Benzodiazepine use for perioperative insomnia and increased risk of post-traumatic stress disorder symptoms after cardiac surgery: A large retrospective cohort study.

OBJECTIVE

To examine the association between perioperative insomnia, sedative-hypnotic treatment, and risk of post-traumatic stress disorder (PTSD) symptoms in patients undergoing cardiac surgery, focusing on benzodiazepines and non-benzodiazepines.

METHODS

We included 1087 adult patients in this single-center retrospective cohort study who underwent first-time cardiac surgery between January 2021 and January 2023 and assessed symptoms via the PTSD Checklist-Civilian Version at the 3-month postoperative follow-up. Patients with a documented history of PTSD, psychotic disorders, or severe cognitive impairment were excluded. Patients with perioperative insomnia (Sleep Quality Numeric Rating Scale ≤5) were classified by treatment modalities. The association between treatment strategies and risk of PTSD symptoms was assessed using multivariable logistic regression.

RESULTS

The prevalence of PTSD symptoms at 3 months postoperatively was 22.1% (240/1087). Perioperative insomnia (odds ratio [OR] 1.71; 95% confidence interval [CI] 1.25-2.35) and constipation (OR 1.52; 95% CI 1.13-2.05) were independent risk factors for PTSD. Within the insomnia subgroup, the distribution of baseline insomnia severity showed no significant differences across treatment groups. After further adjustment, patients receiving benzodiazepine monotherapy had a significantly higher risk of PTSD symptoms than those not using sedatives (adjusted OR 1.79; 95% CI 1.11-2.89), whereas neither non-benzodiazepine monotherapy nor combination therapy was significantly associated. Benzodiazepine dose and risk of PTSD symptoms were not correlated. Age, sex, and preoperative depression were not associated with risk of PTSD symptoms.

CONCLUSIONS

Perioperative insomnia and constipation independently increased risk of PTSD symptoms after cardiac surgery, and non-benzodiazepines appear safer than benzodiazepines for insomnia management.