Mashayekhi Yashar, Ali Auj Ul Huda, Shafique Muhammad Noman, Akbari Tariq, Naz Falak, Shaukat Muneeba, Malik Moeed Akbar, Rehmat Pasbaan, Junaid Mehreen, Fahim Mahnoor, Mubarak Tamer
Medicine, Leicester University Hospital, Leicester, GBR.
Medicine, Rawalpindi Medical University, Rawalpindi, PAK.
Cureus. 2025 May 31;17(5):e85114. doi: 10.7759/cureus.85114. eCollection 2025 May.
Background Postoperative delirium (POD) is a frequent and severe neuropsychiatric complication in surgical patients, often leading to prolonged hospitalization, cognitive decline, and increased healthcare costs. Emerging evidence suggests that preoperative sleep disturbances may significantly contribute to POD risk. This study investigates the association between preoperative sleep quality and POD among adults undergoing elective surgery. Methods A prospective cohort study was undertaken in Islamabad, Pakistan, between December 8, 2024, and March 18, 2025, among 300 patients aged 40 years and older undergoing elective surgery. Pittsburgh Sleep Quality Index (PSQI) was administered preoperatively, whereas POD and cognitive functioning were measured by the Confusion Assessment Method (CAM) and the Mini-Mental State Examination (MMSE), respectively. Statistical analysis involved Pearson correlations, independent t-tests, ANOVA, chi-square tests, and multiple regression, which was conducted using SPSS version 26.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY). Results Poor quality of sleep in the preoperative period correlated significantly with more delirium symptoms (r = 0.374, p < 0.001) and lower cognitive function (r = 0.589, p < 0.001). Those with existing cognitive dysfunction demonstrated poorer sleep patterns and MMSE scores. The only notable exceptions here were for both extremely short (two to four hours) and excessively long (eight to 10 hours) sleep durations, which were each accompanied by increased confusion symptoms. Regression analysis showed that PSQI and MMSE scores significantly predicted CAM results (p < 0.05). Moreover, chronic illnesses like respiratory diseases and cognitive conditions were associated with disturbed sleep and decreased perceived restfulness. Conclusion Preoperative sleep disturbances are strongly related to a high risk of POD and reduced cognitive function in adults with elective surgery. Systematic preoperative screening for sleep quality and the use of targeted sleep interventions could provide effective strategies for POD incidence reduction and optimization of postoperative outcomes. Longitudinal studies are advised in the future to confirm these findings and inform improvements in perioperative care.
术后谵妄（POD）是外科手术患者常见且严重的神经精神并发症，常导致住院时间延长、认知功能下降及医疗费用增加。新出现的证据表明，术前睡眠障碍可能显著增加POD风险。本研究调查择期手术成年患者术前睡眠质量与POD之间的关联。方法：于2024年12月8日至2025年3月18日在巴基斯坦伊斯兰堡对300例40岁及以上接受择期手术的患者进行前瞻性队列研究。术前采用匹兹堡睡眠质量指数（PSQI）进行评估，而POD和认知功能分别通过谵妄评估方法（CAM）和简易精神状态检查表（MMSE）进行测量。统计分析包括Pearson相关性分析、独立t检验、方差分析、卡方检验和多元回归分析，使用SPSS 26.0版软件（IBM SPSS Statistics for Windows，IBM公司，纽约州阿蒙克）进行。结果：术前睡眠质量差与更多谵妄症状（r = 0.374，p < 0.001）及更低认知功能（r = 0.589，p < 0.001）显著相关。存在认知功能障碍的患者睡眠模式和MMSE评分较差。唯一显著的例外是睡眠时间极短（两至四小时）和过长（八至十小时）的情况，这两种情况均伴有更多的混乱症状。回归分析显示，PSQI和MMSE评分显著预测了CAM结果（p < 0.05）。此外，呼吸系统疾病和认知疾病等慢性疾病与睡眠障碍及感觉休息不足有关。结论：术前睡眠障碍与择期手术成年患者发生POD的高风险及认知功能降低密切相关。系统的术前睡眠质量筛查及针对性的睡眠干预措施可为降低POD发生率及优化术后结局提供有效策略。建议未来进行纵向研究以证实这些发现并为围手术期护理的改进提供依据。
