Wearable-derived sleep and circadian features associated with electronic health record-documented persistent...

A substantial percentage of surgical patients develop persistent postsurgical pain, and sleep disruption is an established, modifiable contributor. We examined temporal dynamics linking sleep and circadian rhythms to persistent postsurgical pain, using longitudinal Fitbit and electronic health record (EHR) data from the NIH All of Us Research Program to track sleep and circadian changes preceding EHR documentation of pain beyond expected surgical recovery. Patients later documented with persistent pain showed systematic shifts in wake timing and in heart rate circadian rhythms (elevated amplitude and mesor), with wake timing decoupled from heart rate circadian timing. These changes were absent in a comparison cohort without persistent pain documentation, indicating specificity to persistent postsurgical pain rather than a postoperative or clinical-encounter effect. Findings align with evidence linking altered sleep to pain outcomes and identify cardiac circadian disruption as a distinct marker, suggesting wearable-derived features could capture physiological changes before documentation and inform intervention.