Postoperative Sleep Disturbance Research Articles

Effects of oral pregabalin on postoperative sleep of patients after video-assisted thoracoscopic surgery: a randomized double-blind controlled trial.

The aim of this study was to explore the effect of oral pregabalin at varying concentrations on postoperative sleep of patients undergoing video-assisted thoracic surgery (VATS), and to identify the optimal dosage. A total of 120 VATS-treated patients admitted from June 2023 to October 2023 were randomly assigned to be orally administered with 75 mg pregabalin, 150 mg pregabalin and starch capsules (control group) at a 1:1:1 ratio. One capsule of pregabalin (75 mg) and one capsule of placebo with the same shape and odor, two capsules of pregabalin (150 mg), and two capsules of placebo with the same shape and odor were administered orally to patients in the three groups on the night of surgery, and in the morning and evening of postoperative days 2 and 3. The primary outcome was the incidence of postoperative sleep disturbance (PSD) on postoperative day 1 (POD1). The secondary outcomes included the St.Mary's Hospital Sleep Questionnaire (SMH), the Pittsburg Sleep Quality Index (PSQI) and pain intensity measured with a Numerical Rating Scale (NRS). Multivariate logistic regression analysis was performed to identify risk factors for PSD in VATS-treated patients. The incidence of PSD on POD1 in the 75 mg pregabalin group and 150 mg pregabalin group was significantly lower than that of the control group (45.0% vs. 42.5% vs. 72.5%; P<0.0167 for two-by-two comparisons of groups A and B with group C, respectively). The SMH scores at night on POD1-3 were significantly higher in the 75 mg pregabalin group and 150 mg pregabalin group than those of the control group (P<0.05). Since there was definitive lower incidence of pain in the experimental groups,the median NRS scores of the incisional pain on POD2-3 were significantly lower in the 75 mg pregabalin group and 150 mg pregabalin group (P<0.05). The incidence of dizziness in the 150 mg pregabalin group was significantly higher than that of the 75 mg pregabalin group and control group (55.0% vs. 25.0% vs. 32.5%; P<0.0167 for two-by-two comparisons of groups A and C with group B, respectively). NRS score on POD1, preoperative PSQI and Self-Rating Depression Scale scores were risk factors for PSD in VATS-treated patients. Oral administration of 75 mg or 150mg pregabalin for consecutive three days after VATS effectively reduces the incidence of PSD and improves the quality of sleep.

Anxio-depressive disorders, traumatic symptoms, and suicidality among limb amputees: A cross-sectional and prospective study

IntroductionLimb amputation represents an ultimate therapeutic option in certain severe or progressive pathologies. We conducted this study to describe anxio- depressive disorders, traumatic symptoms, and suicidality among limb amputees, as well as factors associated with their occurrence. Materials and MethodsThis was a cross-sectional and prospective descriptive and analytical study conducted over a two-year period from October 2020 to October 2022, at the following departments of the Mohammed VI University Hospital Center in Oujda: Traumatological and Orthopedic Surgery departements A and B, and Peripheral Vascular Surgery departement, involving 122 patients. ResultsThe average age of our patients was 46.42 ± 14.76 years, with a predominance of males (male-to-female ratio of 2.21). Preoperative assessment of patients occurred 6 to 24 hours before amputation. Immediate postoperative evaluation took place on average 2.18 ± 1.53 days after surgery, ranging from 1 to 8 postoperative days. The prevalence of anxio-depressive disorders according to the MINI scale was 77%, comprising Depression (9%), Adjustment Disorder (36.9%), Acute Stress Disorder (20.5%), Post-Traumatic Stress Disorder (6.6%), and Anxiety Disorders (10.7%), with suicide attempts reported in 16.4% of cases. The mean score on the Hamilton Depression Rating Scale for our patients was 10.81 ± 3.27, on the Hamilton Anxiety Rating Scale was 16.33 ± 5.54, and on the Ducher Suicide Risk Scale was 0.82 ± 1.33. ConclusionThe occurrence of postoperative anxio-depressive disorders, traumatic symptoms, and suicidal behavior is associated with the following factors: male sex, personal history of depression, family history of psychiatric disorders, quality of diagnostic disclosure, postoperative sleep disturbances, postoperative panic attacks, psychological support, and socio-professional reintegration.

Which Interventions Are Effective in Treating Sleep Disturbances After THA or TKA? A Systematic Review.

Poor sleep quality is a common complaint after total joint arthroplasty (TJA), and it is associated with reports of higher pain and worse functional outcomes. Several interventions have been investigated with the intent to reduce the incidence of postoperative sleep disturbance with varying effectiveness. An aggregate of the best available evidence, along with an evaluation of the quality of those studies, is needed to provide valuable perspective to physicians and to direct future research. In this systematic review, we asked: (1) What is the reported efficacy of the most commonly studied medications and nonpharmacologic approaches, and (2) what are their side effects and reported complications? This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search using a combination of controlled vocabulary and keywords was performed utilizing Medline (Ovid), Embase (Ovid), Cochrane Central, and Web of Science databases from database inception to 2023, with the last search occurring October 24, 2023, to identify studies that evaluated a sleep intervention on the effect of patient-reported sleep quality after THA or TKA. Inclusion criteria were clinical trials, comparative studies, and observational studies on adult patients who underwent primary TKA or THA for osteoarthritis and who completed validated sleep questionnaires to assess sleep quality postoperatively. We excluded studies on patients younger than 18 years, patients with sleep apnea, TKA or THA because of trauma or conditions other than osteoarthritis, revision TJA, studies in languages other than English, and studies from nonindexed journals or preprint servers. Two investigators independently screened 1535 studies for inclusion and exclusion criteria and extracted data from the included studies. Ultimately, 14 studies were included in this systematic review, including 12 randomized controlled trials and 2 prospective comparative studies. A total of 2469 participants were included, with a mean ± SD age of 65 ± 7 years and 38% men in control groups and 65 ± 7 years and 39% men in intervention groups. Sleep quality questionnaires utilized included the Pittsburgh Sleep Quality Index, Self-Rating Scale of Sleep, 100-mm VAS - Sleep, Sleep Disturbance Numeric Rating Scale, Likert scales, and one institutionally designed questionnaire. Quality analysis was performed utilizing the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials, where higher scores of 13 indicated a more reliable study, and the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies, where higher scores of 9 indicated a more reliable study and scores < 5 represented a high risk of bias. Two of the randomized controlled trials scored a 12 of 13, and the remaining 10 met every criteria of the JBI checklist. Both comparative studies scored 5 of 9 possible points of the Newcastle-Ottawa Scale. Melatonin and selective cyclooxygenase-2 inhibitor rofecoxib were found to provide a clinically important benefit to sleep quality within the first postoperative week after TJA. However, rofecoxib was withdrawn from the market globally in 2004 over concerns about increased risk of cardiovascular events. Another cyclooxygenase-2 inhibitor, celecoxib, remains available. No other intervention demonstrated a clinical benefit. Side effects of melatonin include dizziness, headache, paresthesia, and nausea, and it is contraindicated in patients with liver failure, autoimmune conditions, or who are receiving warfarin. Long-term adverse effects of rofecoxib include hypertension, edema, and congestive heart failure, and it is contraindicated in patients with renal insufficiency or who are receiving warfarin. Melatonin is considered safe in older patients, but more caution should be taken with rofecoxib. Owing to limited evidence in support of most of the interventions we studied, none of these interventions can be recommended for routine use after TJA. Melatonin and rofecoxib may provide a benefit to sleep quality in some patients, but physicians need to understand the adverse effects and contraindications before recommending these interventions. Additionally, rofecoxib is no longer commercially available. Future investigation is warranted to evaluate the effectiveness of interventions with minimal side effect profiles for providers to be able to make an informed decision about interventions for sleep improvement after TJA. Level III, therapeutic study.

Impact of preoperative anxiety on postoperative outcomes in patients undergoing minimally invasive thoracoscopic surgery: A prospective cohort study

BackgroundPreoperative anxiety is a common preoperative psychological state in patients with cancer and associated with worsening perioperative outcomes. However, high-quality prospective studies on preoperative anxiety in patients undergoing lung surgery are scarce. MethodsWe conducted a prospective cohort study, enrolling a total of 540 patients. Preoperative anxiety in patients undergoing thoracic surgery was measured using the Hospitalization Anxiety Scale. Patients were grouped according to the Hospitalization Anxiety Scale scores as follows: no anxiety (score <8) and anxiety (score ≥8). The association of preoperative anxiety with postoperative complications and non-complicated adverse events was determined by univariate regression and polynomial regression analyses. ResultsA total of 121 patients (22.4 %) experienced preoperative anxiety. The anxiety group had a longer average hospital stay (4.33 vs. 3.85 days). Postoperative complications were similar between groups, but the anxiety group reported worse sleep quality (measured by the Athens Insomnia Scale). Regarding postoperative pain, both groups had comparable rates of mild and severe pain on postoperative day 1. However, the anxiety group experienced significantly higher rates of severe pain on postoperative day 2 and mild pain on postoperative day 3. Additionally, the incidence of postoperative nausea and vomiting was significantly higher in the anxiety group on postoperative day 1. ConclusionsPreoperative anxiety may not increase the rates of postoperative complications in patients undergoing lung surgery. However, it may be associated with postoperative sleep disturbances, pain, nausea, and vomiting, as well as prolong the length of postoperative hospitalization.

Effect of intra-operative Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation: a randomized controlled trial

BackgroundOver the last two decades, a large body of literature has focused on studying the prevalence and outcome of the postoperative delirium and sleep disturbance. The aim of this work was to evaluate the effect of intraoperative administration of Magnesium sulphate on the occurrence of post-operative delirium and insomnia in patients undergoing lumbar fixation.MethodsThis prospective randomized controlled trial was carried out on 80 patients indicated for lumbar fixation; 40 of them received conventional general anesthesia with extra administration of intraoperative magnesium sulphate (Mg sulphate group), and the other 40 received conventional general anesthesia only (control group). Both groups were submitted to pre-operative assessment of depression using Beck Depression inventory (BDI) scale, pre-operative assessment of fatigue using a fatigue questionnaire, pre- and post-operative assessment of insomnia using Insomnia severity index (ISI), post-operative assessment of delirium using Memorial delirium assessment scale (MDAS), post-operative assessment of pain using Visual Analogue Scale (VAS), and pre- and post-operative Quantitative electroencephalography (QEEG).ResultsMg sulphate administration, age, pre-operative BDI, pre-operative ISI, and post-operative VAS were independent predictors of post-operative ISI (P-value < 0.001, 0.047, 0.021, < 0.001, and < 0.001 respectively). Age and post-operative VAS were independent predictors of post-operative MDAS (P-value = 0.008, 0.013 respectively). Mg sulphate administration and pre-operative ISI were independent predictors of post-operative VAS (P-value = 0.010, 0.006 respectively).ConclusionThere was a significant relationship between intraoperative Mg sulphate administration and both post-operative insomnia and pain in unadjusted and adjusted analysis.

Study on the preventive effect of dexmedetomidine on anesthetic associated sleep disturbance in young to middle-aged female patients undergoing hysteroscopy: a study protocol for a crossover randomized controlled trial

BackgroundPostoperative sleep disturbance has a potentially detrimental effect on postoperative recovery. Perioperative patients are affected by several factors. General anesthesia induces a non-physiological state that does not resemble natural sleep. Exposure to propofol/sevoflurane can lead to desynchronization of the circadian rhythm, which may result in postoperative sleep disturbance characterized by mid-cycle advancement of sleep and daytime sleepiness. Dexmedetomidine is a highly selective α2-adrenoceptor agonist with a unique sedative effect that facilitates the transition from sleep to wakefulness. Basic research has shown that dexmedetomidine induces deep sedation, similar to physical sleep, and helps maintain forebrain connectivity, which is likely to reduce delirium after surgery. The aim of this study is to evaluate the influence of exposure to the mono-anesthetic propofol on the development of postoperative sleep disturbance in young and middle-aged female patients undergoing hysteroscopy and whether prophylactic administration of dexmedetomidine influences reducing postoperative sleep disturbance.MethodsThis prospective randomized controlled trial (RCT) will include 150 patients undergoing hysteroscopy at the First Affiliated Hospital of Xiamen University. Participants will be randomly assigned to three groups in a 1:1:1 ratio. The dexmedetomidine group will have two subgroups and will receive a nasal spray of 0.2 µg/kg or 0.5 µg/kg 25 min before surgery, while the control group will receive a saline nasal spray. Three groups will undergo hysteroscopy with propofol-based TIVA according to the same scheme. Sleep quality will be measured using a wearable device and double-blind sleep assessments will be performed before surgery and 1, 3, and 7 days after surgery. SPSS 2.0 is used for statistical analysis. A χ2 test is used to compare groups, and t-test is used to determine statistical the significance of continuous variables.DiscussionThe purpose of this study is to investigate the incidence of propofol-associated sleep disorders and to test a combination of dexmedetomidine anesthesia regimen for the prevention of postoperative sleep disorders. This study will help to improve patients’ postoperative satisfaction and provide a new strategy for comfortable perioperative medical treatment.Trial registrationClinicalTrials.gov NCT06281561. Registered on February 24, 2024.

Intraoperative dexmedetomidine on postoperative sleep disturbance in older patients undergoing major abdominal surgery: A randomized controlled trial protocol

BackgroundPostoperative sleep disturbance (PSD) occurs frequently in patients who undergo major abdominal surgical procedures. Dexmedetomidine is a promising agent to improve the quality of sleep for surgical patients. We designed this trial to investigate the effects of two different doses of intraoperative dexmedetomidine on the occurrence of PSD in elderly patients who have major abdominal surgery. MethodsIn this randomized, double-blind, controlled trial, 210 elderly patients aged ≥65 years will be randomized, with an allocation ratio of 1:1:1, to two dexmedetomidine groups (intraoperative infusion of 0.3 or 0.6 μg/kg/h) and a normal saline placebo group. The primary endpoint is the occurrence of PSD on the first night after surgery, assessed using the Athens Insomnia Scale. The secondary endpoints are (1) the incidence of PSD during the 2nd, 3rd, 5th, 7th, and 30th nights postoperatively; (2) pain at rest and on movement at 24 and 48 h postoperatively, assessed using the Numerical Rating Scale; (3) the incidence of postoperative delirium during 0–7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method; (4) depressive symptoms during 0–7 days postoperatively or until hospital discharge, assessed using the 15-items Geriatric Depression Scale; and (5) quality of recovery on postoperative days 1, 2, and 3, assessed using the 15-items Quality of Recovery Scale. Patients' sleep data will also be collected by Xiaomi Mi Band 7 for further analysis. DiscussionThe findings of this trial will provide clinical evidence for improving the quality of sleep among elderly patients undergoing major abdominal surgery. Ethics and disseminationThis trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University (No. 2023-160). The results will be published in a peer-reviewed journal. Trial registrationChinese Clinical Trial Registry (ChiCTR2300073163).

Association Between Preoperative Sleep Disturbance and Postoperative Delirium in Elderly: A Retrospective Cohort Study.

Postoperative sleep disturbance, characterized by diminished postoperative sleep quality, is a risk factor for postoperative delirium (POD); however, the association between pre-existing sleep disturbance and POD remains unclear. This study aimed to evaluate the association between preoperative sleep disturbance and POD in elderly patients after non-cardiac surgery. This retrospective cohort study was conducted at a single center and enrolled 489 elderly patients who underwent surgery between May 1, 2020, and March 31, 2021. Patients were divided into the sleep disorder (SD) and non-sleep disorder (NSD) groups according to the occurrence of one or more symptoms of insomnia within one month or sleep- Numerical Rating Scale (NRS)≥6 before surgery. The primary outcome was the incidence of POD. Propensity score matching analysis was performed between the two groups. Multiple logistic regression analysis was performed to identify the risk factors for POD. In both the unmatched cohort (16.0% vs 6.7%, P=0.003) and the matched cohort (17.0% vs 6.2%, P=0.023), the incidence of POD was higher in the SD group than in the NSD group. In addition, the postoperative sleep quality and the VAS score at postoperative 24 h were significantly lower in the SD group than in the NSD group. Multivariate logistic regression analysis indicated that age (Odds Ratio, 1.13 [95% CI: 1.04-1.23], P=0.003) and preoperative sleep disturbance (Odds Ratio, 3.03 [95% CI: 1.09-9.52], P=0.034) were independent risk factors for the development of POD. The incidence of POD was higher in patients with pre-existing sleep disturbance than those without it. Whether improving sleep quality for preoperative sleep disturbance may help prevent POD remains to be determined.

Effect of transcranial direct current stimulation on postoperative sleep disturbance in older patients undergoing lower limb major arthroplasty: a prospective, double-blind, pilot, randomised controlled trial

BackgroundPostoperative sleep disturbance (PSD) is a common and serious postoperative complication and is associated with poor postoperative outcomes.AimsThis study aimed to investigate the effect of transcranial direct current stimulation (tDCS)...

Post-Anesthesia Sleep Disturbances: A Review Article

General anesthesia is used in modern surgical practice to achieve low-reactivity consciousness, involving analgesia, hypnosis, amnesia, and immobility. Recently, studies have revealed a complex correlation between general anesthesia and postoperative sleep disturbances. In the days following surgery, patients who have undergone anesthesia may experience an increased level of Rapid Eye Movement (REM) sleep due to the suppression of REM sleep during anesthesia. Postoperative complications, such as delirium, may be caused by these disturbances. In particular, anesthesia can exacerbate sleep disorders among vulnerable populations, including those with preexisting disabilities. Insomnia, somnolence, appetite loss, and social withdrawal can be symptoms of preexisting sleep disorders that can worsen postoperative outcomes. There is still considerable uncertainty surrounding the relationship between general anesthesia and sleep disturbances. This scoping review aims to shed light on the incidence of sleep disturbances following surgical and dental anesthesia procedures and investigate the intricate connection between postoperative sleep and general anesthesia. A pioneering study in the field of anesthesia and perioperative care is embarked upon by exploring this critically important topic.

Does Melatonin Improve Sleep Following Primary Total Knee Arthroplasty? A Randomized, Double-Blind, Placebo-Controlled Trial

BackgroundSleep impairment following total knee arthroplasty (TKA) is common and may decrease patient satisfaction and recovery. Standardized postoperative recommendations for sleep disturbances have not been established. We aimed to assess whether melatonin use could promote healthy sleep and reduce sleep disturbance in the acute period following TKA. MethodsPatients undergoing primary, elective TKA between July 19, 2021 and January 4, 2024 were prospectively enrolled and randomized to receive either 5 mg of melatonin nightly or placebo for 14 days postoperatively. Participants recorded their nightly pain on the visual analog scale, the number of hours slept, and the number of night-time awakenings in a sleep diary starting the night of surgery (postoperative day [POD] 0). Sleep disturbance was assessed preoperatively and on POD 14 using the patient-reported outcome measurement information system sleep disturbance form. Epworth Sleepiness Scores were collected on POD 14 to assess sleep quality. ResultsOf the 138 patients enrolled, 128 patients successfully completed the study protocol, with 64 patients in each group. Melatonin patients trended toward more hours of sleep on POD 2 (placebo: 5.0 ± 2.4, melatonin: 5.8 ± 2.0, P = .084), POD 3 (placebo: 5.6 ± 2.2, melatonin: 6.3 ± 2.0, P = .075), and averaged over POD 1 to 3 (placebo: 4.9 ± 2.0, melatonin: 5.6 ± 1.8, P = .073), although no differences were observed on POD 4 or after. Fewer night-time awakenings in the melatonin group were observed on POD 1 (placebo: 4.4 ± 3.9, melatonin: 3.6 ± 2.4, P = .197), although this was not statistically significant. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System Sleep Disturbance score increases were comparable for both groups (placebo: 4.0 ± 8.4, melatonin: 4.6 ± 8.2, P = .894). The melatonin (65.4%) and placebo (65%) groups demonstrated similar rates of increased sleep disturbance. ConclusionsMelatonin may promote longer sleep in the immediate postoperative period after TKA, although these benefits wane after POD 3. Disturbances in sleep should be expected for most patients, although melatonin may have an attenuating effect. Melatonin is safe and can be considered for TKA patients experiencing early sleep disturbances postoperatively.

Association between perioperative self-reported sleep disturbances and delirium risk in elderly patients following total joint arthroplasty: a cohort study.

Perioperative sleep disturbance may increase delirium risk. However, the role of perioperative sleep disturbance in delirium following total joint arthroplasty remains unclear. This prospective cohort study aimed to observe the delirium risk in patients with sleep disturbances. After excluding pre-existing sleep disturbances, older patients scheduled for total joint arthroplasty from July 17, 2022, to January 12, 2023, were recruited. Preoperative sleep disturbance or postoperative sleep disturbance was defined as a Chinese version of the Richards-Campbell Sleep Questionnaire (RCSQ) score of <50 during hospitalisation. A cut-off score of 25 was used to classify the severity of sleep disturbance. The primary outcome was the incidence of postoperative delirium. In all, 11.6% of cohort patients (34/294) developed delirium. After multivariate analysis, a preoperative Day 1 RCSQ score of ≤25 (odds ratio [OR] 3.62, 95% confidence interval [CI] 1.19-10.92; p = 0.02), occurrence of sleep disturbances (OR 2.76, 95% CI 1.19-6.38; p = 0.02) and RCSQ score of ≤25(OR 2.91, 95% CI 1.33-6.37; p = 0.007) postoperatively were strong independent predictors of delirium. After sensitivity analysis for daily delirium, a postoperative Day 1 RCSQ score of ≤25 (OR 9.27, 95% CI 2.72-36.15; p < 0.001) was associated with a greater risk of delirium on postoperative Day 1, with a reasonable discriminative area under the curve of 0.730. We concluded that postoperative but not preoperative sleep disturbances may be an independent factor for delirium risk. Sleep disturbance on the first night after surgery was a good predictor of subsequent delirium, no matter the nature of self-reported sleep disturbance.

Effect of dexmedetomidine infusion on postoperative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial

BackgroundMost women with breast cancer are prone to postoperative sleep disturbances (POSD). Little is known about the differences between sevoflurane and propofol combined with dexmedetomidine on POSD in the same context. We investigated the effect of intra-operative sevoflurane or propofol combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep structures. MethodsA monocentric, randomized-controlled, double-blind trial. Female patients undergoing radical surgery for breast cancer were randomly assigned to receive sevoflurane and placebo, sevoflurane and dexmedetomidine, propofol and placebo, or propofol and dexmedetomidine. Dexmedetomidine was administered at 1.0 μg kg−1 infusion 15 min before induction, then infused at 0.4 μg kg−1 h−1 until the surgical drain started to be placed. The primary outcome was the incidence of POSD within the postoperative first three days (defined as an Athens Insomnia Scale score ≥ 6 points on at least one day of postoperative first three days). The secondary outcome was the duration of sleep structures, collected from the Fitbit Charge 2® smart bracelet (Fitbit, Inc., San Francisco, CA, USA). ResultsThere were 188 women analyzed with the modified intention-to-treat method. The incidences of POSD in the dexmedetomidine and placebo groups were similar (p = 0.649). In the sevoflurane sedation strategy, dexmedetomidine decreased nocturnal wakefulness on postoperative first day (p = 0.001). In the propofol sedation strategy, dexmedetomidine increased nocturnal deep sleep on postoperative first (p < 0.001) and third (p < 0.001) days. ConclusionIntra-operative infusion of dexmedetomidine had no significant effect on POSD but decreased nocturnal wakefulness in the sevoflurane group and increased nocturnal deep sleep in the propofol group. Trial registrationRegistered at www.chictr.org.cn (ChiCTR2300070136).

Effects of ultrasound-guided stellate ganglion block on postoperative sore throat and postoperative sleep disturbance after lumbar spine surgery: a randomized controlled trial

BackgroundPostoperative sore throat and sleep disturbance are prevalent among patients undergoing spinal surgery, and these conditions can substantially impact their postoperative satisfaction and quality of life. The present study aimed to examine the impact of ultrasound-guided stellate ganglion block (SGB) on the occurrence of postoperative sore throat (POST) and postoperative sleep disturbance (PSD) in patients who undergo lumbar spine surgery under general anesthesia.MethodsSixty patients were randomly assigned to either the experimental group (SGB group) or the control group (CG). Both groups received the same induction and maintenance drugs. However, the SGB group received a right SGB under ultrasound guidance 15 min before anesthesia induction, while the CG did not receive any block anesthesia intervention before anesthesia induction. We monitored the incidence and severity of POST at 1, 6, 24, and 48 h after surgery in both groups. Additionally, we evaluated the deep sleep quality score on the first, second, and fifth days after surgery in both groups.ResultsThe incidence of POST at 1 h and 6 h after surgery was significantly lower in the SGB group (10.0% and 13.3%) than in the CG (43.3% and 36.7%) (P < 0.05). The postoperative sore throat scores of the SGB group (0.10 ± 0.31 and 0.17 ± 0.46) at 1 h and 6 h after surgery were lower than those of the CG (0.57 ± 0.73 and 0.50 ± 0.77) (P < 0.05). Moreover, the deep sleep quality score on the first, second, and fifth days after surgery were significantly higher in the CG (5.40 ± 3.37, 4.70 ± 3.19, 4.53 ± 3.44) than in the SGB group (3.87 ± 2.30, 3.13 ± 1.77, 3.03 ± 1.84) (P < 0.05).ConclusionUltrasound-guided SGB can reduce the incidence and severity of POST and improve PSD in patients undergoing lumbar spine surgery.Trial registrationThis study was registered on Chinese Clinical Trial Registry, (ChiCTR2200065279) on 01/11/2022.

Comparison of the Effects of Desflurane and Sevoflurane on Variations in Salivary Melatonin and Sleep Disturbance After Total Knee Arthroplasty: A Single-center, Prospective, Randomized, Controlled, Open-label Study

PurposeAnesthesia has been shown to disrupt the circadian rhythm. Recovery of the circadian rhythm after general anesthesia might help alleviate symptoms of insomnia and postoperative delirium. We hypothesized that recovery of the circadian rhythm is faster after total knee arthroplasty (TKA) with desflurane than with sevoflurane. This study compared the influence of sevoflurane versus desflurane anesthesia on the postoperative circadian rhythm of melatonin in adults undergoing TKA. DesignSingle-center, prospective, randomized, controlled, open-label study. MethodsThis study involved adult patients undergoing TKA at a university hospital in Japan from May 1, 2018 to December 31, 2019. The primary outcome of the study was the comparison of the effect of sevoflurane and desflurane on the circadian rhythm of salivary melatonin for 3 days postoperatively. The secondary outcomes were postoperative fatigue and sleep quality for 3 days postoperatively. FindingsTwenty-eight patients (American Society of Anesthesiologists physical status of I or II) were scheduled for TKA and randomized to receive sevoflurane (n = 14) or desflurane (n = 14) anesthesia. There was no significant difference in the melatonin concentration between the sevoflurane and desflurane groups. The salivary melatonin concentration after sevoflurane or desflurane anesthesia was significantly higher at 9:00 p.m. on a postoperative day (POD)0 and POD1 than on POD3 (P < .05). Patients in the desflurane group had significantly greater fatigue than those in the sevoflurane group at 7:00 a.m. and 12:00 p.m. on POD3 (P < .05). Patients in the sevoflurane group had a deeper sleep than those in the desflurane group on POD0 (P < .05). In the sevoflurane group, the sleep time during the night of POD2 was longer than that on POD0 (6.1 vs 4.2 hours, P < .05). ConclusionsUnder the current study conditions, desflurane was equivalent to sevoflurane in terms of the postoperative salivary melatonin concentration and sleep disturbance after TKA but not in terms of recovering the postoperative circadian rhythm.

Preoperative Anxiety and Its Postoperative Associated Factors in Patients Receiving Post Anesthetic Recovery Care at Surgical Intensive Care Unit

Objectives: This study determined the postoperative associated factors with preoperative anxiety in patients receiving post anesthetic recovery care at surgical intensive care unit. Methods: In this cross-sectional correlational study, 84 postoperative patients were admitted to a surgical intensive care unit for post anesthetic recovery care. Participants completed questionnaires on anxiety, pain, stress, and sleep disturbance on the preoperative day and on the morning of postoperative day 1. Data were analyzed with χ 2 -test, unpaired t-test, Pearson correlation analysis and logistic regression. Results: Forty patients (47.6%) had a high preoperative anxiety score of ≥ 18. Higher preoperative anxiety was associated with greater postoperative anxiety (r = 0.24, &lt;i&gt;p&lt;/i&gt; = 0.026), higher postoperative stress (r = 0.24, &lt;i&gt;p&lt;/i&gt; = 0.026), and poorer postoperative sleep (r = 0.39, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). High preoperative anxiety was associated with postoperative physical restraint (B = 1.72, OR: 5.59, 95% CI: 1.19-21.32). High preoperative anxiety was associated with postoperative sleep disturbance (B = 0.29, OR: 1.34, 95% CI: 1.08-1.65). Conclusions: High preoperative anxiety is associated with poorer sleep during the first postoperative night among surgical intensive care unit patients.

Prediction of risk factors of sleep disturbance in patients undergoing total hip arthroplasty.

The purpose of this study was to assess sleep quality in patients undergoing total hip arthroplasty (THA) from preoperatively to 12weeks postoperatively and to establish a risk predictor for postoperative sleep disturbance to enable early care and intervention. A self-designed data collection form was used. Patients were assessed preoperatively and at 5 postoperative time points using visual analog scale (VAS) for pain, sleep quality and neuropsychological status with the following assessment tools: the Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI), the Epworth Sleepiness Scale (CESS), the Zung Self-Rating Anxiety Scale (ZSAS) and the Epidemiological Studies Depression Scale (CESD). Univariate and multivariate logistic regression analysis was used for the identification of risk factors for postoperative sleep disturbance. The receiver operating characteristic (ROC) curve was plotted to evaluate the regression model. Of the 290 eligible patients, 193 (133 women) were included in the study. There was a 60.6% prevalence of preoperative sleep disturbance. The CPSQI score increased significantly at 2weeks postoperatively compared to preoperative baseline, but appeared to decrease at 4weeks postoperatively. Multivariate logistic regression analysis showed that pain (VAS score: OR = 1.202 [95% CI = 1.002-1.446, P < 0.05]), daytime sleepiness (CESS score: OR = 1.134 [95% CI = 1.015-1.267, P < 0.05]) and anxiety (ZSAS score: OR = 1.396 [95% CI = 1.184-1.645, P < 0.001]) were risk factors associated with postoperative sleep disturbance at 2weeks. The ROC curve showed that the AUC was 0.762, the sensitivity was 83.19% and the specificity was 64.86%. Postoperative sleep disturbance is highly prevalent in the first 2weeks after THA. The risk prediction model constructed according to the above factors has good discriminant ability for the risk prediction of sleep disturbance after THA. The use of this risk prediction model can improve the recognition of patients and medical providers and has good ability to guide clinical nursing observation and early screening of sleep disturbance after THA.

Postoperative Sleep Disturbance in Patients Undergoing Arthroplasty: Risk Prediction Modeling Based on Logistic Regression

To construct a risk predictive model for postoperative sleep disturbance (PSD) in patients undergoing arthroplasty by using logistic regression. We retrospectively collected the data of 4286 patients who underwent joint replacement surgeries at a tertiary-care hospital in Chengdu, China between January 1, 2017 and September 30, 2021. With 3001 cases in the training set and 1285 cases in the test set, we constructed the model by using a logistic regression algorithm to screen for predictors in Matlab, displaying the predicted risks of postoperative sleep disturbance with nomographs. The performance of the model was assessed by the area under the curve ( AUC) of the receiver operating characteristic curve, accuracy, precision, recall, F1 value, and calibration curve. A total of 9 predictors, including post-admission preoperative sleep disturbance, ward type, body mass index, smoking status, range of diseases, joint mobility (flexion), joint mobility (extension), preoperative last hemoglobin, and type of surgery, were eventually included in the study for predictive modeling . The performance assessment findings of the predictive model were as follows, AUC value, 0.708 (95% confidence interval: 0.677-0.740), accuracy, 75.20%, precision, 65.80%, recall, 43.70%, and F1 value, 0.525. The calibration curve showed good agreement between the predicted probabilities and the actual data. The model constructed in the study has good predictive efficacy and the nomographs are simple and easy to use. With this model, health workers can make preoperative prediction of the risk of PSD in arthroplasty patients based on the predictors, which facilitates early prevention and reduces the risk of postoperative sleep disturbance in patients.

Perioperative Use of Ketamine.

Postoperative pain continues to be one of the most common challenges following surgeries. Multimodal analgesia has been of particular focus as non-opioid alternatives have been encouraged due to concerns of the opioid epidemic. Ketamine has been an especially useful adjunct in multimodal pain regimens within the past few decades. This article highlights the current use and advances surrounding the perioperative use of ketamine. Ketamine has antidepressive effects at subanesthetic doses. Intraoperative ketamine may be beneficial in reducing postoperative depression. Additionally, newer studies are exploring whether ketamine can be useful in reducing postoperative sleep disturbances. Ketamine continues to be a great tool in perioperative pain control, especially during an opioid epidemic. As its use continues to expand and gain more popularity in the perioperative period, more research could shed light on the additional nonanalgesic benefits of ketamine use.

Neurometabolic and structural alterations of medial septum and hippocampal CA1 in a model of post-operative sleep fragmentation in aged mice: a study combining 1H-MRS and DTI.

Post-operative sleep disturbance is a common feature of elderly surgical patients, and sleep fragmentation (SF) is closely related to post-operative cognitive dysfunction (POCD). SF is characterized by sleep interruption, increased number of awakenings and sleep structure destruction, similar to obstructive sleep apnea (OSA). Research shows that sleep interruption can change neurotransmitter metabolism and structural connectivity in sleep and cognitive brain regions, of which the medial septum and hippocampal CA1 are key brain regions connecting sleep and cognitive processes. Proton magnetic resonance spectroscopy (1H-MRS) is a non-invasive method for the evaluation of neurometabolic abnormalities. Diffusion tensor imaging (DTI) realizes the observation of structural integrity and connectivity of brain regions of interest in vivo. However, it is unclear whether post-operative SF induces harmful changes in neurotransmitters and structures of the key brain regions and their contribution to POCD. In this study, we evaluated the effects of post-operative SF on neurotransmitter metabolism and structural integrity of medial septum and hippocampal CA1 in aged C57BL/6J male mice. The animals received a 24-h SF procedure after isoflurane anesthesia and right carotid artery exposure surgery. 1H-MRS results showed after post-operative SF, the glutamate (Glu)/creatine (Cr) and glutamate + glutamine (Glx)/Cr ratios increased in the medial septum and hippocampal CA1, while the NAA/Cr ratio decreased in the hippocampal CA1. DTI results showed post-operative SF decreased the fractional anisotropy (FA) of white matter fibers in the hippocampal CA1, while the medial septum was not affected. Moreover, post-operative SF aggravated subsequent Y-maze and novel object recognition performances accompanied by abnormal enhancement of glutamatergic metabolism signal. This study suggests that 24-h SF induces hyperglutamate metabolism level and microstructural connectivity damage in sleep and cognitive brain regions in aged mice, which may be involved in the pathophysiological process of POCD.