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Preoperative REM sleep is associated with complication development after colorectal surgery

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Abstract

Background

While total sleep duration and rapid eye movement (REM) sleep duration have been associated with long-term mortality in non-surgical cohorts, the impact of preoperative sleep on postoperative outcomes has not been well studied.

Methods

In this secondary analysis of a prospective observational cohort study, patients who recorded at least 1 sleep episode using a consumer wearable device in the 7 days before elective colorectal surgery were included. 30-day postoperative outcomes among those who did and did not receive at least 6 h of total sleep, as well as those who did and did not receive at least 1 h of rapid eye movement (REM) sleep, were compared.

Results

34 out of 95 (35.8%) patients averaged at least 6 h of sleep per night, while 44 out of 82 (53.7%) averaged 1 h or more of REM sleep. Patients who slept less than 6 h had similar postoperative outcomes compared to those who slept 6 h or more. Patients who averaged less than 1 h of REM sleep, compared to those who achieved 1 h or more of REM sleep, had significantly higher rates of complication development (29.0% vs. 9.1%, P = 0.02), and return to the OR (10.5% vs. 0%, P = 0.04). After adjustment for confounding factors, increased REM sleep duration remained significantly associated with decreased complication development (increase in REM sleep from 50 to 60 min: OR 0.72, P = 0.009; REM sleep ≥ 1 h: OR 0.22, P = 0.03).

Conclusion

In this cohort of patients undergoing elective colorectal surgery, those who developed a complication within 30 days were less likely to average at least 1 h of REM sleep in the week before surgery than those who did not develop a complication. Preoperative REM sleep duration may represent a risk factor for surgical complications; however additional research is necessary to confirm this relationship.

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Acknowledgements

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Funding

Research reported in this article was supported by award T32CA163177 (Dr. Kane) from the National Institutes of Health, the University of Virginia Department of Surgery, and a generous gift from a grateful patient. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, University of Virginia Health System, Charlottesville, USA

    William J. Kane, Taryn E. Hassinger, Ashley N. Charles, Sook C. Hoang, Charles M. Friel & Traci L. Hedrick

  2. School of Medicine, University of Virginia, Charlottesville, USA

    David L. Chu

  3. The College of Arts and Sciences, University of Virginia, Charlottesville, USA

    Emma L. Myers

  4. Department of Anesthesiology, University of Virginia Health System, Charlottesville, USA

    Robert H. Thiele

  5. Department of Medicine, University of Virginia Health System, Charlottesville, USA

    Eric M. Davis

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Correspondence to Traci L. Hedrick.

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Dr. Hassinger, Ms. Myers, Mr. Chu, Ms. Charles, Dr. Hoang, Dr. Friel, Dr. Thiele, and Dr. Davis have no conflicts of interest or financial ties to disclose.

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Kane, W.J., Hassinger, T.E., Chu, D.L. et al. Preoperative REM sleep is associated with complication development after colorectal surgery. Surg Endosc 36, 2532–2540 (2022). https://doi.org/10.1007/s00464-021-08541-8

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