) and female (55.6%) with a mean age of 48 (range 18-89). Patients had an average total sleep time of 6 hr 36 min (±4 hr 17 min) per 24 hours. Sleep was fragmented, averaging 9.1 awakenings totaling 26.6 minutes. Median opioid use was 45.1 morphine milligram equivalents daily (MED). Each additional MED during the hospitalization period was associated with shorter inpatient sleep duration, specifically an average of 2.7 minutes less of sleep (p=0.004).

This study demonstrated that participants needing surgery for isolated orthopaedic injuries experienced short, fragmented sleep while hospitalized. This study's findings also indicate that higher inpatient opioid utilization is associated with worse sleep quality.

Level 2.