Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study.
Chen C, Yang S, et al. • Journal of clinical anesthesia • 2026
Untreated preoperative sleep disturbance independently predicts both early delirium and postoperative cognitive dysfunction after major non-cardiac surgery in older adults, with a PSQI≥10 effectively identifying high-risk patients.
Key Findings
Results
Preoperative sleep disturbance was associated with significantly increased risk of postoperative cognitive dysfunction (POCD) at all four assessment timepoints through 180 days.
At postoperative day 7: 41.7% vs. 27.1% (RR=1.44, 95%CI 1.16-1.79; P<0.001)
At postoperative day 30: 36.1% vs. 18.2% (RR=1.73, 95%CI 1.33-2.25; P<0.001)
At postoperative day 90: 25.7% vs. 13.0% (RR=1.66, 95%CI 1.22-2.25; P<0.001)
At postoperative day 180: 19.4% vs. 8.9% (RR=1.75, 95%CI 1.21-2.52; P<0.001)
SD was defined as PSQI>7 (n=288) and non-SD as PSQI≤7 (n=247) in a cohort of 535 patients aged ≥60 years
Results
Preoperative sleep disturbance was associated with increased risk of postoperative delirium in the first three postoperative days.
Delirium incidence was 29.9% in SD patients vs. 18.6% in non-SD patients
RR=1.43, P=0.006
Delirium was assessed on postoperative days 1-3
Results
Preoperative sleep disturbance was associated with poorer quality of recovery as measured by QoR-15 scores.
The difference in QoR-15 scores between SD and non-SD groups was 8 points (P<0.001)
QoR-15 is a 15-item quality of recovery scale
Results
Preoperative sleep disturbance was associated with persistent insomnia at 180 days postoperatively.
At postoperative day 180, persistent insomnia was present in 34.7% of SD patients vs. 13.8% of non-SD patients (P<0.001)
Insomnia severity was assessed at postoperative days 30, 90, and 180 as a secondary outcome
Results
A PSQI score of ≥10 was identified as the optimal threshold for predicting POCD risk in older surgical patients.
PSQI≥10 had a sensitivity of 71.8% and specificity of 69.4% for predicting POCD
This threshold was identified as optimally predictive compared to other cutpoints
The standard PSQI cutoff for sleep disturbance used for group stratification was PSQI>7
Methods
This was a multicenter prospective cohort study enrolling 535 older adults undergoing major non-cardiac surgery.
Patients were aged ≥60 years undergoing major non-cardiac surgery of ≥2 hours duration
Study was conducted between June 30, 2024 and May 31, 2025
Patients were stratified into SD (PSQI>7, n=288) and non-SD (PSQI≤7, n=247) groups
POCD was assessed on postoperative days 7, 30, 90, and 180
Generalized estimating equations were used to identify independent predictors of POCD
What This Means
This research suggests that older adults who have trouble sleeping before surgery face a significantly higher risk of thinking and memory problems after surgery. The study followed 535 patients aged 60 and older who underwent major non-cardiac operations lasting at least two hours. Patients who had poor sleep quality before surgery (measured by a standard questionnaire called the Pittsburgh Sleep Quality Index) were roughly 1.4 to 1.75 times more likely to experience cognitive problems—difficulties with memory, attention, and thinking—at every follow-up point tested, from one week to six months after surgery. They were also more likely to experience delirium (sudden confusion) in the days immediately following surgery and had a poorer overall recovery experience.
The study also found that sleep problems did not simply resolve after surgery. At six months postoperatively, about 35% of patients who had preoperative sleep disturbances still had persistent insomnia, compared to only about 14% of those without preoperative sleep problems. Importantly, the researchers identified that a PSQI score of 10 or higher was the best threshold for identifying patients at high risk for postoperative cognitive problems, offering a practical screening tool that clinicians could use before surgery.
This research suggests that preoperative sleep quality is an independent risk factor for postoperative cognitive decline in older surgical patients—meaning it contributes to risk beyond other known factors. The findings point toward preoperative sleep assessment and potential sleep optimization as possible strategies to reduce the burden of cognitive complications following major surgery in older adults, though further research would be needed to determine whether treating sleep problems before surgery actually reduces these cognitive risks.
Chen C, Yang S, Shi Y, Zhu Z, Xiong X, Huang L, et al.. (2026). Impact of preoperative sleep disturbance on perioperative neurocognitive disorders in older adults undergoing major non-cardiac surgery: A multicenter prospective cohort study.. Journal of clinical anesthesia. https://doi.org/10.1016/j.jclinane.2026.112123