Association between preoperative sleep disturbance and psychomotor recovery profiles after general anesthesia in day surgery: a prospective cohort study

Sleep disturbances impair neurocognitive function, but their impact on early psychomotor recovery after day surgery remains unclear. This study aimed to investigate the impact of preoperative sleep disturbance on postoperative psychomotor recovery in patients undergoing hysteroscopic day surgery under general anesthesia, with a focus on psychomotor function and emergence from anesthesia. A prospective cohort study was conducted, including 110 patients scheduled for elective hysteroscopic day surgery. Participants were divided into two groups based on their Pittsburgh Sleep Quality Index (PSQI) scores: the Non-Sleep Disturbance (NSD) group (PSQI ≤ 5) and the Sleep Disturbance (SD) group (PSQI > 5). Psychomotor recovery was assessed using the Digit Symbol Substitution Test (DSST) and Trail Making Tests (TMT-A and TMT-B) at 30, 60, and 90 min post-extubation. Secondary outcomes included anesthesia-related time parameters, postoperative adverse events, and sleep quality on postoperative days 1 and 3, evaluated using the Athens Insomnia Scale (AIS). At 30 min post-extubation, the NSD group demonstrated significantly better psychomotor performance than the SD group (DSST: P = 0.0312; TMT-A: P = 0.0008; TMT-B: P = 0.0146). However, percentage change analysis for TMT-A revealed no significant differences between groups at any time point. No significant differences were observed between groups at 60-90 min for DSST or TMT-B. The SD group had a shorter anesthesia induction time (P < 0.0001), but no differences were found in eye-opening or extubation times. Both groups achieved similar Aldrete scores in the PACU (P = 0.7699). Postoperative sleep quality (AIS scores) and adverse events, including pain, nausea, and dizziness, were comparable between the groups. Patients with preoperative sleep disturbances undergoing general anesthesia exhibit delayed psychomotor recovery in the early postoperative phase, particularly within 30 min post-extubation. Continuous monitoring during this critical period is essential to ensure patient safety and optimize recovery outcomes in day surgery settings.