Pharmacotherapeutic interventions to improve postoperative sleep quality in older adult patients: a systematic review and meta-analysis
Abstract
BACKGROUND
Postoperative sleep impairment is common in older adult patients and is associated with delayed recovery and a negative impact on overall health, daily functioning, and quality of life. Older adults are particularly vulnerable because of age-related physiological changes and reduced functional reserves. We conducted a systematic review to assess the efficacy of pharmacotherapeutic interventions for improving postoperative sleep in older adults.
METHODS
PubMed, the Cochrane Library, and Embase were searched from inception to August 20, 2025. Randomised controlled trials investigating pharmacological interventions aimed at improving postoperative sleep in patients aged ≥60 yr were included. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and certainty of evidence was evaluated using the GRADE framework. Random-effects meta-analysis was performed where appropriate. The review was registered in PROSPERO (CRD420250651275).
RESULTS
Of the 525 identified studies, 21 met the inclusion criteria. Assessed interventions included dexmedetomidine, esketamine, alprazolam, remimazolam, melatonin, and zolpidem. Dexmedetomidine was the most consistently effective, improving both subjective and objective sleep. Subgroup meta-analysis comparing dexmedetomidine with placebo showed a moderate, statistically significant improvement in sleep quality (standardised mean differences -0.51; 95% confidence interval -0.86 to -0.17; p<0.001; I2=94%). Evidence for other…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Tryptophan Metabolism and Gut-Brain Homeostasis
- Rationale for a Multi-Factorial Approach for the Reversal of Cognitive Decline in Alzheimer’s Disease and MCI: A Review
- Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit
- Relationship between sleep disorders and gut dysbiosis: what affects what?
- The role of CLOCK gene in psychiatric disorders: Evidence from human and animal research
- Genetic, Transcriptome, Proteomic, and Epidemiological Evidence for Blood-Brain Barrier Disruption and Polymicrobial Brain Invasion as Determinant Factors in Alzheimer’s Disease
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.