ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Prevalence and risk factors of sleep disturbances before and after spinal surgeries: a systematic review and meta-analysis.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSleep disturbances frequently affect patients undergoing spinal surgery, impairing recovery, reducing quality of life, increasing postoperative complications, and impairing physical function improvements. However, the prevalence and associated risk factors of these disturbances remain poorly understood. This systematic review and meta-analysis aims to bridge this gap.
methodsThe review protocol was prospectively registered on PROSPERO (CRD42024599851). A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted on November 14th, 2025. Studies evaluating sleep disturbances in adults undergoing spinal surgery were included. Proportional meta-analysis was conducted using a generalized linear mixed model. Studies utilizing sleep questionnaires and studies using spinal disability outcome measures with a sleep component were meta-analyzed separately. Heterogeneity was investigated via meta-regressions. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS).
resultsTwenty studies were included. Preoperative sleep disturbance prevalence varied substantially by assessment instrument, ranging from 44.7% (95% CI: 28.6% to 61.7%) using PIRS-20 and 54.3% (95% CI: 47.7% to 60.8%) using PROMIS-SD to 91.2% (95% CI: 70.5% to 97.8%) using the PSQI. Younger age explained part of the between-study heterogeneity. Postoperative sleep disturbance prevalence was 35.3% (95% CI: 14.3% to 64.0%) using the PSQI and 29.7% (95% CI: 24.4% to 35.6%) using PROMIS-SD, while male sex was associated with a higher postoperative prevalence. Spinal disability outcome measures reported preoperative and postoperative sleep disturbance prevalences ranging from 79.7% to 84.2% and 27.2% to 52.0%, respectively. Consistent preoperative risk factors included younger age, female sex, greater pain severity, disability, and lower educational attainment. Greater pain, pre-existing sleep problems, and increased intraoperative bleeding volume were the most consistent postoperative risk factors.
conclusionsSleep disturbances are highly prevalent before spinal surgery and remain common after surgery, although prevalence estimates vary substantially according to the assessment instrument used. Pain and disability appear to be important determinants of perioperative sleep disturbance. Routine screening and targeted perioperative interventions may improve patient outcomes.
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