Effect of Intraoperative Dexmedetomidine Dose on Postoperative First Night Sleep Quality in Elderly Surgery Patients: A Retrospective Study With Propensity Score-Matched Analysis

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.

Effect of Dexmedetomidine on Postoperative Sleep Quality: A Systematic Review

“…As for the different time point, the DEX was used during the surgery for sedation in nine studies, 5 , 7 , 10 , 15–18 , 21 , 26 as an adjuvant for the regional block in one studies, 22 for postoperative analgesia in nine studies 8 , 12–14 , 19 , 23–25 , 27 and both in surgery and after surgery in eight studies. 9 , 11 , 20 And in 2 retrospective study 15 , 16 and one RCT 25 compared the effect of sleep quality of low dose of DEX (<0.2 μg/kg/h) and high dose (>0.2 μg/kg/h). As for other RCT studies, nine studies used DEX at a low dose and ten studies used DEX at a high dose.…”

“…And 6 of these studies showed that perioperative use of DEX increased the incidence of hypotension or significantly lowered blood pressure compared to the controls group. [11][12][13]15,24,25 The other 6 studies did not find associations between the use of DEX and hypotension. 14,17,19,23,26,27 Nine studies compared the effect of perioperative DEX versus the control group on postoperative bradycardia.…”

Successful peripheral nerve block under dexmedetomidine sedation for femoral neck fracture fixation in a 97-year-old patient

“… 17 18 Furthermore, in elderly patients, intraoperative DEX use can remarkably improve the first night sleep quality after surgery, resulting in PD prevention. 19 DEX has been used safely not only in our patient but also in another super-old patient. 20 Briefly, DEX can be a useful anaesthetic adjuvant for a wide range of clinical applications due to its safety and effectiveness.…”

“…Moreover, DEX exhibits neuroprotective effects and decreases the incidence of PD,16 leading to shorter hospital stays 17 18. Furthermore, in elderly patients, intraoperative DEX use can remarkably improve the first night sleep quality after surgery, resulting in PD prevention 19. DEX has been used safely not only in our patient but also in another super-old patient 20.…”

Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

“…Moreover, recent studies have suggested that intraoperative dexmedetomidine infusion is associated with lower incidence of postoperative acute kidney injury, diminished opioid consumption, and shorter extubation time and hospital stay in older adult patients [1]. It may also improve the quality of the first night's sleep following surgery [2][3][4].…”