Perioperative sleep management in cardiac surgery: an evidence-oriented narrative review of pharmacological, behavioral, and respiratory support strategies.

Perioperative sleep disturbance is a common problem in patients undergoing cardiac surgery. It may manifest as reduced sleep quality, impaired sleep continuity, and disrupted sleep architecture, and may be associated with postoperative delirium, cognitive decline, and delayed recovery. As an evidence-oriented narrative review, this article summarizes pharmacological interventions, behavioral therapies, and respiratory support strategies for perioperative sleep management in cardiac surgery. Current evidence suggests that melatonin and its receptor agonists may help regulate circadian rhythms and improve subjective sleep quality, but their effects on outcomes such as delirium, length of hospital stay, and objective sleep architecture remain inconsistent. Dexmedetomidine has sedative properties resembling non-rapid eye movement sleep; however, findings across studies are inconsistent, and hemodynamic adverse effects require careful attention. Although GABAergic hypnotics may shorten sleep latency, they may increase the risk of respiratory depression, delirium, and adverse cognitive events. Behavioral interventions and environmental optimization are generally feasible, but much of the supporting evidence comes from patients with chronic insomnia, general surgical populations, or ICU settings; therefore, extrapolation to perioperative cardiac surgical patients should be cautious. CPAP, BiPAP, and high-flow nasal cannula oxygen therapy mainly improve oxygenation and reduce respiratory support requirements, whereas their direct sleep-related benefits remain unclear. Overall, risk-stratified multimodal sleep management is clinically rational, but large-scale, multicenter studies are still needed to further clarify its efficacy, safety, and applicable patient populations.