Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study.

BACKGROUND

Perioperative neurocognitive disorders (PND) significantly affect recovery in older adult surgical patients. However, whether untreated preoperative sleep disturbance (SD) independently contributes to postoperative cognitive dysfunction (POCD) remains unclear.

METHODS

This multicenter prospective cohort study involving 535 patients aged ≥60 years undergoing major non-cardiac surgery (≥2 h) was conducted between June 30, 2024 and May 31, 2025. Patients were stratified by Pittsburgh Sleep Quality Index (PSQI): SD (PSQI>7, n = 288) or non-SD (PSQI≤7, n = 247). The primary outcome was POCD assessed on postoperative days 7, 30, 90, and 180. Secondary outcomes included postoperative delirium (days 1-3), 15-item quality of recovery (QoR-15) scores, and insomnia severity (days 30, 90, and 180). Generalized estimating equations identified independent predictors of POCD.

RESULTS

Compared with non-SD patients, SD patients showed significantly increased POCD risk on postoperative day 7 (41.7 % vs. 27.1 %; RR = 1.44, 95 %CI 1.16-1.79; P < 0.001), day 30 (36.1 % vs. 18.2 %; RR = 1.73, 95 %CI 1.33-2.25; P < 0.001), day 90 (25.7 % vs. 13.0 %; RR = 1.66, 95 %CI 1.22-2.25; P < 0.001), and day 180 (19.4 % vs. 8.9 %; RR = 1.75, 95 %CI 1.21-2.52; P < 0.001). Preoperative SD was associated with increased delirium risk (29.9 % vs. 18.6 %; RR = 1.43, P = 0.006), poorer QoR-15 scores (difference = 8, P < 0.001), and persistent insomnia (34.7 % vs. 13.8 % at day 180, P < 0.001). PSQI≥10 optimally predicted POCD risk (sensitivity 71.8 %, specificity 69.4 %).

CONCLUSIONS

Untreated preoperative SD independently predicts both early delirium and POCD after major non-cardiac surgery. A PSQI≥10 effectively identifies high-risk older adult patients, emphasizing preoperative sleep optimization as a potential strategy to mitigate postoperative cognitive impairment.