Causes and Effects of Postoperative Sleep Disorders and Treatment Strategies for Preoperative, Intraoperative, and Postoperative Settings-A Narrative Review

Abstract

Sleep is an essential part of everyday life and disturbed sleep can produce numerous deleterious effects on the body. An especially prevalent and detrimental subset of sleep disturbances are sleep disturbances that occur in patients during the postoperative period. To better understand these disorders and how to treat them, a literature search was conducted to identify and consolidate recent advancements in this field. This narrative review discusses the structure of a typical night of sleep and the causes, effects, and treatment strategies of Postoperative Sleep Disturbances (PSDs). Factors that contribute to the development of PSDs have been identified at all stages of the surgical process, including the preoperative, intraoperative, and postoperative timepoints. Exposure to these factors can accumulate during each step and may decrease the quality of sleep postoperatively. The development of PSDs has been found to affect multiple systems throughout the body and can ultimately lead to poorer recovery times and increased postoperative mortality. As a result, multiple therapeutic approaches are being investigated for their role in reducing the prevalence of these disorders. This has revealed promising interventions throughout the surgical process, such as preoperative nerve blocks, intraoperative infusions, and postoperative behavioral interventions. However, despite these successful findings, work still needs to be completed to optimize these techniques and generalize intervention strategies.

Keywords: consequences; contributing factors; delayed recovery; interventions; postoperative sleep disturbances; surgery; treatments.

Figure 1

Causes of Postoperartive Sleep Disturbances (PSDs): Surgical patients are exposed to multiple factors throughout their hospital stay that contribute to the development of PSDs. Preoperatively, pre-existing sleep disorders and age play a large role in determining risk. Intraoperatively, factors such as surgical parameters and anesthetic agents can further alter the risk. Major factors in the postoperative period include surgical pain, analgesics, and the hospital environment. Exposure to these factors across the surgical timeline aggregate in a cumulative manner to affect a patient’s risk of developing PSDs.

Figure 2

Effects of PSD: Sleep disorders that occur following surgery can lead to multiple complications, including confusion, metabolic dysregulation, hypertension, increased cortisol levels, and heightened pain perception. These detrimental effects can all contribute to increased length of hospital stay and poorer recovery.

Figure 3

Treatment Strategies for PSD: These are several examples of treatment strategies that can be used at different timepoints during the operative process to reduce the occurrence of PSD. Preoperative interventions include nerve blocks and insulin injections. Intraoperative interventions include tailoring anesthetic agents and intraoperative infusions. Postoperative interventions include providing melatonin/other pharmaceuticals, eye masks, earplugs, noise masking, and cognitive (CBT) therapies.