Abstract
Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. The main objective of this study was to examine the role of sleep disturbance in the development and long-term maintenance of chronic postherniorrhaphy inguinal pain (CPIP), with exploration of sex differences. From 2012 to 2017, a national cohort of patients with prior groin hernia repair (n = 2084;45.8% females) were assessed for the development of CPIP 12 months after surgery. Patients then underwent long-term (median 5.0 years) follow-up to evaluate the contribution of sex and sleep disturbance on the maintenance of CPIP. Associations between pre- and postoperative sleep problems (assessed at long-term follow-up) and CPIP were tested using logistic regression. Females had higher rates of CPIP with negative impact on daily activities 12 months after surgery as compared to males (14.6 vs 9.2%, P < .0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, P = .003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio [aOR] 1.76 [95%CI 1.26–2.46], P = .001) and CPIP in the long-term (aOR 2.20 [1.61–3.00] , P < .0001). CPIP was associated with insomnia and depression. Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. PerspectiveFemales are at heightened risk for CPIP as compared to males. Increased severity of pain symptoms are linked to poorer sleep and psychiatric morbidity. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.
Highlights
Persistent pain after groin hernia repair is a major health problem
Preoperative selfreported poor sleep quality predicts higher pain intensity and analgesic consumption on the first day after breast cancer surgery[69] or Caesarean delivery,[48] and chronic sleeping difficulties are associated with increased risk for severe acute postoperative pain after abdominal or orthopedic surgery.[40]. Despite these links between perioperative sleep and pain, it is unknown whether preoperative sleep problems are associated with the development of chronic postsurgical pain (CPSP), and no previous study has evaluated the influence of sleep disturbance on chronic postherniorrhaphy inguinal pain (CPIP)
The study population was relatively healthy with most patients belonging to American Society of Anesthesiology (ASA) physical status category 1; a higher proportion of women were ASA 1 compared to men (Table 1)
Summary
Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. Many of the preoperative factors that heighten risk for CPIP are nonmodifiable, such as young age,[21] female sex,[36] genetic predisposition[8,18] and surgery for a recurrent hernia.[1] Over the last decades, it has become increasingly clear that disturbance of sleep continuity or poor sleep quality may adversely impact multiple health outcomes, including persistent pain.[3,11,23,30,32] Rates of insomnia (trouble initiating sleep and maintaining sleep) are highly prevalent in chronic pain disorders ranging between 50% and 88%.62. Differing rates and impact of sleep disturbances may partially explain sex-differences related to CPIP
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