Abstract
Background: Postoperative sleep disorder is common in elderly surgery patients, and it often worsens their recovery after surgery. This study aimed to explore the effect of intraoperative dexmedetomidine dose on postoperative sleep quality.Methods: Based on information regarding dexmedetomidine use during surgery from an electronic medical record system, 4,349 elderly surgery patients were divided into three groups: 1,374 without intraoperative use of dexmedetomidine (Non-DEX), 917 with dexmedetomidine 0.1–0.2 μg/kg/h (Low-DEX), and 2,058 with dexmedetomidine >0.2 μg/kg/h (High-DEX). The numerical rating scale (NRS) for sleep disturbance during the first night after surgery was recorded, and the incidence of NRS ≥ 6 was considered the primary outcome.Results: NRS (P < 0.001) and incidence of severe sleep disturbance (P < 0.001) were lower in patients receiving intraoperative dexmedetomidine than in those without the intraoperative use of dexmedetomidine. Patients in the Low-DEX group had the lowest incidence, followed by those in the High-DEX and Non-DEX groups (6.7% vs. 13.7% vs. 19.5%). After propensity score matching, 906 pairs of elderly surgery patients were included in the Low-DEX and High-DEX groups, and the Low-DEX group had lower NRS (2.7 ± 2.1 vs. 3.1 ± 2.4, P < 0.001) than the High-DEX group. The incidence of severe sleep disturbance was lower in the Low-DEX group than in the High-DEX group (6.6% vs. 12.8%) with an odds rate of 0.48 (95% confidence interval, 0.35 to 0.67).Conclusions: For elderly patients, intraoperative dexmedetomidine use can significantly improve the quality of the first night sleep after surgery. Low-dose (0.1–0.2 μg/kg/h) dexmedetomidine can have an improvement effect on sleep quality, and it is recommended to improve the quality of postoperative sleep.
Highlights
For elderly patients undergoing surgery, postoperative sleep disorder is a very common clinical problem that may worsen the patients’ recovery after surgery, e.g., increasing the risk of inadequate postoperative pain control, delirium, or cognitive dysfunction [1,2,3,4,5]
A difference was found in age, BMI, rates of pulmonary disease, and whether or not the patient underwent general anesthesia between the Low-DEX and HighDEX groups
Based on the current study, the results showed that for elderly surgery patients, both a low dose (0.1–0.2 μg/kg/h) and a high dose (>0.2 μg/kg/h) of intraoperative dexmedetomidine can significantly decrease the incidence of first night severe sleep disturbance (SSD) after surgery compared to patients who did not use dexmedetomidine during the surgery
Summary
For elderly patients undergoing surgery, postoperative sleep disorder is a very common clinical problem that may worsen the patients’ recovery after surgery, e.g., increasing the risk of inadequate postoperative pain control, delirium, or cognitive dysfunction [1,2,3,4,5]. One randomized small sample size study demonstrated that intraoperative continuous infusions of dexmedetomidine (0.1 μg/kg/h) can improve the first night sleep quality in elderly patients following lung cancer surgery [13]. Another recent randomized study found that dexmedetomidine use (0.2–0.7 μg/kg/h) during a daytime operation can better improve postoperative sleep quality in patients (aged 30 to 55) undergoing laparoscopic abdominal surgeries [14]. These studies demonstrated that intraoperative dexmedetomidine use may be an optional strategy to improve the postoperative sleep quality of elderly surgery patients. This study aimed to explore the effect of intraoperative dexmedetomidine dose on postoperative sleep quality
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