Sleep deficiency and opioid use/misuse in adolescents following surgery - PROJECT SUMMARY
Prescription opioid misuse is a significant burden on adolescent public health in the United States. Opioid
misuse often starts with prescribed opioids, with surgery representing a key pathway by which adolescents are
first prescribed opioids for the management of acute pain. Yet, little is known about the critical period following
surgery during which adolescents initiate prescription opioid misuse or the modifiable behavioral mechanisms
contributing to this process. These are critical gaps in our knowledge impeding our ability to identify
adolescents at increased risk for opioid misuse and to develop interventions aimed at reducing prescription
opioid misuse. Sleep deficiency (including sleep deprivation, noncircadian sleep, sleep disorders, and poor
sleep quality) is an important proximal risk factor for prescription opioid misuse. Sleep is often disturbed during
the perioperative period, a time when many adolescents are exposed to their first opioid prescription. Indeed,
in our own preliminary study, we found that sleep deficiency present both before surgery and during the
immediate postsurgical period was associated with increased opioid use. However, this pilot study did not
allow us to characterize aspects of sleep most strongly related to opioid use and did not allow us to evaluate
mechanisms, such as pain and psychological factors, underlying the sleep – opioid use relationship.
Furthermore, data are urgently needed to determine how sleep deficiency prospectively predicts the
development of opioid misuse behaviors in the context of other putative factors, such as a history of substance
use, pain intensity, psychosocial (e.g., depression), peer, and family factors. Given that sleep deficiency is
modifiable, it is a critical focus of research aimed at reducing the development of adolescent opioid misuse
behaviors. Therefore, this project aims to 1) test the direct and mediation pathways of sleep deficiency, pain,
psychological factors, and opioid use following sports-injury surgery, and 2) develop and validate a
multivariable prediction model to identify adolescents at increased risk of prescription opioid misuse over the
24 months following surgery. To address these aims, we propose a prospective, observational study of N= 400
adolescents (10-19 years) who receive their first ever opioid following sports injury surgery. Presurgery,
participants will undergo comprehensive multimodal sleep assessments (surveys and actigraphy monitoring) to
measure sleep deficiency. Participants will also report on previous substance use, pain intensity, psychosocial,
peer, and family factors. Adolescents will then be followed over the first 14 days after surgery using ecological
momentary assessment to capture real-time daily data on sleep, pain, psychological factors, and opioid use.
We will use an innovative electronic medication monitoring methodology to accurately measure opioid use
(total number of doses and duration) following surgery. Follow-up assessments at 3-months, 6-months, 12-
months, and 24-months will track opioid misuse developing over time. We will apply modern machine learning
algorithms to develop and validate models predicting adolescent prescription opioid misuse.
