Risk factors for postoperative sleep disturbance after total joint arthroplasty: a systematic review and meta-analysis

Abstract Objective Postoperative sleep disturbance (PSD) is a common complication following total joint arthroplasty (TJA) and impairs functional recovery. Numerous studies have identified potential risk factors for PSD; however, existing evidence is derived primarily from small observational studies with inconsistent findings, and no systematic review has synthesized this evidence. Accordingly, we conducted a systematic review and meta-analysis to synthesize evidence on risk factors for PSD in patients undergoing TJA. Methods We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, Ovid MEDLINE, CINAHL, the China National Knowledge Infrastructure (CNKI), the Wanfang Database, the VIP Database, and the Chinese Biomedical Literature Database from the inception of each database up to May 2026. The methodological quality of the included studies and the certainty of evidence were independently assessed by two reviewers. Meta-analyses were performed using RevMan 5.4 software with either fixed-effects or random-effects models, selected based on statistical heterogeneity. Results Thirteen observational studies (2865 patients) were included. Postoperative pain had the numerically largest pooled OR among the three meta-analysed factors [OR = 1.61, 95% CI (1.25, 2.06), 95% PI (0.76, 3.43)], representing a 61% higher odds of PSD. Preoperative anxiety [OR = 1.39, 95% CI (1.25, 1.54)] and depression [OR = 1.25, 95% CI (1.08, 1.44)] showed smaller but consistent associations. GRADE certainty was low for all three factors. Conclusions Postoperative pain, preoperative anxiety, and preoperative depression are associated with PSD following TJA, with pain demonstrating the numerically largest effect size among the three factors. Given the low certainty of evidence and the prediction interval for pain crossing the null, these findings should inform future interventional research rather than definitive clinical protocols.