Background Patients with pectus excavatum have a poorer subjective sleep quality and quality of life than the general population. The Nuss procedure has been shown to improve these patients' quality of life, but data regarding their postoperative sleep quality are lacking. We aimed to evaluate the objective sleep quality of adults with pectus excavatum before and after the Nuss procedure. Methods Twenty-eight participants completed this study. Epworth Sleepiness Scale (ESS) scores for daytime sleepiness, Pittsburgh Sleep Quality Index (PSQI) scores for subjective sleep quality, and overnight polysomnography for objective sleep quality were evaluated before and 6 months after the Nuss procedure.Results Subjective sleep quality improved after the Nuss procedure. The median PSQI score decreased from 7 [interquartile range (IQR): 5; 9] to 5 (IQR: 4; 7, p = 0.029); the median percentage of poor PSQI sleep quality decreased from 64.3 to 35.7% (p = 0.048). The median percentage of rapid eye movement sleep significantly increased after surgery [15.6% (IQR: 12.2%; 19.8%) vs. 20.4% (IQR: 14.5%; 24.9%), p = 0.016]. Sleep interruptions also improved, with the median arousal index decreasing from 9.5 (IQR: 4.8; 18.2) to 8.2 (IQR: 4.3; 12.1; p = 0.045). However, there was no significant change in ESS scores after surgery (p = 0.955). Conclusions Pectus excavatum may be associated with poor subjective and objective sleep quality in adults, and the condition may improve after the Nuss procedure. For adults with pectus excavatum who report poor subjective sleep quality, polysomnography should be considered to assess their preoperative and postoperative sleep condition. Characteristics Cases (n = 28) Age, years (IQR) 24.0 (22.0; 27.5) Gender Male, n (%) 25 (89.3%) Female, n (%) 3 (10.7%) Body height, cm (IQR) 173 (167; 177.8) Body weight, kg (IQR) 62.5 (55.0; 65.8) Body mass index, kg/m 2 (IQR) 20.2 (18.9; 21.9) Haller index (IQR) 3.6 (3.3; 4.3) Pulmonary function rest FVC, % of predicted value (IQR) 80.0 (69.5; 91.3) FEV1, % of predicted value (IQR) 83.5 (73.5; 91.3) FEV1/FVC, % (IQR) 87.5 (83.3; 91.0) TLC, % of predicted value (IQR) 88.5 (84.0; 96.0) Restrictive lung defect, n (%) 2 (7.1%) Continuous data (age, body height, body weight, body mass index, Haller index) are shown as the median and interquartile range, and categorical data (gender) are shown as a count (%) IQR interquartile range, FVC forced vital capacity, FEV1 forced expiratory volume in 1 s, TLC total lung capacity