The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study

Abstract

Objective

The study aimed to investigate the effects of intraoperative dexmedetomidine on postoperative sleep disturbance for different surgical patients and compare such effects between different dose of dexmedetomidine.

Methods

A total of 7418 patients undergoing nine types of non-cardiac major surgeries were retrospectively studied. Patients were separated into DEX (dexmedetomidine) or Non-DEX (Non-dexmedetomidine) groups based on the use of dexmedetomidine during surgery. The patients who reported they could not fall asleep during the night or woke up repeatedly during the most of the night at the day of the surgery and whose NRS were >6 were defined as cases with severe sleep disturbance. Propensity score matched analysis based on all preoperative baseline data was performed along with logistic regression analysis including different surgery types and dosage of dexmedetomidine use.

Results

In both of the unmatched cohort (OR, 0.49 [95% CI: 0.43–0.56]) and matched cohort (0.49 [95% CI: 0.42–0.58]), the DEX group had a significantly lower incidence of severe sleep disturbance than the Non-DEX group. In the subgroup analysis, for gynecological and urological surgery population, the ORs for DEX-group reached 0.21 (95% CI, 0.13–0.33; P<0.0001) and 0.30 (95% CI,0.19–0.47; P<0.0001), respectively. In addition, low-dose dexmedetomidine (0.2–0.4 μg·kg⁻¹·h⁻¹) showed the greatest effect with an odds ratio of 0.38 (95% CI: 0.31–0.44; P<0.0001), and the incidence of severe sleep disturbance in the low-dose group was significantly lower (11.5% vs. 17.7% vs. 16.5%, P<0.0001) than that in the medium- (0.4–0.6 μg·kg⁻¹·h⁻¹) and high-dose (0.6–0.8 μg·kg⁻¹·h⁻¹) groups.

Conclusion

Intraoperative dexmedetomidine use can significantly decrease the incidence of severe sleep disturbance on the day of surgery for patients undergoing non-cardiac major surgery, and the effects were most significant in patients receiving gynecological and urological surgery. Furthermore, low-dose dexmedetomidine (0.2–0.4 μg·kg⁻¹·h⁻¹) is most effective for prevention of postoperative sleep disturbance.

Keywords:

• dexmedetomidine
• intraoperative use
• postoperative sleep disturbance

Abbreviations

DEX, dexmedetomidine; Non-DEX, Non-dexmedetomidine; BMI, Body Mass Index; OSAHS, Obstructive sleep apnea hypopnea syndrome; ASA, American Society of Anesthesiologists; ENT, ear-nose-throat; PCIA, patient controls intravenous analgesia; PONV, Postoperative nausea and vomiting; OR, odds ratio; CI, confidence interval; Ref., Reference.

Data Sharing Statement

The dataset in the current study is available from the corresponding author (email: [email protected]) on reasonable request.

Author Contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest in this work.

Additional information

Funding

The study was supported by National Key Research and Development Project (No. 2018YFC0117200), and Clinical Research Projects of Second Affiliated Hospital, Army Medical University (No. 2015YLC09 and 2016YLC10).