The impact of preoperative sleep disorders on postoperative pain and recovery in patients undergoing gastrectomy: a prospective cohort study

BACKGROUND: Poor sleep quality is a common comorbidity in surgical patients, but its specific impact on postoperative outcomes in gastric cancer surgery remains underexplored. This study investigated the association of preoperative sleep disorders on pain sensitivity, analgesic consumption, and recovery in this population. METHODS: One hundred patients undergoing elective gastrectomy were prospectively enrolled and stratified into two groups based on the Pittsburgh Sleep Quality Index (PSQI): a Non-Sleep Disorder group (PSQI < 8, n = 50) and a Sleep Disorder group (PSQI ≥ 8, n = 50). Preoperative assessments included quantitative sensory testing (pressure, cold, heat), anxiety and depression scales, and sleep quality. Postoperative outcomes included pain scores (VAS), sufentanil consumption, rescue analgesia, recovery milestones, and length of hospital stay (LOS). RESULTS: Preoperatively, the Sleep Disorder group demonstrated a significantly lower heat pain threshold (19.63 ± 14.32 s vs. 33.89 ± 16.78 s, p < 0.001) and a higher heat pain score (3.56 ± 1.76 vs. 2.50 ± 0.89, p < 0.001). Postoperatively, this group reported higher VAS scores at extubation (2.60 ± 0.67 vs. 1.88 ± 0.85, p < 0.001), required more rescue analgesia (38.0% vs. 14.0%, p = 0.011), and consumed more sufentanil at 24 h (111.38 ± 39.24 µg vs. 97.71 ± 25.31 µg, p = 0.042) and 48 h (190.46 ± 61.75 µg vs. 169.39 ± 36.83 µg, p = 0.041). Despite a shorter time to first flatus (4.48 ± 1.92 vs. 5.36 ± 2.30 days, p = 0.040), their overall LOS was significantly longer (8.0 vs. 7.0 days, p = 0.005). CONCLUSION: In patients undergoing gastric cancer surgery, preoperative sleep disorders are associated with heightened pain sensitivity, increased postoperative opioid requirements, and prolonged hospitalization. These findings highlight the importance of preoperative sleep assessment and tailored perioperative management.