Abstract
Postoperative sleep disturbance (PSD) is common after surgery and is characterized by insomnia, fragmented sleep, altered sleep-wake patterns, and excessive daytime sleepiness. Stellate ganglion block (SGB) modulates sympathetic activity and may improve sleep through autonomic, analgesic, and anti-inflammatory mechanisms. We searched eight Chinese and international databases from inception to January 1, 2025, and included 10 randomized controlled trials involving 734 participants, predominantly from China. Compared with placebo, routine care, or active control, SGB was associated with lower subjective sleep scores on the night of surgery (standardized mean difference [SMD], - 2.09; 95% confidence interval [CI], - 3.36 to - 0.83), postoperative day 1 (SMD, - 2.27; 95% CI, - 2.85 to - 1.68), postoperative day 3 (SMD, - 1.12; 95% CI, - 1.70 to - 0.55), and 4 weeks after surgery (SMD, - 1.16; 95% CI, - 1.55 to - 0.77). The 4-week effect remained statistically significant; however, no formal interaction test was performed, and the numerical differences between time points should not be interpreted as evidence of a statistically significant temporal decline. SGB also increased total sleep time by approximately 72 min (mean difference, 71.76 min; 95% CI, 51.51-92.01). The estimate for sleep efficiency was based on only two studies and showed substantial heterogeneity (mean difference, 11.45% points; 95% CI, 1.79-21.11; I² = 86%). Substantial heterogeneity for subjective sleep quality (I² = 90%) and the limited geographic diversity of the included trials reduce the certainty and generalizability of the findings. SGB may improve postoperative sleep, particularly during the early postoperative period, but larger multicenter randomized controlled trials are required.