術前の不眠症は高齢者の人工関節置換術患者における術後の睡眠断片化を悪化させる：前向きコホート研究

Preoperative insomnia is prevalent among elderly arthroplasty patients, yet its impact on postoperative sleep disturbance (PSD) remains underexplored. This study investigated whether preexisting insomnia exacerbates postoperative sleep fragmentation in total hip/knee arthroplasty (THA/TKA) patients under spinal anesthesia.

In this prospective cohort study 121 patients aged ≥65 undergoing THA/TKA were stratified by preoperative insomnia. Sleep was assessed via subjective metrics including Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS) and Insomnia Severity Index (ISI). Meanwhile, the EEG-based monitor and actigraphy were used to assess the objective sleep quality and conduct sleep staging.

Pre-existing insomnia exacerbates postoperative sleep fragmentation, manifested by persistently elevated microarousals (operative night to postoperation day2, POD2) and prolonged sleep latency. Selective REM suppression occurs in insomnia patients during the acute postoperative phase (operative night and POD1), independent of NREM duration alterations. Subjective sleep quality assessments revealed that the insomnia group demonstrated significantly higher AIS and ISI scores compared to the non-insomnia group.

Preoperative insomnia independently exacerbates postoperative sleep fragmentation in elderly arthroplasty patients. The study was registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR2400085184) on June 8, 2024.