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

Abstract

Study objectives To assess the effect of dexmedetomidine (DEX) on postoperative sleep quality using polysomnography (PSG) to identify possible interventions for postoperative sleep disturbances. Methods An electronic search of PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science was conducted from database inception to November 20, 2022. Randomized controlled trials (RCTs) on the effect of DEX administration on postoperative sleep quality using PSG or its derivatives were included. No language restrictions were applied. The sleep efficiency index (SEI), arousal index (AI), percentages of stage N1, N2 and N3 of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were measured in our meta-analysis. Results Five studies, involving 381 participants were included. Administration of DEX significantly improved SEI, lowered AI, decreased the duration of stage N1 sleep and increased the duration of stage N2 sleep compared to placebo groups. There were no significant differences in the duration of stage N3 sleep and REM sleep. DEX administration lowered the postoperative Visual Analogue Scale (VAS) score and improved the Ramsay sedation score with no adverse effect on postoperative delirium (POD). However, high heterogeneity was observed in most of the primary and secondary outcomes. Conclusions Our study provides support for the perioperative administration of DEX to improve postoperative sleep quality. The optimal dosage and overall effect of DEX on postoperative sleep quality require further investigation using large-scale randomized controlled trials.

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

“…Comparable sleep alterations have not been documented with dexmedetomidine administration (Figure). 6,7 A recent meta-analysis of 5 randomized controlled trials (381 adults total) compared the sleep quality of patients who received dexmedetomidine pre-, peri-, or postoperatively to either placebo or other analgesics or sedating medications after elective surgery. Significant sleep quality improvements were observed in sleep efficiency (ratio of total sleep time/ time observed) and arousal (arousals per hours of sleep) indices, as well as decreased "light" (stage 1) and increased "deeper" (stage 2) sleep among those who received dexmedetomidine.…”

“…The study revealed no differences with respect to stage 3 or REM sleep. 6 A randomized, double-blind, placebo-controlled study by Wu et al 7 examined intraoperative dexmedetomidine infusion versus saline for 96 adults undergoing endoscopic sinus surgery. Each patient was observed for 1 night both preoperatively and postoperatively, where sleep architecture independent of sedating medications was analyzed using polysomnography.…”

“…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.…”

“…10 In contrast, dexmedetomidine’s alpha-2 agonism within the brainstem’s locus coeruleus is believed to exert sedative effects via an endogenous sleep pathway more closely resembling physiologic sleep. 6,11 This mechanism, in combination with its favorable effects on postsurgical inflammation, pain, and delirium, may improve postoperative sleep patterns. 6,7,11…”

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

“…Following publication of the original article [ 1 ], the authors reported an error under the Discussion section, page 11. Figure 4 citation should be corrected to Figure 2.…”