The Bidirectional Relationship Between Perioperative Sleep Deprivation and Postoperative Pain — Mechanisms and Clinical Implications: A Narrative Review

Jing Liu,1 Zenghui Liang,1 Heng Wang,1 Shuhan Chen,1,2 Yanle Xie,3 Fei Xing,1,2 Zhongyu Wang,1,2 Jingjing Yuan1,2 1Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 2Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan, People’s Republic of China; 3Department of Anesthesiology, Henan Provincial Chest Hospital, Chest Hospital of Zhengzhou University, Weiwu Road, Zhengzhou, 450000, People’s Republic of ChinaCorrespondence: Jingjing Yuan, Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 Jian She East Road, Er Qi District, Zhengzhou, Henan, People’s Republic of China, Tel +86-13513719631, Email [email protected]: Although the understanding of pain mechanism and management has made substantial progress, postoperative pain relief is still an important health care problem. Surgical patients also often report preoperative and postoperative sleep problems. Clinical and experimental studies show that chronic pain and sleep disorders influence each other. Pain disturbs sleep, and sleep deprivation or sleep disorders increase pain. However, there are still many problems about the direction of causality between them and the mechanism that may explain their relationship. In-depth subjective and objective evaluation of pain and sleep supports the view that sleep disorder is a more powerful and reliable predictor of pain, and pain is a predictor of sleep disorder. Recent progress in multimodal imaging, molecular biology, and neural circuit analysis has uncovered how sleep deprivation — especially in the perioperative setting — influences pain sensitivity, the transition to chronic pain, and brain function through mechanisms spanning peripheral nerves, the spinal cord, subcortical areas, and cortical structures.Keywords: postoperative pain, sleep disturbance, sleep deprivation, mechanisms