Feasibility of Patient-Controlled Sleep with Dexmedetomidine in Treating Chronic Intractable Insomnia

Abstract

Background: Patient-Controlled Analgesia (PCA) is an on-demand system which allows patients to self-administer intravenous medications in small bolus doses. Based on the principles of PCA, we developed Patient-Controlled Sleep (PCSl) for chronic intractable insomnia that the traditional analgesics in PCA was replaced with dexmedetomidine (Dex), an alpha-2 agonist widely used for premedication, sedation, anxiolysis and analgesia. The objective of the study was to establish a system and assess the safety. Methods: Patients with chronic intractable insomnia undergoing PCSl (n=20) between May 2015 and Mar 2019 were evaluated with the Pittsburgh Sleep Quality Index (PSQI), Symptom Check list 90 (SCL-90), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before and after the treatment. The patient characteristics, overall outcomes and related side effects were also assessed. Results: Fifteen patients completed the treatment. The duration of PCSl varied from days to four months, and the dosage of Dex gradually decreased without eliciting signs or symptoms of tolerance or physical dependence. The sleep quality improvement occurred immediately after the therapy in 12/15 patients, and of which, 7/15 patients achieved continuous improved sleep quality in final follow-up. Conclusions: This study suggests that PCSl with Dex is a feasible and safe treatment for chronic intractable insomnia. Funding Statement: This research was funded by the National Natural Science Foundation of China, grant number 81671076. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The retrospective review was approved by the Institutional Review Board (IRB) of the Aviation General Hospital of China Medical University (HK20090528). All participants provided written informed consent.