Rest assured: High sleep efficiency reduces postoperative complications and opioid prescriptions in patients...

To assess the relationship between preoperative sleep efficiency (percentage of time asleep while in bed) and postoperative outcomes in gynecologic oncology patients.

This is a secondary analysis of a prospective cohort study that included 90 patients undergoing gynecologic surgeries from March 2021 to November 2023. Preoperative sleep efficiency was measured via Oura rings over the seven days prior to surgery and analyzed as a continuous variable and in quartiles. Primary outcomes were 30-day postoperative complications, with secondary outcomes including total morphine milligram equivalents (MME) prescribed at discharge and pain scores on postoperative day 1 (POD1). Multivariable analyses controlled for age, body mass index, frailty status, neoadjuvant chemotherapy, use of preoperative sleep medications, and surgical approach.

Higher preoperative sleep efficiency was independently associated with fewer 30-day postoperative complications. On multivariable analysis, each 1 % increase in sleep efficiency was associated with 6 % lower adjusted odds of complications. (aOR: 0.94; 95 % CI: 0.89-0.996) and significantly lower total MME prescribed at discharge (β = -13.94; 95 % CI: -19.35 to -8.53). Patients in the highest sleep efficiency quartile (>89.0 %) had lower odds of experiencing a complication compared to those in the lowest quartile (aOR: 0.28; 95 % CI: 0.09-0.92). Sleep efficiency was not significantly associated with POD1 pain scores (β = -0.06; 95 % CI: -0.13 to 0.01).

Preoperative sleep efficiency is associated with fewer postoperative complications and lower MME prescribed at discharge. This may be modifiable risk factor to improve recovery and outcomes.