Perioperative sleep disturbances in older adults: a scoping review of epidemiology and treatment

Abstract

Purpose: Perioperative sleep disturbances are prevalent in older adults undergoing surgery, contributing to poor postoperative recovery, increased complications, and prolonged hospitalization. Despite their clinical significance, standardized assessment and management approaches remain insufficient.

Methods: A scoping review conducted in accordance with PRISMA-ScR guidelines was performed using PubMed, Embase, and Web of Science. Studies focusing on perioperative sleep disturbances in older adults (aged ≥ 65 years) were included, covering prevalence, risk factors, and outcomes. No language restrictions were applied, and studies in English, Chinese, and Japanese were included. Both subjective (e.g., Pittsburgh Sleep Quality Index) and objective (e.g., actigraphy, polysomnography) assessment tools were reviewed, with data synthesized narratively to summarize evidence on prevalence, risk factors, and management strategies.

Results: Preoperative sleep disturbances prevalence ranges from 0 to 91%, while postoperative sleep disturbances affect 6.7% to 93% of patients. Most included studies enrolled participants aged 65-75 years, limiting generalizability to older adults ≥ 80 years. sleep disturbances are associated with increased postoperative pain sensitivity, heightened risk of delirium, cognitive decline, and prolonged recovery. Additionally, sleep disturbances correlate with worsened emotional states, including anxiety and depression, which further impair functional recovery. Key risk factors include pain, anesthesia, hospital environmental factors, and preexisting psychological distress. Management strategies involve multimodal analgesia, psychological interventions, environmental modifications, and pharmacologic treatments (e.g., dexmedetomidine, melatonin).

Conclusion: Perioperative sleep disturbances significantly impact postoperative recovery by affecting pain levels, cognitive function, emotional stability, and overall rehabilitation progress. Standardized assessment and targeted interventions are needed to mitigate these effects. Future research should refine diagnostic criteria and explore individualized treatment approaches to optimize perioperative sleep management.

Keywords: Intervention; Older adults; Perioperative; Sleep disturbances; Sleep quality.