Effect of Preoperative Sleep Disorders on Postoperative Enteral Nutrition Intolerance in Patients with Digestive Tract Tumors: A Prospective Cohort Study.

Purpose: To investigate the effect of preoperative sleep disorders (SD) on postoperative enteral nutrition intolerance (ENI) and intestinal barrier, and explore its potential mechanism. Patients and Methods: This study was a prospective cohort study that included 67 patients (26 in SD group and 41 in non-SD group) undergoing digestive tract tumor surgery. Preoperative sleep status was assessed using the Pittsburgh Sleep Quality Index. Postoperative ENI was evaluated using the Enteral Nutrition Tolerance Scale. Perioperative serum cortisol, intestinal barrier markers (D-lactate, diamine oxidase and human lipopolysaccharide binding protein), ferroptosis markers (ferrous ions, reduced glutathione and lipid peroxide malondialdehyde) and intestinal flora characteristics were measured. Results: The incidence of ENI in SD group was 53.8%, which was significantly higher than that in non-SD group (26.8%, P=0.038). Perioperative levels of serum intestinal barrier markers in SD group were higher than those in non-SD group (P<0.05). The preoperative cortisol level was positively correlated with the increase in the intestinal barrier marker human lipopolysaccharide binding protein (r=0.3621, P=0.0170) and ferroptosis marker malondialdehyde (r=0.3660, P=0.0171). In SD group, the relative abundance of opportunistic pathogens (Enterobacteriaceae, Burkholderiaceae, etc) increased, while the relative abundance of probiotics (Bifidobacteriaceae) decreased. Conclusion: Preoperative sleep disturbances were significantly associated with the occurrence of postoperative enteral nutrition intolerance in patients with gastrointestinal tumors. The intestinal barrier damage of these patients may be related to hypothalamic-pituitary-adrenal axis activation, oxidative stress induction and intestinal flora imbalance.