• Chun-Lei Ou-Yang, Li-Bin Ma, Xiao-Dong Wu, Yu-Long Ma, Yan-Hong Liu, Li Tong, Hao Li, Jing-Sheng Lou, Jiang-Bei Cao, and Wei-Dong Mi.
• From the Department of Anaesthesiology, The First Medical Centre of Chinese People's Liberation Army (PLA) General Hospital (CO-Y, LM, XW, YM, YL, LT, HLi, JL, JC, WM), Medical School of Chinese People's Liberation Army (CO, WM), Department of Anaesthesiology, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital (CO), National Clinical Research Centre for Geriatric Diseases, People's Liberation Army General Hospital, Beijing, China (JC, WM).
• Eur J Anaesthesiol. 2024 Mar 1; 41 (3): 226233226-233.

BackgroundSleep disturbances in the peri-operative period have been associated with adverse outcomes, including postoperative delirium (POD). However, research on sleep quality during the immediate postoperative period is limited.ObjectivesThis study aimed to investigate the association between sleep quality on the night of the operative day assessed using the Sleep Quality Numeric Rating Scale (SQ-NRS), and the incidence of POD in a large cohort of surgical patients.DesignA prospective cohort study.SettingA tertiary hospital in China.PatientsThis study enrolled patients aged 65 years or older undergoing elective surgery under general anaesthesia. The participants were categorised into the sleep disturbance and no sleep disturbance groups according to their operative night SQ-NRS.Main Outcome MeasuresThe primary outcome was delirium incidence, whereas the secondary outcomes included acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively.ResultsIn total, 3072 patients were included in the analysis of this study. Among them, 791 (25.72%) experienced sleep disturbances on the night of operative day. Patients in the sleep disturbance group had a significantly higher risk of developing POD (adjusted OR 1.43, 95% CI 1.11 to 1.82, P  = 0.005). Subgroup analysis revealed that age 65-75 years; male sex; ASA III and IV; haemoglobin more than 12 g l -1 ; intra-operative hypotension; surgical duration more than 120 min; and education 9 years or less were significantly associated with POD. No interaction was observed between the subgroups. No significant differences were observed in the secondary outcomes, such as acute kidney injury, stroke, pulmonary infection, cardiovascular complications and all-cause mortality within 1 year postoperatively.ConclusionsThe poor subjective sleep quality on the night of operative day was independently associated with increased POD risk, especially in certain subpopulations. Optimising peri-operative sleep may reduce POD. Further research should investigate potential mechanisms and causal relationships.Trial Registrychictr.org.cn: ChiCTR1900028545.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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