{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T10:36:34Z","timestamp":1777286194116,"version":"3.51.4"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The mechanism linking postoperative sleep duration to postoperative delirium (POD) remains unclear. This study examined the potential indirect pathway involving depressive symptoms (assessed via the PHQ-9) in the association between postoperative sleep duration and POD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 500 patients aged \u2265 65 years undergoing unilateral total hip or knee arthroplasty under general anesthesia. The associative pathways among sleep duration, depressive symptoms, and POD were assessed using covariate-adjusted three-step linear probability models with heteroscedasticity-consistent (HC3) robust standard errors, validated via 1000-resample bootstrapping and the Sobel test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Postoperative sleep duration had significant total (\u03b2=-0.174, 95% CI [-0.190, -0.158]) and direct (\u03b2=-0.045, 95% CI [-0.057, -0.032]) associations with POD. An indirect pathway involving depressive symptoms was statistically significant (\u03b2=-0.129, 95% CI [-0.146, -0.113]). Adjusted paths for sleep duration\u2192PHQ-9 (\u03b2=-2.660, 95% CI [-2.913, -2.407]) and PHQ-9\u2192POD (\u03b2=0.049, 95% CI [0.045, 0.052]) were significant. Sensitivity analysis showed E-values of 1.67, 1.26, and 1.53 for total (OR\u00a0=\u00a00.840), direct (OR\u00a0=\u00a00.956), and indirect (OR\u00a0=\u00a00.879) pathways, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Depressive symptoms are indirectly associated with the relationship between postoperative sleep duration and POD, alongside a direct independent association of sleep duration. Concurrent assessment and management of sleep and depressive symptoms are essential for optimizing perioperative care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1796472","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T09:45:31Z","timestamp":1777283131000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep duration, depressive symptoms, and postoperative delirium: a mediation analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Li-Heng","family":"Li","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, 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