Impact of a structured sleep hygiene intervention on postoperative recovery and pain management in elderly orthopedic patients: A randomized controlled trial

Project Abstract

This randomized controlled trial investigates whether a structured sleep hygiene intervention can enhance postoperative recovery and pain management in elderly orthopedic patients undergoing elective hip or knee arthroplasty. The study adopted a two-arm parallel design enrolling 220 participants aged 65 years and older, randomized 11 to either a structured sleep hygiene program plus standard perioperative care or standard perioperative care alone. The sleep hygiene intervention spanned preoperative education (two sessions), immediate postoperative guidance, and a two-week at-home continuation supported by daily sleep diaries and nurse follow-up. Components included consistent sleep-wake schedules, light exposure optimization, environmental modifications to minimize noise and daytime napping, caffeine and alcohol restriction, relaxation techniques, and strategies to reduce nocturnal pain perception through coordinated analgesia planning and nonpharmacologic adjuncts. Primary outcomes focused on length of hospital stay and global postoperative recovery as measured by the Postoperative Recovery Index at day 7, day 14, and at discharge. Secondary outcomes included pain intensity (Numerical Rating Scale 0–10) at rest and during mobilization, analgesic consumption (opioid and nonopioid), sleep quality (Pittsburgh Sleep Quality Index and actigraphy-derived metrics), incidences of delirium assessed by Confusion Assessment Method, functional mobility (Timed Up and Go test and 6-minute walk test), patient satisfaction, and adverse events. Data were collected at baseline (preoperative), during hospitalization, and at 1- and 3-month postoperative follow-ups. A blinded outcomes assessor performed all evaluations. Statistical analysis employed intention-to-treat principles. Mixed-effects models evaluated longitudinal trajectories of recovery and pain outcomes, adjusting for covariates including age, sex, comorbidity burden (Charlson Comorbidity Index), baseline sleep quality, type of arthroplasty, anesthesia technique, and perioperative analgesia regimen. Time-to-event analyses examined length of stay, while logistic regression estimated delirium risk. Missing data were addressed using multiple imputation. The trial hypothesizes that improved sleep quality and circadian alignment will reduce pain perception, decrease opioid requirements, and accelerate mobilization, thereby shortening hospital stay and enhancing overall recovery. Preliminary feasibility demonstrated high adherence to the sleep intervention with minimal disruption to standard care. Results are anticipated to show that the sleep hygiene program yields clinically meaningful improvements in sleep parameters, reduces nocturnal pain bursts, and lowers delirium incidence, which collectively contribute to faster functional recovery and higher patient-reported satisfaction. The study will discuss implications for integrating structured sleep hygiene into enhanced recovery pathways for elderly orthopedic patients, potential mechanisms linking sleep and nociception, and recommendations for tailoring interventions to diverse hospital settings. Limitations include potential heterogeneity in baseline sleep disorders and adherence variability, which will be explored in secondary analyses. The findings aim to inform perioperative care guidelines and offer a scalable, nonpharmacologic strategy to optimize postoperative outcomes in an aging surgical population.

Project Overview

What This Project Is About

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A straightforward study that looks at whether teaching elderly patients simple sleep routines around the time of orthopedic surgery can help them recover faster and feel less pain after the operation. It compares a sleep hygiene program to usual care to see if better sleep leads to better outcomes.

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The Problem It Addresses

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Many older adults have trouble sleeping after surgery, which can slow healing and increase pain, mood issues, and the need for pain medicines. There is not much clear evidence on whether a structured sleep plan can help them recover more smoothly.

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Objectives of the Project

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1. Describe current sleep patterns and recovery outcomes in elderly orthopedic patients after surgery.
2. Test whether a structured sleep hygiene program improves recovery speed and reduces pain compared with usual care.
3. Explore patient satisfaction and feasibility of implementing sleep routines in a hospital setting.

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What You Will Do Step by Step

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1. Review existing research on sleep, recovery, and pain in older adults.
2. Design a simple sleep hygiene program tailored for the hospital stay.
3. Recruit eligible elderly orthopedic patients and obtain consent.
4. Randomly assign participants to the sleep program or usual care.
5. Apply the sleep program during the immediate postoperative period.
6. Collect data on sleep quality, pain scores, analgesic use, and recovery milestones.
7. Analyze data using basic statistics to compare groups.
8. Interpret results and discuss practical implications for care in hospitals.

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Expected Outcome

It is expected that the sleep hygiene group will report better sleep, lower pain scores, faster mobilization, and shorter hospital stays, supporting broader use of sleep-focused care in postoperative plans for elderly patients.