Sleep quality after shoulder arthroplasty - A systematic review.

Background: Shoulder arthroplasty has been shown to improve pain and function. However, its effect on postoperative sleep quality remains poorly defined. The purpose of this systematic review is to summarize changes in sleep quality after shoulder arthroplasty. Methods: MEDLINE, Embase and Web of Science were searched from database inception to 31 October 2025, for studies reporting postoperative sleep outcomes following primary shoulder arthroplasty with at least one reported postoperative sleep-related outcome. Due to heterogeneity amongst studies and outcomes, results were synthesized descriptively. Results: Eighteen studies comprising 2512 patients were included. Preoperative sleep disturbance was highly prevalent (84-97%). Minimal improvement in sleep quality was reported within the first 6 weeks postoperatively, followed by a marked improvement by 6 months. This was generally sustained at longer follow-up. However, 13-16% of patients reported persistent difficulties sleeping comfortably. Seventeen studies (94%) reported subjective sleep outcomes, while only two studies (11%) reported on objective sleep measures using wearable devices. Conclusion: Shoulder arthroplasty is generally associated with meaningful improvement in sleep quality between 6 weeks and 6 months postoperatively, with improvements plateauing thereafter. The existing literature is limited by heavy reliance on subjective, often non-validated, sleep measures and a paucity of objective sleep data.