Incidence and factors associated with poor sleep quality following elective surgery: a prospective observational study

Purpose We aimed to determine the incidence of poor sleep quality on postoperative day 1 and to evaluate its association with perioperative factors, including patient demographics and the degree of surgical invasiveness. Methods This prospective observational study included inpatients aged ≥18 years who were scheduled for elective surgery under general anesthesia and were transferred to a general ward postoperatively without receiving sedatives. The primary outcome was self-reported sleep quality assessed using the Richards–Campbell Sleep Questionnaire (RCSQ), with scores <50 indicating poor sleep quality. Risk ratios for poor sleep quality were estimated using generalized estimating equations. The analysis included surgical invasiveness categorized by the Operative Stress Score, which evaluates non-cardiac surgery on a 5-point scale (1 indicating the lowest and 5 the highest invasiveness), as well as other clinically relevant factors. Results Of the 301 eligible patients, 246 (81.7%) were included in the analysis. The mean (standard deviation) RCSQ score was 37.2 (28.4), and 65.8% (95% confidence interval: 59.7–71.4%) of patients met the criteria for poor sleep quality. No statistically significant association was observed between poor sleep quality and the degree of surgical invasiveness. However, age (risk ratio: 1.01; 95% confidence interval: 1.00–1.01) and body mass index (risk ratio: 1.01; 95% confidence interval: 1.002–1.02) were independently associated with an increased risk of poor sleep quality. Conclusion Poor subjective sleep quality on postoperative day 1 was highly prevalent among patients undergoing elective surgery and was independently associated with age and body mass index, but not with surgical invasiveness.