Perioperative Sleep Disorders (PSD) are prevalent among elderly patients and have been confirmed as independent risk factors for Postoperative Delirium (POD) and other Perioperative Neuropsychiatric impairments (PND). With the intensifying population aging, effective management of perioperative sleep issues in this group has become particularly crucial. This systematic review synthesizes recent literature on the epidemiological characteristics, pathophysiological mechanisms, clinical manifestations, and correlations with postoperative delirium in elderly patients. We focus on analyzing the impact of pharmacological and non-pharmacological sleep intervention strategies on postoperative delirium incidence. By integrating current clinical trials and basic research findings, this review aims to explore optimized perioperative sleep management strategies and their potential effects in reducing postoperative delirium, providing theoretical foundations and practical recommendations for clinical practice.