Abstract
BackgroundSleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits.MethodsWe recruited 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, we decreased or increased the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation.ResultsThe MACawake of sevoflurane was 0.80% [95% confidence interval (CI), 0.683–0.926%] in the sleep disordered group vs 0.60% [95% CI, 0.493–0.689%] in the control group. The relative median potency between groups was 0.750 (95% CI, 0.236–0.969). Patients with sleep disorders had significantly higher orexin-A levels than control (72.17 ± 18.24 vs. 36.16 ± 14.18 pg/mL). A significant, positive relationship was detected between orexin-A level and probability of awakening (OR = 1.081, 95% CI is 1.020–1.146, P = 0.008).ConclusionsMACawake of sevoflurane is higher in mild-aged women of breast surgery with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis.Clinical trial registrationChinese Clinical Trial Registry (ChiCTR1800016022), date of registration 07 May 2018.
Highlights
Sleep disorders are commonly encountered in clinic
We hypothesized that sleep disorders along with a change of orexin-A might modulate the hypnotic potency of anesthetics in humans
The following inclusion criteria were used for subjects with sleep disorders [8]: difficulty initiating or maintaining sleep≥6 months, with Pittsburgh Sleep Quality Index (PSQI) ≥7, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria [9]; Hamilton Anxiety Scale (HAMA) < 7; and Hamilton Depression Scale (HAMD) < 7
Summary
Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. This phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits Sleep disorders such as insomnia are commonly encountered in clinic because of fear, anxiety, pain, or a disruptive environment. Cao et al BMC Anesthesiology (2020) 20:17 isoflurane anesthesia in rats subjected to sleep deprivation [4]. This theory has yet to be confirmed in humans. We hypothesized that sleep disorders along with a change of orexin-A might modulate the hypnotic potency of anesthetics in humans
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