Limited Efficacy of Pharmacological Interventions for Improving Postoperative Sleep Quality in Primary Total Joint Arthroplasty Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
BACKGROUND
Sleep disturbances are common after total joint arthroplasty (TJA) and are associated with impaired recovery, increased complications, and prolonged hospital stays. Although various pharmacological interventions have been evaluated to improve postoperative sleep quality among TJA patients, consensus on their efficacy and safety remains elusive.
METHODS
We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive search of PubMed, Embase, Scopus, and Web of Science was performed on October 5, 2024, with no language or publication date restrictions. Randomized controlled trials (RCTs) comparing pharmacological interventions versus routine postoperative care in TJA patients were included. Data on subjective sleep quality scores and objective measures like actigraphy and polysomnography were extracted, and the risk of bias was assessed using the National Institutes of Health (NIH) RCT tool. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. There were 24 studies involving 2,934 patients included.
RESULTS
Meta-analysis revealed that zolpidem significantly improved sleep quality (Hedges' g = -1.510; P < 0.001) and enhanced objective sleep parameters up to three weeks postoperatively.…
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. Reported size: 2,934 participants or records.
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