Reduce Sleep Disturbances to Improve Post-Surgery Success
Sleep disturbances represent a significant and potentially modifiable risk factor for post surgical outcomes.
Sleep disturbances are modifiable risks
Sleep disturbances represent a significant and potentially modifiable risk factor for post-operative complications and/or diminished clinical outcomes following elective total joint arthroplasty and spine surgery. The term “sleep disturbances” refers to a broad spectrum of conditions ranging from obstructive sleep apnea (OSA), a clinical diagnosis characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, to more general perturbations in sleep quality, continuity, and/or duration.
OSA is the most common risk factor
Among these conditions, OSA has the deepest and most consistent basis as a risk factor for medical and thromboembolic complications and hospital utilization, after elective orthopedic surgical procedures [1-6]. Even in the absence of documented OSA, poor preoperative sleep quality has been associated worse early postoperative pain, higher analgesic consumption, diminished functional capacity, and longer length of hospital stay [7].
Sleep issues can impede recovery
Moreover, compelling evidence suggests that underlying sleep disturbances may exacerbate patients’ pain and magnify the effects of maladaptive psychological phenotypes in the early post-operative period. Screening for sleep disturbances using validated instruments, such as the Patient Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance score, can facilitate recognition of ‘at risk’ patients and prompt the modification of perioperative analgesic regimens to further optimize clinical outcomes [8,9].
Citations & Sources
- Thomas TL, Rampam S, Nithagon P, Goh GS. Increased Risk of Postoperative Complications in Patients Who Have Obstructive Sleep Apnea Undergoing Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. Dec 2024;39(12):3119-3127.e1. doi:10.1016/j.arth.2024.06.015
- Naveen N, Sabacinski K, Booth M. Impact of Preoperative Obstructive Sleep Apnea on Complications, Healthcare Utilization, and Revision Rates Following Primary Total Knee and Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. Cureus. Jun 2026;18(6):e111137. doi:10.7759/cureus.111137
- Tang A, Aggarwal VK, Yoon RS, Liporace FA, Schwarzkopf R. The Effect of Obstructive Sleep Apnea on Venous Thromboembolism Risk in Patients Undergoing Total Joint Arthroplasty. J Am Acad Orthop Surg Glob Res Rev. Apr 1 2022;6(4). doi:10.5435/JAAOSGlobal-D-21-00248
- Sanghvi PA, Burkhart RJ, Adelstein JM, et al. Outcomes following total shoulder arthroplasty in patients with obstructive sleep apnea. J Shoulder Elbow Surg. Dec 2025;34(12):e1142-e1150. doi:10.1016/j.jse.2025.03.003
- Narayanan R, Tarawneh OH, Dalton J, et al. Impact of Obstructive Sleep Apnea on Outcomes After Anterior Cervical Discectomy and Fusion: A Propensity Matched Analysis. Spine (Phila Pa 1976). Oct 1 2025;50(19):1313-1318. doi:10.1097/brs.0000000000005212
- Thiru SS, Rossettie S, Rani R, et al. Outcomes after total shoulder arthroplasty in obstructive sleep apnea patients: a retrospective cohort analysis of over 10,000 patients. Eur J Orthop Surg Traumatol. May 16 2026;36(1). doi:10.1007/s00590-026-04781-3
- Sun X, Yu J, Luo J, Xu S, Yang N, Wang Y. Meta-analysis of the association between obstructive sleep apnea and postoperative complications. Sleep Med. Mar 2022;91:1-11. doi:10.1016/j.sleep.2021.11.019
- Yu L, Buysse DJ, Germain A, et al. Development of short forms from the PROMIS™ sleep disturbance and Sleep-Related Impairment item banks. Behav Sleep Med. Dec 28 2011;10(1):6-24. doi:10.1080/15402002.2012.636266
- Parikh R, Berezin L, Saripella A, et al. The clinical effectiveness of preoperative screening and post-screening interventions for obstructive sleep apnea: A systematic review and meta-analysis. J Clin Anesth. Feb 2026;109:112084. doi:10.1016/j.jclinane.2025.112084