The prevalence of and risk factors for sleep disturbances: a systematic review and meta‐analysis

Abstract Background Determining the prevalence and risk factors related to sleep disturbance is beneficial for risk stratification, preventative interventions, and care planning. The objectives of this systematic review and meta‐analysis are to determine the prevalence and risk factors of sleep disturbances and their associated postoperative complications in surgical patients. Method A systematic search of the databases MEDLINE, MEDLINE ePubs Ahead of Print and In‐ process, Embase Classic+Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to February 23, 2022, was conducted. The inclusion criteria were: (1) adult patients undergoing a surgical procedure; (2) in‐patient population; (3) assessed for pre‐ and postoperative sleep disturbances using the Pittsburgh Sleep Quality Index (PSQI) and/or objective sleep assessment tools, and (4) English language articles. The pooled prevalence of sleep disturbances was calculated using inverse‐variance random‐effects model. The 95% confidence interval (CI) was calculated using normal approximation calculation. Sensitivity analysis was performed to determine the effect of each study on the meta‐analysis estimates. Result The systematic search resulted in 21,951 articles. Twelve studies involving 1,497 patients were included. The pooled prevalence of sleep disturbances at preoperative assessment was 60% (95% CI: 50%, 69%) (Figure). Risk factors for postoperative sleep disturbances were preexisting disturbed sleep and preoperative anxiety. Patients with postoperative delirium had a higher prevalence of pre‐ and postoperative sleep disturbances. Patients with postoperative delirium also had higher wake after sleep onset percentage (WASO%) in preoperative assessment using actigraphy. Conclusion The prevalence of preoperative sleep disturbances is high at 60%. In adult surgical patients undergoing inpatient surgery, preoperative sleep disturbance and anxiety were the two main risk factors for postoperative sleep disturbance. Surgical patients with postoperative delirium were associated with a higher prevalence of pre‐and postoperative sleep disturbances. Preventing sleep disturbances in surgical patients may be important for postoperative outcomes.