Sleep disturbance in patients undergoing shoulder surgery: a current concepts review

Sleep is a critical and multifaceted contributor toward patient health. Its relevance toward peri- and post-operative health following shoulder surgery is underappreciated. The purpose of this review is to consolidate existing literature pertinent to sleep disturbance in shoulder surgery patients to guide clinical care and identify future directions of study.

A narrative review of the English-language literature was performed. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from January 2000 through September 2025 using combinations of the terms "sleep," "sleep disturbance," "insomnia," "Pittsburgh Sleep Quality Index," "rotator cuff," "shoulder pain," "glenohumeral osteoarthritis," "shoulder arthroplasty," and "shoulder surgery." Clinical studies, systematic reviews, and mechanistic investigations relevant to sleep in the shoulder-surgery population were included; non-English articles, case reports, and studies not reporting a shoulder-specific outcome were excluded. No quantitative synthesis or meta-analysis was performed.

Across multiple shoulder pathologies, sleep disturbance affects up to 80-90% of patients pre-operatively, which may persist post-operatively. Nocturnal pain appears to be a primary driver of sleep disturbance. The female sex, comorbid depression and anxiety, elevated body mass index, and persistent post-operative narcotic use are associated with disruptions in patients' sleep. Interleukin-6 and tumor necrosis factor-alpha may be associated with increased pain and inflammation. Following surgery, the use of sling immobilization, use of bedding that is personalized to patients' bodies and/or utilizes memory foam, and sleeping in a semi-reclined position may alleviate pain and disturbance. Non-pharmacologic interventions like cognitive behavioral therapy and mindfulness are also associated with improved outcomes.

Sleep disturbance is a common and multifaceted pathology affecting shoulder surgery patients before and after surgery. Clinicians ought to be aware of the modifiable and non-modifiable risk factors, which span from age and body mass index to comorbid pathology and medication use.