Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit

Abstract

Background Patients admitted to the intensive care unit (ICU) after surgery often develop sleep disturbances. The authors tested the hypothesis that low-dose dexmedetomidine infusion could improve sleep architecture in nonmechanically ventilated elderly patients in the ICU after surgery. Methods This was a pilot, randomized controlled trial. Seventy-six patients age 65 yr or older who were admitted to the ICU after noncardiac surgery and did not require mechanical ventilation were randomized to receive dexmedetomidine (continuous infusion at a rate of 0.1 μg kg−1 h−1; n = 38) or placebo (n = 38) for 15 h, i.e., from 5:00 pm on the day of surgery until 8:00 am on the first day after surgery. Polysomnogram was monitored during the period of study-drug infusion. The primary endpoint was the percentage of stage 2 non–rapid eye movement (stage N2) sleep. Results Complete polysomnogram recordings were obtained in 61 patients (30 in the placebo group and 31 in the dexmedetomidine group). Dexmedetomidine infusion increased the percentage of stage N2 sleep from median 15.8% (interquartile range, 1.3 to 62.8) with placebo to 43.5% (16.6 to 80.2) with dexmedetomidine (difference, 14.7%; 95% CI, 0.0 to 31.9; P = 0.048); it also prolonged the total sleep time, decreased the percentage of stage N1 sleep, increased the sleep efficiency, and improved the subjective sleep quality. Dexmedetomidine increased the incidence of hypotension without significant intervention. Conclusions In nonmechanically ventilated elderly patients who were admitted to the ICU after noncardiac surgery, the prophylactic low-dose dexmedetomidine infusion may improve overall sleep quality.

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

“…Prior studies have demonstrated that increased postoperative pain scores were associated with an increased rate of postoperative delirium (27,28). Additionally, the current study found that patients receiving dexmedetomidine had improved sleep quality, which is similar to previous work (29,30). While quality improvement projects aimed at improving sleep have been shown to reduce delirium, other data has shown that sleep quality is not associated with transition to delirium (31)(32)(33).…”

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…Neither study, however, demonstrated a decrease in sleep fragmentation or an increase in deep sleep or REM sleep that are thought to be the most restorative sleep stages and thus potentially most important to recovery. A third, observational trial, not included in this analysis, corroborated these findings with regard to sleep architecture and noted preserved day-night cycling when dexmedetomidine was administered overnight in mechanically ventilated ICU patients (522). One recently published double-blind, placebocontrolled RCT of 100 delirium-free critically ill adults receiving sedatives, and not included in the evidence profile, found that the administration of low-dose dexmedetomidine did not change Leeds Sleep Evaluation Questionnaire scores between the dexmedetomidine and placebo groups (370).…”

Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety

“…This is a central neural pathway playing a key role in inducing natural sleep. Dexmedetomidine has been shown to have the ability to improve natural sleep when given to intensive care patients in both low, non-sedative dosages [18] and in sedative dosages [19]. Dexmedetomidine also lowers sympathetic tone.…”