The association between sleep quality and postoperative pain after half-impacted mandibular third molar extraction: comparison of three statistical models.

BACKGROUND: Pain is the common complication after tooth extraction, while the reasons behind it still remains. Insomnia, another prevalent issue, negatively affects physical, mental health, and quality of life. The relations between postoperative pain and insomnia have not been discussed before. METHODS: In this prospective study, we enrolled patients who visited the Department of Oral Surgery, West China Stomatology Hospital of Sichuan University from November 2024 to February 2025 based on inclusion and exclusion criteria. Athens Insomnia Scale (AIS), as an internationally recognized self-rating scale of sleep quality were applied for insomnia evaluation. Visual Analogue Scale (VAS) was applied for postoperative pain measurement. Multiple linear regression was conducted for the analysis of population characteristics and AIS scores. Restricted cubic spline (RCS) logistic regression model, weighted quantile sum (WQS) regression model, and bayesian kernel machine regression (BKMR) model were applied for analyzing interactions among AIS items and postoperative pain. RESULTS: Gender and age are closely to higher AIS scores. Based on RCS logistic regression model analysis, more AIS scores are related to more severe postoperative pain. Based on qgcomp model regression index analysis, AIS-3 and AIS-5 has negative effect on postoperative pain. While other AIS items show positive effects, among which AIS-6 has the biggest effect. Based on BKMR model analysis, AIS-1 and AIS-8 showed a promoting trend in post-tooth extraction pain, while other items had no significant impact on postoperative pain. CONCLUSIONS: In this prospective study, we noticed the importance of the levels and subtypes of insomnia in preventing postoperative pain. Various AIS item could contribute to postoperative pain in different way. Managing sleep conditions could be beneficial for releasing postoperative pain in clinics.