New research suggests preoperative sleepiness is a potential warning sign for perioperative neurocognitive disorders in older adults.
Key takeaways:
- A study of patients over 60 found that those with excessive daytime sleepiness experienced greater cognitive decline six weeks after surgery.
- Daytime sleepiness affects up to 20% of adults and is often overlooked in preoperative evaluations.
- Perioperative neurocognitive disorders are linked to worse postoperative quality of life, longer hospital stays, and potential loss of independence.
- Researchers suggest screening for sleepiness could identify patients at higher risk for complications like delirium.
People aged 60 and older who experience excessive daytime sleepiness may face a higher risk of memory and thinking problems following surgery, according to a study presented at the ANESTHESIOLOGY 2025 annual meeting.
Researchers found that daytime sleepiness, a symptom of sleep deficiency affecting up to 20% of adults, may increase the likelihood of perioperative neurocognitive disorders (PNDs).
“Asking patients, their family or caregivers if they doze frequently during the day or have trouble staying alert might provide an important clue to brain health after surgery,” says Jeffry Takla, MD, lead author of the study and a postdoctoral associate in anesthesiology at Duke University School of Medicine, in a release. “Excessive daytime sleepiness is often overlooked in preoperative evaluations, but it can elevate the risk of [perioperative neurocognitive disorders]. PNDs have been associated with worse postoperative quality of life and increased hospital length of stay.”
Understanding Perioperative Neurocognitive Disorders Risks
Perioperative neurocognitive disorders involve issues with thinking and awareness that can impact up to 40% of older patients post-surgery. These disorders often manifest as delirium—a sudden state of confusion characterized by disorientation, focus difficulties, or inability to follow instructions. While delirium can fluctuate days after surgery, PNDs can persist for weeks or months, leading to longer-term confusion, memory deficits, and concentration issues.
In the study, 96 patients aged 60 or older scheduled for non-cardiac surgery completed the Epworth Sleepiness Scale and underwent home sleep apnea testing. Participants received cognitive and delirium assessments before and after their procedures.
Among the cohort, 11 patients (11.5%) experienced moderate to severe daytime sleepiness. At a six-week follow-up, 82 patients returned for testing, and 14 (17.1%) were found to have experienced a postoperative neurocognitive disorder. The eight patients with moderate to severe excessive daytime sleepiness who completed follow-up testing demonstrated greater global cognitive decline compared to those without significant sleepiness.
Clinical Implications
Takla notes that patients may not fully recover their previous level of independence following perioperative neurocognitive disorders, potentially requiring caregiver assistance or transition to assisted living.
Families and caregivers play a role in mitigating risks by monitoring patients for new signs of memory problems, inattention, or agitation. Alerting the care team allows for investigation into causes and supportive measures, such as re-orienting the patient, early mobilization, and ensuring adequate nutrition and hydration.
“Excessive daytime sleepiness isn’t a normal part of aging,” says Takla in a release. “It often stems from poor or fragmented sleep, sleep disorders such as sleep apnea, medication side effects, or other health or mental health conditions.”
Future research aims to determine if a direct link exists between sleepiness and perioperative neurocognitive disorders incidence. “If such a relationship exists, researchers should explore whether detecting and treating excessive daytime sleepiness can lower the risk of PNDs, such as delirium, in older patients after surgery,” says Takla in a release. “People who have this problem may consider having a sleep study or sleep hygiene counseling, especially if their symptoms continue or interfere with daily function.”
