Association between preoperative sleep disturbance and postoperative delirium in older adults: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to investigate the association between preoperative sleep disturbance and postoperative delirium (POD) in older surgical patients. A comprehensive search encompassing PubMed, Embase, Cochrane Library, and Web of Science was conducted from inception to December 30, 2024. Subgroup and sensitivity analyses were performed to explore heterogeneity. Seventeen studies involving 49 758 patients were included. The findings indicated a significant association between preoperative sleep disturbance, variously defined across studies, and POD (OR: 2.84; 95% CI: 1.63-4.93; p = 0.002). Subgroup analyses revealed a higher incidence of POD in patients undergoing cardiac (OR: 3.03; 95% CI: 1.78 - 5.15, p < 0.0001), orthopedic (OR: 4.48; 95% CI: 2.83-7.10, p < 0.00001), or other non-cardiac surgeries (OR: 2.36; 95% CI: 1.55-3.60, p < 0.0001). Additionally, an association was found in moderate to-high complexity surgery (OR: 0.79; 95% CI: 0.71-0.88, p < 0.0001). Obstructive sleep apnea (OSA) (OR: 2.18; 95% CI: 1.10-4.29, p = 0.02) and unspecified sleep disturbance (OR: 3.92; 95% CI: 2.66-5.79, p < 0.00001) were also significantly associated with POD. This systematic review and meta-analysis identifies a significant association between preoperative sleep disturbance and a higher incidence of postoperative delirium in older surgical patients. These findings underscore the importance of sleep quality assessment in preoperative care. Further research is warranted to elucidate the underlying mechanisms and enhance interventions.