Ecological Momentary Assessment of Sleep, Pain, and Opioid Use Among Adolescents Following Surgery

Opioids are critical for acute pain management following surgery among adolescents, yet are associated with significant negative consequences, including opioid misuse (Harbaugh, 2018). Sleep deficiency is common following surgery and extant research indicates strong cross-sectional associations between sleep deficiency and increased problematic opioid use (Groenewald, 2019; 2021). This study examined daily pain and mood as mechanisms linking previous night’s sleep deficiency and next day prescription opioid use. This prospective, observational study enrolled 106 adolescents (11-19 years) undergoing orthopedic outpatient surgery. Using ecological momentary assessment, participants reported on sleep, pain, and mood over the first 14 days following surgery; postsurgical opioid use was measured using an electronic medication cap monitoring device, eCAPTM. Multi-level structural equation models, controlling for surgery type and prescribed opioid dose, suggest that pain, but not mood mediated associations between postsurgical sleep quality (b = -0.05, se = 0.01, 95% CI [-0.08, -0.02] p = 0.001), sleep onset latency (b = 0.002, se = 0.001, 95% CI [0.001, 0.003], p = 0.002), and wake after sleep onset (b = 0.002, se = 0.0001, 95% CI [0.001, 0.003], p < 0.001) and opioid use, at both the within-person and between-person levels. Results highlight that greater previous night’s sleep deficiency was associated with greater next day pain, which, in turn, was associated with greater opioid use. Our findings should be considered preliminary yet underscore the need for a comprehensive and personalized approach to postsurgical pain management and opioid use, including targeting sleep in interventions.