The prevalence and risk factors of sleep disturbances in surgical patients: A systematic review and meta-analysis

Sleep Med Rev. 2023 Jun:69:101786. doi: 10.1016/j.smrv.2023.101786. Epub 2023 Apr 19.


Determining the prevalence and risk factors related to sleep disturbance in surgical patients would be beneficial for risk stratification and perioperative care planning. The objectives of this systematic review and meta-analysis are to determine the prevalence and risk factors of sleep disturbances and their associated postoperative complications in surgical patients. The inclusion criteria were: (1) patients ≥18 years old undergoing a surgical procedure, (2) in-patient population, and (3) report of sleep disturbances using a validated sleep assessment tool. The systematic search resulted in 21,951 articles. Twelve patient cohorts involving 1497 patients were included. The pooled prevalence of sleep disturbances at preoperative assessment was 60% (95% Confidence Interval (CI): 50%, 69%) and the risk factors for postoperative sleep disturbances were a high preoperative Pittsburgh sleep quality index (PSQI) score indicating preexisting disturbed sleep and anxiety. Notably, patients with postoperative delirium had a higher prevalence of pre- and postoperative sleep disturbances and high preoperative wake after sleep onset percentage (WASO%). The high prevalence of preoperative sleep disturbances in surgical patients has a negative impact on postoperative outcomes and well-being. Further work in this area is warranted.

Keywords: Pittsburgh sleep quality index; Postoperative complications; Risk factors; Sleep disturbances; Surgery.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anxiety
  • Humans
  • Prevalence
  • Risk Factors
  • Sleep Wake Disorders* / epidemiology
  • Sleep Wake Disorders* / etiology
  • Sleep*