The impact of perioperative sleep disorders in patients undergoing laparoscopic gynecological surgery under general anesthesia on anesthesia recovery and postoperative pain

MIAO Lina; LIU Gongyao; HOU Haitao; LIU Xing

doi:10.3969/j.issn.1006-5725.2025.24.006

Abstract：Objective To analyze the influence of perioperative sleep disorders on anesthesia recovery and postoperative pain in patients undergoing laparoscopic gynecological surgery under general anesthesia.Methods A total of 160 patients who underwent laparoscopic gynecological surgery at the hospital from March 2024 to March 2025 were retrospectively selected as research subjects.According to the preoperative Pittsburgh Sleep Quality Index(PSQI),they were divided into the non-sleep-disorder(NSD)group(PSQI≤5 points,n=80)and the sleep-disorder(SD)group(PSQI>5 points,n=80).The following aspects were compared between the two groups:anesthesia recovery indicators[recovery time,modified Aldrete score,orientation recovery time,adverse reactions during the recovery period,total dosage of remifentanil,total dosage of propofol,minimum alveolar concentration(MAC)value of sevoflurane,time from drug discontinuation to extubation,intraoperative mean arterial pressure(MAP),intraoperative heart rate(HR),and rescue analgesia utilization rate];pain indicators[Visual Analogue Scale(VAS)score,opioid dosage,and number of patient-controlled analgesia(PCA)presses].Moreover,multi-variate linear regression,decision tree modeling,and mediation effect analysis were employed to explore the relationships among sleep quality,anesthesia recovery,and postoperative pain.Results The recovery time and orientation recovery time in the NSD group were shorter than those in the SD group(P<0.05),and the modified Aldrete score was higher(P<0.05).The total propofol dosage,intraoperative HR,and rescue analgesia utiliza-tion rate in the SD group were higher than those in the NSD group(P<0.05).The incidence of adverse reactions,VAS scores at various postoperative time points,opioid dosage,and number of PCA presses in the NSD group were all lower than those in the SD group(P<0.05).Multivariate regression analysis indicated that for every 1-point increase in PSQI,recovery time was prolonged by 0.63 minutes,orientation recovery time was delayed by 0.55 minutes,the modified Aldrete score decreased by 0.05 points,postoperative VAS score increased by 0.20～0.22 points,opioid dosage increased by 0.87 mg,and the number of PCA presses increased by 0.98(P<0.05).The extended model demonstrated that after incorporating intraoperative factors,the predictive performance for recovery time(R2=0.456)and postoperative pain(R2=0.524)was significantly enhanced.Time from drug discontinuation to extubation,remifentanil dosage,and bispectral index(BIS)value were key predictive factors for recovery time;sevoflurane MAC value and MAP fluctuations made significant contributions to postoperative pain prediction.PSQI score maintained an independent predictive role in both models(β=0.421/0.312).Decision tree analysis confirmed that PSQI was the core factor for predicting anesthesia recovery and postoperative pain(importance:51%).Recovery time in patients with PSQI<5.5 was significantly shorter than in those with PSQI≥5.5(18.68 minutes vs.23.29 minutes).The pain prediction model incorporating anesthesia recovery indicators exhibited better performance than the model without such indicators(R2=0.391 vs.0.336).Mediation effect analysis revealed that the modified Aldrete score exerted a mild mediating effect between PSQI and postoperative pain(mediation proportion:5.98%).The direct effect of PSQI on pain accounted for 93.8%of the total effect,suggesting that sleep disorders mainly affect postoperative pain through other mechanisms.Conclusions Sleep disorders affect postoperative pain experi-ence by prolonging anesthesia recovery time and reducing the modified Aldrete score.The direct effect is domi-nant,indicating that clinical practice should focus on sleep quality assessment and intervention to improve postop-erative pain management.