An in-depth analysis of postoperative insomnia in elderly patients and its implications on rehabilitation

Abstract

Objectives: (1) Assess the prevalence of postoperative insomnia; (2) identify the risk factors for postoperative insomnia before exposure to surgery; (3) explore the impact of postoperative insomnia on rehabilitation.

Methods: A study was conducted with 132 participants aged ≥ 65 undergoing spine interbody fusion. We collected the basic demographic data, Numeric Rating Scales (NRS), Pittsburgh Sleep Quality Index (PSQI), Geriatric Depression Scale (GDS), and Beck Anxiety Inventory (BAI). We measured Quality of Recovery 40 (QoR-40), GDS, BAI, NRS, and PSQI on the first and third nights post-surgery, followed by QoR-40 and NRS assessments two weeks after surgery.

Results: The cases of postoperative insomnia on the first and third nights and after two weeks were 81 (61.36%), 72 (54.55%), and 64 (48.48%), respectively, and the type of insomnia was not significantly different (P = 0.138). Sleep efficiency on the first night was 49.96% ± 23.51. On the first night of postoperative insomnia, 54 (66.67%) cases were depression or anxiety, and the PSQI was higher in this group than in the group without anxiety or depression (P < 0.001). PSQI, GDS, and the time of surgery were related factors for postoperative insomnia (PPSQI < 0.001, PGDS = 0.008, and PTime = 0.040). Postoperative rehabilitation showed differences between the insomnia and non-insomnia groups (P < 0.001).

Conclusions: The prevalence of postoperative insomnia in the elderly was high, and postoperative insomnia had a significant correlation with postoperative rehabilitation. Interventions that target risk factors may reduce the prevalence of postoperative insomnia and warrant further research.

Clinical trial registration: Multivariate analysis of postoperative insomnia in elderly patients with spinal surgery and its correlation with postoperative rehabilitation ( https://www.chictr.org.cn/bin/project/edit?pid=170201 ; #ChiCTR2200059827).

Keywords: Postoperative rehabilitation; Risk factor; Sleep loss; Spine interbody fusion.

Fig. 1

Flow diagram of the study. The entire procedure was categorized into presurgery, surgery, postsurgery stages, and a 2-week follow-up period. PSQI, Pittsburgh Sleep Quality Index; GDS, Geriatric Depression Scale; BAI, Beck Anxiety Inventory; MFS, Multidimensional Frailty Score; NRS, Numeric Rating Scale; QoR-40, Quality of Recovery 40

Fig. 2

PSQI distribution of the insomnia group. On the first night after surgery, 81 patients experienced postoperative insomnia. Among them, 17.28% had a PSQI score ranging from 8 to 10, while 45.68% had scores between 11 and 15. The remaining 37.04% had scores ranging from 16 to 21. PSQI, Pittsburgh Sleep Quality Index

Fig. 3

The type of postoperative insomnia over time. There was no difference in the type of insomnia during the three nights after surgery. a The type of insomnia on the first night after surgery, b The type of insomnia on the third night after surgery, c The type of insomnia 2 weeks after surgery. SOI, sleep onset insomnia; SMI, sleep maintenance insomnia

Fig. 4

Preoperative risk factors for postoperative insomnia. PSQI (pre), GDS (pre), and the time of surgery were related factors for postoperative insomnia (P-value for PSQI < 0.001, P-value for GDS = 0.008, P-value for Time = 0.040). The time of surgery, determined by return room time before or after 4:00 _PM divided into "early start" or "late start"; Education level, divided into "higher than K-12 education" or "K-12 education and below"; Underlying medical conditions, diseases except for spinal disease. PSQI, Pittsburgh Sleep Quality Index; GDS, Geriatric Depression Scale; BAI, Beck Anxiety Inventory; MFS, Multidimensional Frailty Score; NRS, Numeric Rating Scale; pre, preoperative; OR, odds ratio; CI, confidence interval