Single-Item Screening Tool for Sleep Disturbance Aids Perioperative Management

Although pain and trouble sleeping are often intertwined in the perioperative period, problems with sleep are infrequently evaluated. According to researchers at Walter Reed National Military Medical Center (WRNMMC), in Bethesda, Md., however, a single item from the Defense and Veterans Pain Rating Scale (DVPRS) may make it easier for clinicians to screen for sleep disturbances.

Results from the prospective study of adults undergoing surgical procedures suggest that the DVPRS sleep item may be a good indicator of sleep disturbances in the week following surgery, with a score of 4 or greater indicating moderate to severe sleep disturbance. While the DVPRS showed a moderate to strong correlation with a more rigorously tested measurement tool both preoperatively and postoperatively, DVPRS had better performance postoperatively than preoperatively.

“These preliminary results indicate that the DVPRS sleep interference item may be most useful in the immediate postoperative period to further guide the clinical conversation with regard to pain management,” said Albert Hsu, MD, a resident physician at WRNMMC.

According to Dr. Hsu, despite the obvious interplay between postsurgical pain and sleep disturbances, only intensity of pain is routinely assessed. Screening for sleep problems, he said, may optimize perioperative pain management.

“We feel that it’s important to assess sleep in the perioperative period because how much difficulty someone has sleeping may help us gauge his or her pain control,” Dr. Hsu said. “Better sleep assessment could add to a multidimensional evaluation of perioperative pain.”

Although there are currently numerous measures of sleep, including the Pittsburgh Sleep Quality Index and the Functional Outcomes of Sleep Questionnaire, many of these are cumbersome and have limited applicability outside the research setting, Dr. Hsu noted. In other words, no single-item measure has been identified to screen for sleep problems.

The DVPRS is a five-item questionnaire that is used across Department of Defense and Department of Veterans Affairs health systems to measure pain. As Dr. Hsu explained, the DVPRS helps clinicians assess intensity of pain and how it affects functioning across four domains. There’s also a single item assessing the effect of pain on sleep. Patients can choose a numbered response between 0 and 10, with a cutoff of 4 or greater indicating moderate to severe sleep interference.

In this preliminary report, Dr. Hsu and his colleagues evaluated the degree of congruence between the DVPRS Sleep Interference item and the National Institutes of Health’s Patient-Reported Outcomes Measurement Information System Sleep Disturbance (PROMIS-SD) Scale score. Adult patients undergoing surgical procedures at WRNMMC completed the DVPRS sleep interference item and the PROMIS-SD prior to surgery and again seven days after surgery. PROMIS-SD scores of 60 or greater were categorized as indicating below-average functioning. DVPRS sleep scores were categorized as mild (0-3), moderate (4-6) and severe (7-10). Investigators used Spearman correlations to examine the relationship between the DVPRS-Sleep Interference item and PROMIS-SD scores at each time point.

According to the researchers, this improved performance on postoperative day 7 suggests that the DVPRS Sleep Interference item may serve to screen for sleep disturbances in the immediate postoperative period, but further research is needed to fully understand the psychometric properties of the individual DVPRS items as screening instruments.

The moderator of the session, Beverley Ors er, MD, PhD, FRCPC, professor of physiology and anesthesia at the University of Toronto, asked Dr. Hsu to compare the time it takes patients to complete these two questionnaires.

“This DVPRS sleep item is a single question and takes about 10 seconds to administer,” Dr. Hsu said. “PROMIS, on the other hand, is a very precise tool that may take several minutes to complete.” If clinically validated, the DVPRS sleep item as a screening tool for sleep disturbances may assist clinicians during the perioperative period.