Preoperative REM sleep is associated with complication development after colorectal surgery

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 hours of total sleep, as well as those who did and did not receive at least 1 hour of rapid eye movement (REM) sleep were compared. RESULTS: 34 out of 95 (35.8%) patients averaged at least 6 hours of sleep per night, while 44 out of 82 (53.7%) averaged 1 hour or more of REM sleep. Patients who slept less than 6 hours had similar postoperative outcomes compared to those who slept 6 hours or more. Patients who averaged less than 1 hour of REM sleep, compared to those who achieved 1 hour 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 hour: 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 hour 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.