Factors affecting postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction

This study aimed to examine the postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction and to identify the associated factors.

We carried out a prospective cohort study of patients who underwent flap transfer for head and neck reconstruction at our institute between August 2020 and December 2021. The insomnia severity index (ISI) was used to examine the patients' sleep quality at postoperative week 1. Patients with an ISI score ≥ 15 were recognized as suffering from significant clinical insomnia. Descriptive statistics was used to expound the postoperative sleep quality. Associations between postoperative sleep quality and clinical variables were examined using the Chi-squared test and a Binary logistics regression model to identify the associated risk factors.

Among the 101 patients included, their average ISI score was 15.6 (range 2-25), and 62 patients (61.4%) experienced significant clinical insomnia. Anxiety (odds ratio = 8.361; 95% confidence interval: 1.001-69.837; P = 0.049) and postoperative complications (odds ratio = 6.285; 95% confidence interval: 1.941-20.351; P = 0.002) were significantly associated with postoperative insomnia of the included patients.

Postoperative sleep disturbances are highly prevalent among patients undergoing flap transfer for head and neck reconstruction, for which anxiety and postoperative complications are independent risk factors. Psychotherapy is necessary for patients with anxiety symptoms and measures should be taken to minimize the postoperative complications. Moreover, pain treatment is necessary to improve postoperative sleep quality and quality of life.