Improving Patient Sleep Before Surgery: The Case for Sleep Prehabilitation

Sleep health includes quality, quantity, and timing of sleep and is negatively affected by surgery. Poor preoperative sleep health is associated with worse surgical outcomes, including greater morbidity and hospital length of stay. In this narrative review, we describe the rationale and supporting evidence for preoperative sleep interventions, or sleep prehabilitation, to improve perioperative outcomes. Our review highlights the link between impaired sleep health and surgical outcomes via several mechanisms including chronic, systemic low-grade inflammation; insulin resistance; and cognitive function. Instruments and intervention strategies to measure and improve sleep health, respectively, are discussed. We conclude with sleep prehabilitation recommendations and identify research priorities for the field.