Risk Factors for Postoperative Sleep Disturbance in Elderly Patients Undergoing Hip Arthroplasty Surgery: The Role of Preoperative Depression and Anxiety

Abstract

Background: Postoperative sleep disturbance (PSD) is a common complication following hip arthroplasty surgery (HAS), yet the role of preoperative psychological factors remains incompletely understood. This study aimed to identify risk factors for PSD in elderly patients undergoing HAS, with a specific focus on the impact of preoperative depression and anxiety.

Methods: A case-control study was conducted on 204 elderly patients (age ≥ 60 years) who underwent HAS. Patients were categorized into PSD (n = 81) and non-PSD (n = 123) groups based on a Pittsburgh Sleep Quality Index (PSQI) global score > 7 at one-month follow-up. Data on demographics, preoperative psychological status (measured using the Self-Rating Anxiety Scale (SAS) and SelfRating Depression Scale (SDS) as documented in medical records), perioperative clinical indicators, and postoperative sleep quality were extracted from electronic medical records. Univariate analyses, multivariable logistic regression, correlation analysis, and interaction assessments were performed.

Results: Multivariable logistic regression identified four independent risk factors for PSD: higher preoperative SAS score (odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.08–1.20, p < 0.001), higher preoperative SDS score (OR = 1.14, 95% CI: 1.08–1.21, p < 0.001), higher postoperative day 1 pain score (OR = 1.69, 95% CI: 1.13– 2.53, p = 0.011), and longer time to first ambulation (OR = 1.13, 95% CI: 1.08–1.18, p < 0.001). Preoperative SAS and SDS scores were positively correlated with postoperative PSQI scores (r = 0.36 and r = 0.28, respectively, both p < 0.001). Stratified analysis confirmed preoperative anxiety/depression’s significant association with PSD regardless of preoperative sleep status. Preoperative anxiety and postoperative high pain showed a significant positive additive interaction (Relative Excess Risk due to Interaction (RERI) = 9.41, 95% CI: 2.77–34.12). The model had an area under curve (AUC) of 0.90 (95% CI: 0.85–0.94) and good calibration (Hosmer–Lemeshow p = 0.316).

Conclusions: Preoperative depression and anxiety are significant independent risk factors for PSD in elderly HAS patients, exhibiting a synergistic effect with postoperative pain. These findings underscore the critical need to integrate routine preoperative psychological screening and targeted multidisciplinary interventions into perioperative care protocols to mitigate PSD and improve recovery outcomes.