Relationship between sleep disturbances and depressive symptoms in patients after general anesthesia: A retrospective case-control study

doi:10.5498/wjp.v15.i8.105770

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Psychiatry. Aug 19, 2025; 15(8): 105770
Published online Aug 19, 2025. doi: 10.5498/wjp.v15.i8.105770

Table 1 Baseline patient data

Factor	Subitem	Group	n = 102	mean ± SD	χ²/t	P value
Demographic characteristics	Age (years)		102	44.36 ± 6.58	-	-
	Body weight (kg)		102	60.42 ± 7.83	-	-
	Height (cm)		102	160.38 ± 5.62	-	-
	BMI (kg/m²)		102	23.56 ± 2.79	-	-
	Marital status	Married/unmarried	76/26	-	0.965	0.327
	Occupation	Civil service/others	58/44	-	1.2	0.274
	Living condition	City/country	59/43	-	0.585	0.444
Health condition	Hypertension		26	0.2549	3.667	0.056
	Diabetes		15	0.1471	1.987	0.158
	Heart disease		10	0.098	2.426	0.12
	Liver and kidney dysfunction		8	0.0784	1.678	0.195
Sleep status	PSQI score (score)	0-5/6-10/11-15/16-21	52/36/10/4	-	-	-
Sleep status	PSQI score (score)	0-5/6-10/11-15/16-21	52/36/10/4	3.56 ± 1.29	3.567	0.010^a
Psychology	HAMD score (score)	0-7/8-14/15-21/22 and above	55/32/10/5	-	-	-
Psychology	HAMD score (score)	0-7/8-14/15-21/22 and above	55/32/10/5	6.20 ± 4.21	4.265	0.021^b
Life style	Smoking habits	Smoking/no smoking	20/82	-	1.225	0.268
	Drinking habits	Drinking/not drinking	18/84	-	0.982	0.321
	Exercise habit	Yes/no	42/60	-	1.836	0.176
	Eating habits	Good/bad	64/38	-	2.107	0.147
Preoperative examination data	Routine blood test	White blood cell count (× 10⁹/L)	-	5.56 ± 1.21	-	-
	Routine blood test	Red blood cell count (× 10⁹/L)	-	4.35 ± 0.30	-	-
	Blood glucose (mmol/L)		102	5.08 ± 1.05	-	-
	Blood lipid (mmol/L)		102	4.12 ± 0.91	-	-

^aP < 0.05 vs good preoperative sleep quality group [Pittsburgh Sleep Quality Index (PSQI) score 0-5].

^bP < 0.05 vs preoperative group without depressive symptoms (Hamilton Depression Rating Scale score 0-7).

Assessment of sleep quality (PSQI scores) in 102 patients undergoing laparoscopic hysterectomy under general anesthesia. Data presented as mean ± SD. P < 0.05 indicates statistically significant difference. PSQI: Pittsburgh Sleep Quality Index; HAMD: Hamilton Depression Rating Scale; BMI: Body mass index.

Table 2 Evaluation results of sleep quality in patients with different periods, n (%)

Point of time	Good sleep quality (0-5)	Mild sleep disturbance (6-10)	Moderate sleep disturbance (11-15)	Severe sleep disturbance (16-21)	χ²	P value
Pre-surgery	36 (35.29)	42 (41.18)	18 (17.65)	6 (5.88)	-	-
1 week after surgery	28 (27.45)	38 (37.25)	26 (25.49)	10 (9.80)	8.231	0.041^a
1 month after surgery	32 (31.37)	40 (39.22)	22 (21.57)	8 (7.84)	3.223	0.358
3 months after surgery	35 (34.31)	38 (37.25)	21 (20.59)	8 (7.84)	2.42	0.491

^aP < 0.05 vs preoperative (one-way ANOVA with Tukey post hoc).

Table 3 Results of assessment of depressive symptoms in patients with different periods, n (%)

Point of time	No depression symptoms (0-7)	Mild depression symptoms (8-16)	Moderate depression symptoms (17-23)	Severe depression symptoms (24 and above)	χ²	P value
Pre-surgery	53 (51.96)	31 (30.39)	14 (13.73)	4 (3.92)	-	-
1 week after surgery	44 (43.14)	39 (38.24)	15 (14.71)	4 (3.92)	3.456	0.329
1 month after surgery	49 (48.04)	37 (36.27)	13 (12.75)	3 (2.94)	1.268	0.738
3 months after surgery	51 (50.00)	34 (33.33)	14 (13.73)	3 (2.94)	0.858	0.836

Table 4 Recovery of patients after surgery

Recovery indicators	Postoperative recovery	Frequency (n)	Proportion (%)	χ²	P value
Hospital stay, days
3-5	Good	62	60.78	3.528	0.171
6-7	Average	35	34.31
> 7	Poor	5	4.90
Incidence of complications
Postoperative infection	Low	3	2.94	6.118	0.103
Postoperative hemorrhage	Low	2	1.96
Deep vein thrombosis	Low	2	1.96
No complications	Ideal	96	93.14
Physical recovery
Daily activities were resumed within 2 weeks after surgery	Good	72	70.59	1.734	0.419
Limited recovery within 2 weeks after surgery	Average	24	23.53
A significant dysfunction	Poor	6	5.88

Table 5 Results of monitoring physiological indicators in different periods of patients

Point of time	Heart rate (beats/minute)	Systolic blood pressure (mmHg)	Diastolic blood pressure (mmHg)	Oxygen saturation (%)	Temperature (°C)
1 day after surgery	82.45 ± 5.36	121.65 ± 6.88	76.90 ± 5.21	98.22 ± 1.25	37.01 ± 0.56
1 week after surgery	80.30 ± 4.29	122.15 ± 5.74	77.12 ± 5.05	98.56 ± 1.12	36.87 ± 0.48
1 month after surgery	78.90 ± 4.61	119.43 ± 7.11	75.87 ± 4.83	98.74 ± 1.08	36.86 ± 0.49
3 months after surgery	77.56 ± 5.14	118.72 ± 6.98	75.26 ± 4.44	98.63 ± 1.15	36.83 ± 0.51
F	2.971	3.234	3.115	0.325	0.542
P value	0.035^a	0.022^b	0.027^c	0.808	0.662

^aP < 0.05, there was a statistically significant difference in the heart rate at each time after surgery.

^bP < 0.05, there was a statistically significant difference in systolic blood pressure at various time points after surgery.

^cP < 0.05, there was a statistically significant difference in diastolic blood pressure at various time points after surgery.

Table 6 Results of inflammatory factor levels in patients with different periods

Point of time	CRP (mg/L)	TNF-α (pg/mL)
1 day after surgery	14.32 ± 5.21	15.82 ± 3.45
1 week after surgery	10.75 ± 3.13	13.47 ± 2.89
1 month after surgery	6.22 ± 2.04	9.15 ± 2.02
3 months after surgery	4.29 ± 1.65	8.42 ± 1.79
F	11.253	8.721
P value	0.000^a	0.001^b

^aP < 0.01 vs 1 day postoperatively.

^bP < 0.01 vs 1 week postoperatively.

CRP: C-reactive protein; TNF-α: Tumor necrosis factor-α.

Table 7 Correlation results between sleep disturbances and depression symptoms of patients

Variable	PSQI score	HAMD score	Age	BMI	Systolic blood pressure (mmHg)	Diastolic blood pressure (mmHg)	Heart rate (beats/minute)	CRP (mg/L)
PSQI score	1
HAMD score	0.62^a	1
Age	0.18	0.15	1
BMI	0.12	0.1	0.35^h	1
Systolic blood pressure	0.24^b	0.22^b	0.01	0.08	1
Diastolic blood pressure	0.2	0.21^e	0.12	0.1	0.74ⁱ	1
Heart rate	0.28^c	0.30^f	-0.07	0.13	0.40^j	0.47^l	1
CRP	0.32^d	0.36^g	0.1	0.08	0.27^k	0.33^m	0.38ⁿ	1

^aP < 0.01 [Pittsburgh Sleep Quality Index (PSQI) score was positively correlated with Hamilton Depression Rating Scale (HAMD) score].

^bP < 0.05 (PSQI score was positively correlated with systolic blood pressure).

^cP < 0.05 (PSQI score was positively correlated with heart rate).

^dP < 0.01 [PSQI score was positively correlated with C-reactive protein (CRP)].

^eP < 0.05 (HAMD score was positively correlated with diastolic blood pressure).

^fP < 0.01 (HAMD score was positively correlated with heart rate).

^gP < 0.01 (HAMD score was positively correlated with CRP).

^hP < 0.01 (Age was positively correlated with body mass index).

ⁱP < 0.01 (Systolic blood pressure was positively correlated with diastolic blood pressure).

^jP < 0.01 (Heart rate was positively correlated with systolic blood pressure).

^kP < 0.05 (CRP was positively correlated with systolic blood pressure).

^lP < 0.01 (Heart rate was positively correlated with diastolic blood pressure).

^mP < 0.01 (CRP was positively correlated with diastolic blood pressure).

ⁿP < 0.01 (CRP was positively correlated with heart rate).

Correlation matrix between sleep disturbances and depression symptoms. Systolic blood pressure. Correlation coefficients calculated using Spearman's rho for non-normally distributed variables (CRP, tumor necrosis factor-α). CRP: C-reactive protein; PSQI: Pittsburgh Sleep Quality Index; HAMD: Hamilton Depression Rating Scale; BMI: Body mass index.

Table 8 Results of logistic regression analysis between sleep disturbances and depression symptoms in patients

Factor	β	SE	Wald χ²	P value	OR	95%CI
Constant term	-2.214	0.51	18.325	< 0.001^a	0.11	0.049-0.246
PSQI score	0.312	0.074	17.045	< 0.001^b	1.366	1.185-1.577
Age	0.015	0.008	4.232	0.04^c	1.016	1.000-1.033
Gender (male = 1)	0.292	0.271	1.157	0.282	1.339	0.801-2.239
BMI	-0.084	0.054	2.481	0.115	0.92	0.817-1.036
Hypertension (Yes = 1)	0.745	0.298	6.264	0.012	2.106	1.161-3.821
Diabetes (Yes = 1)	0.567	0.322	3.07	0.08	1.763	0.927-3.341

^aP < 0.001 (independent predictive effect of Pittsburgh Sleep Quality Index score).

^bP < 0.05 (age effect).

^cP < 0.05 (effect of hypertension).

PSQI: Pittsburgh Sleep Quality Index; OR: Odds ratio; BMI: Body mass index.

Table 9 Results of mediation effect analysis

Path/effect type	Coefficient (β)	SE	t	P value	95%CI
PSQI → CRP (a path)	0.32	0.09	3.56	< 0.001^a	(0.14, 0.50)
CRP → HAMD (b path)	0.56	0.15	3.73	< 0.001^a	(0.26, 0.85)
PSQI → HAMD (total effect, c)	0.49	0.08	6.13	< 0.001^a	(0.33, 0.64)
PSQI → HAMD (direct effect, c′)	0.31	0.09	3.44	< 0.001^a	(0.13, 0.49)
Indirect effect (a × b)	0.18	0.07 (Boot SE)	-	< 0.001^a	(0.05, 0.30) (Bootstrap 95%CI)

^aP < 0.001, all paths (Bootstrap 95%CI does not include 0).

The indirect effect was estimated using 5000 Bootstrap resamples. The Bootstrap 95%CI did not include zero, indicating a statistically significant partial mediation effect of CRP on the relationship between PSQI and HAMD. CRP: C-reactive protein; PSQI: Pittsburgh Sleep Quality Index; HAMD: Hamilton Depression Rating Scale.

Citation: Jia XP, Lou QX, Chen XZ, Zhang YZ. Relationship between sleep disturbances and depressive symptoms in patients after general anesthesia: A retrospective case-control study. World J Psychiatry 2025; 15(8): 105770
URL: https://www.wjgnet.com/2220-3206/full/v15/i8/105770.htm
DOI: https://dx.doi.org/10.5498/wjp.v15.i8.105770