Associations of preoperative sleep disturbance with intraoperative and postoperative adverse outcomes among Chinese surgical patients: evidence from the China surgery and anesthesia cohort (CSAC).

Background: Despite of the established association between sleep disturbance and impaired health, these association among the Chinese surgical patients are lacking.

Method: This study utilized data from the China Surgery and Anesthesia Cohort (CSAC) which included patients aged 40-65 years who underwent surgery at four medical centers between July 15, 2020 and November 24, 2023. Preoperative sleep quality one month before surgery was assessed using Pittsburgh Sleep Quality Index(PSQI), and sleep patterns were identified through k-means clustering. We ascertained two intraoperative, nine within-hospital, and eight after-discharge adverse outcomes. Logistic regression models were used to examine the interested associations. We additionally used mediation analyses to evaluate the mediating role of postoperative neuropsychological traits on the studied associations.

Results: The mean age of 14,129 included participants was 52.3 years with a predominance of females (58.8 %). Preoperative sleep disturbance was associated with two within-hospital (odds ratios[ORs] = 1.19-1.52) and all eight after-discharge adverse outcomes, with the most pronounced ORs observed for postoperative moderate-to-severe sleep disturbance(ORs = 3.88-18.64 at 1 month, 3.44-13.31 at 6 months, and 3.98-15.58 at 12 months), and depression(1.88-3.30 at 1 month, 2.20-3.96 at 6 months, and 2.44-5.60 at 12 months), compared with no sleep disturbance group. Analyses of preoperative sleep patterns indicated that compared to the 'least affected' group, patients featured by the 'multiple sleep problems with daytime dysfunction' obtained the highest estimates for the majority of studied adversities. Mediation analyses identified moderate-to-severe sleep disturbance and depression after surgery were significant mediators of longer-term adverse outcomes.

Conclusions: Preoperative sleep disturbance was significantly associated with multiple adverse outcomes. These findings underscore the importance of assessing and managing sleep quality to improve overall prognosis.