A randomized placebo-controlled double-blind study of dexmedetomidine on postoperative sleep quality in patients with endoscopic sinus surgery

Abstract

Background Postoperative sleep disorder is common and may cause aggravated postoperative pain, delirium, and poor prognosis. We accessed the effect of intraoperative intravenous dexmedetomidine on postoperative sleep quality in patients with endoscopic sinus surgery. Methods This single-center, double-blind, placebo-controlled randomized clinical trial enrolled a total of 110 participants aged 18 years to 65 years who were scheduled to receive endoscopic sinus surgery. Placebo (normal saline) or dexmedetomidine infusion (load dose 0.5 μg kg−1 over 10 min, followed by maintenance dose 0.2 ug kg−1 h−1) during surgery. The primary outcome was postoperative sleep quality. Secondary outcomes were postoperative Ramsay sedation scores, Visual Analog Scale (VAS) scores, serum cortisol, 5-hydroxytryptamine (5-HT) and hypocretin, delirium, and postoperative nausea and vomiting (PONV). Results Among enrolled 110 patients, 55 were randomized to administer intraoperative dexmedetomidine and placebo. In total, 14 patients (7 in each group) were excluded because of protocol deviations, and 96 patients (48 in each group) were included in the per-protocol analysis. The dexmedetomidine group had a significantly higher sleep efficiency index(SEI) (66.85[3.00] vs 65.38[3.58]), the ratio of rapid eye movement sleep to total sleep(REM)(13.63[1.45] vs 12.38[2.11]) and lower arousal index (AI) (7.20[1.00] vs 8.07[1.29]), higher Ramsay sedation score at post-operation 1 h, 12 h point, lower VAS scores at post-operation 1 h, 12 h, 24 h point, lower cortisol, higher 5-HT and hypocretin in serum than the placebo group. Conclusion In this randomized clinical trial, dexmedetomidine can improve the sleep quality of patients undergoing endoscopic sinus surgery. These results suggest that this therapy may be a viable strategy to enhance postoperative sleep quality in patients with endoscopic sinus surgery. Trial registration The study was approved by the Bethune International Peace Hospital Ethics Committee (2021-KY-129) and registered in the Chinese Clinical Trial Registry (www.chictr.org.cn/index.aspx, 28/09/2021).

Effects of dexmedetomidine on postoperative sleep quality: a systematic review and meta-analysis of randomized controlled trials

“…After reviewing the full text of the remaining 52 potentially eligible articles, 21 were excluded because they were study protocols, one was a review, 15 had no PSG data, seven were not for surgical patients, one was not an adult study, one was not an RCT, and one had no control group. Five eligible studies were identified [13,14,[18][19][20]. The selection process is illustrated in Fig.…”

“…Compared to gamma-aminobutyric acid (GABA) agonists, DEX more closely resembles natural NREM sleep [8,9]. Several studies have reported favorable effects of DEX on sleep quality in patients after surgery or in the intensive care unit (ICU), as evaluated by objective tools, sleep questionnaires, or subjective assessments [10][11][12][13][14]. However, no meta-analysis of randomized controlled trials (RCTs) has focused on the effect of DEX on sleep quality in postoperative patients, and the optimal dosage and overall effect of DEX remain unclear.…”

Dexmedetomidine for Preventing Sleep Disturbance after Ambulatory Anesthesia: A Case Report

“…6,11 This mechanism, in combination with its favorable effects on postsurgical inflammation, pain, and delirium, may improve postoperative sleep patterns. 6,7,11 Sleep disturbances after ambulatory procedures have also been documented; 4 however, the true incidence and severity are difficult to quantify given insufficient followup. We report the case of a 24-year-old man with a history of ASD, who experienced a propofol-induced exacerbation of an underlying sleep-onset disorder that did not recur with the primary use of dexmedetomidine during an outpatient procedure.…”

“…1,2 Propofol exposure has been shown to impair sleep quality, [3][4][5] whereas similar effects have not been observed with dexmedetomidine administration. 6,7 Propofol-induced sleep disturbance may be related to circadian rhythm alterations at the level of the suprachiasmatic nuclei (SCN) and impaired melatonin production. 8 Circadian rhythm sleep-wake disorders are known to be common among patients with autism spectrum disorder (ASD).…”

“…6,11 This mechanism, in combination with its favorable effects on postsurgical inflammation, pain, and delirium, may improve postoperative sleep patterns. 6,7,11…”