Poor preoperative sleep quality in elderly patients is associated with increased risk of postoperative delirium, specifically ICU delirium in patients aged over 65 years.
Key Findings
Results
Overall postoperative delirium frequency did not differ significantly between middle-aged (45-64 years) and elderly (≥65 years) patients in the ward setting.
Total sample size was 150 patients
Patients were assigned to age groups solely according to chronological age
No statistically significant variation in postoperative delirium frequency was found between groups in the ward setting (p = 0.248)
No statistically significant variation was found in ICU delirium between the two age groups overall (p = 0.471)
Results
Poor preoperative sleep quality (PSQI >5) in patients aged over 65 years was significantly associated with ICU delirium.
The association between poor preoperative sleep quality and ICU delirium was statistically significant in elderly patients (p = 0.03)
Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), with a score >5 indicating poor sleep quality
This finding was specific to the ICU setting, not the general ward setting
The study was conducted from August to December 2023 at Konya City Hospital, Turkiye
Methods
The study employed multiple validated preoperative and postoperative assessment tools to evaluate sleep quality, cognitive function, and delirium.
Preoperative assessments included the STOP-Bang questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Mini-Mental State Examination (MMSE)
Postoperatively, the PSQI and Quality of Recovery-15 (QoR-15) were reassessed
Delirium screening was performed daily for 72 hours using the 3D-CAM and ICU-CAM tools
Patients discharged early were followed up by phone to complete the delirium screening period
Only surgeries lasting more than 2 hours under general anaesthesia were included
Methods
The observational study design involved routine clinical care monitoring of patients undergoing surgeries of more than 2 hours under general anaesthesia.
Study was conducted at the Department of Anaesthesiology and Reanimation, University of Health Sciences, Konya City Hospital
Study duration was from August to December 2023
Intraoperative and postoperative parameters were recorded in addition to pre- and postoperative assessments
Continuous variables were compared using the independent t-test or Mann-Whitney U test depending on data distribution
Categorical variables were analysed using the chi-square or Fisher's exact test, with p < 0.05 considered statistically significant
What This Means
This research suggests that the quality of sleep before surgery may play an important role in whether older patients develop delirium (a state of confusion and disorientation) after their operation. The study followed 150 patients aged 45 and older who underwent surgeries lasting more than two hours under general anesthesia in Turkey. Patients were assessed for sleep quality before surgery using a standard questionnaire, and were monitored for signs of delirium every day for up to 72 hours after surgery using established clinical tools.
The key finding was that elderly patients (aged 65 and over) who had poor sleep quality before their surgery—measured by a score above 5 on the Pittsburgh Sleep Quality Index—were significantly more likely to develop delirium while in the intensive care unit (ICU) after surgery. This relationship was not observed in the middle-aged group (45-64 years), and the difference in overall delirium rates between the two age groups was not statistically significant when looking at the general ward setting.
This research suggests that measuring and potentially addressing sleep quality before surgery in older patients could be an important step in reducing the risk of postoperative delirium, which is a serious complication that can prolong hospital stays and affect recovery. The authors note that these findings warrant further study, as the observational design and relatively small sample size limit the conclusions that can be drawn about cause and effect.
Ates D, Tire Y, Mermer A, Kozanhan B. (2026). The Effect of Preoperative Sleep Quality on Postoperative Delirium in Middle-Aged and Elderly Patients: A Clinical Setting.. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. https://doi.org/10.29271/jcpsp.2026.02.147