# Preoperative sleep disturbance as a risk factor for moderate-to-severe postoperative pain in hemifacial spasm patients: a prospective cohort study

## TL;DR

Poor sleep before surgery increases the risk of severe pain after hemifacial spasm surgery, suggesting preoperative sleep management could improve recovery.

## Contribution

This study identifies preoperative sleep disturbances as an independent risk factor for postoperative pain in hemifacial spasm patients.

## Key findings

- 22 out of 120 patients experienced moderate-to-severe pain at one week post-surgery.
- Poor sleep quality (PSQI ≥ 7) was associated with a 36.8% increased risk of postoperative pain.
- Multivariate analysis confirmed sleep disturbance as an independent predictor of postoperative pain.

## Abstract

This study aims to examine the impact of preoperative sleep disturbances on postoperative pain levels among individuals undergoing hemifacial spasm (HFS) surgery. The findings will establish a theoretical foundation for developing targeted interventions to ameliorate postoperative pain management in this patient population.

Hemifacial spasm patients who were treated and operated on at Peking University People’s Hospital from October 2023 to February 2024 were selected as participants via convenience sampling. Sleep quality was quantitatively assessed using the Pittsburgh Sleep Quality Index (PSQI), while postoperative pain severity was measured with the Numerical Rating Scale (NRS). Perioperative clinical data were systematically recorded at postoperative day 1, 3, and 7 (POD 1, 3, and 7). Univariate and multivariate regression analyses were subsequently conducted to identify predictors of moderate-to-severe pain persisting at the 1-week postoperative timepoint.

A cohort of 120 patients diagnosed with hemifacial spasm participated in this study. Based on preoperative Pittsburgh Sleep Quality Index (PSQI) scores, participants were stratified into two groups: a low-sleep-quality group (PSQI ≥ 7, n = 25) and a high-sleep-quality group (PSQI < 7, n = 95). At POD 7, a total of 22 patients (18.33%) developed moderate-to-severe pain (NRS ≥ 4). Univariate analysis revealed that the pain incidence was significantly higher in the poor sleep quality group (PSQI ≥ 7) compared to the good sleep quality group (44.0% vs. 11.58%, p = 0.006). After adjusting for confounding variables, multivariate analysis confirmed that preoperative sleep disturbance (PSQI score) was an independent risk factor for postoperative pain (adjusted OR = 1.368, 95% CI: 1.154–1.621, p < 0.001). Each 1-point increase in PSQI score was associated with a 36.8% increase in pain risk. Sensitivity analysis using dichotomized PSQI variables (cut-off values ≥5 or ≥7) yielded consistent results, showing significantly increased pain risk in the poor sleep quality group (OR = 6.263 and 6.419, respectively, both p = 0.001), supporting the robustness of the primary analysis findings.

Preoperative sleep disturbances elevate the risk of patients with hemifacial spasm experiencing moderate-to-severe pain postoperatively. Therefore, proactive management of sleep disturbances prior to surgery represents a valuable strategy for enhancing postoperative analgesia in this patient population. However, the generalizability of these findings is limited to HFS patients undergoing MVD, and further validation in broader surgical cohorts is warranted.