Effect of Dexmedetomidine on Postoperative Sleep Quality: A Systematic Review

Figures & data

Figure 1 Flow chart of the study.

Abbreviation: ICU, intensive care unit.

Table 1 Studies Included in This Systematic Review

	Type of Study	Sample Size	Age (Con/Dex)	Surgery	Interventions	Control	Level of Evidence
Mao et al, 2020^Citation20	RCT	56	63/65	Lateral thoracotomy	10 mins befor induction: DEX 0.5 μg/kg/h; During surgery: DEX 0.2–0.4 μg/kg/h; For 5 days after surgery: DEX 0.06 μg/kg/h	Placebo	I
Liu et al, 2020^Citation18	RCT	119	70/70/70	Total hip arthroplasty	During surgery: DEX 0.6 μg/kg; After surgery: FCIB	Placebo; FCIB	II
Shi et al, 2020^Citation17	RCT	106	69/69	Thoracoscopic lobectomy	During surgery: DEX 0.5 μg/kg/h	Placebo	I
Duan et al, 2020^Citation16	Retrospective cohort study	7418	54/53	Non-cardiac surgery	During surgery: DEX 0.2–0.7μg/kg/h	Placebo	III
Cai et al, 2020^Citation15	Retrospective cohort study	4379	72/71/71	Non-cardiac surgery	During surgery low dose: DEX 0.1–0.2 μg/kg/h; During surgery high dose: DEX >0.2 μg/kg/h	Placebo	III
Song et al, 2019^Citation5	RCT	75	42/43	Laproscopic abdominal surgery	During surgery in day group and night group	None	II
Sun et al, 2019^Citation19	RCT	557	68/69	Non-cardiac surgery	PCIA: DEX 0.1 μg/kg/h with sufentanil 2 μg/kg and tropisetron 6 mg	PCIA: 2 μg/kg sufentanil and 6mg tropisetron	I
Yu et al, 2019^Citation21	RCT	557	31/31	Cesarean surgery	During surgery after delivery: DEX 0.5 μg/kg for 20 mins; PCIA: DEX 150 μg and sufentanil 150 μg	Placebo after delivery; PCIA: sufentanil 150 μg	I
Li et al, 2018^Citation14	RCT pilot study	58	67/69	Open abdominal surgery	PCIA: DEX 2 μg/mL and 0.5 mg/mL morphine	PCIA: 0.5 mg/mL morphine	II
Author	Type of study	Sample size	Age (Con/Dex)	Surgery	Interventions	Control	Level of evidence
Su et al, 2017^Citation13	RCT	700	——	Non-cardiac surgery	After surgery: 0.1μg/kg/h to the 0800h on postoperative day 1	Placebo	I
Chen et al, 2017^Citation12	RCT	60	45/43	Abdominal hysterectomy	PCIA: DEX 0.05 μg/kg/h with sufentanil 0.02 μg/kg/h	PCIA: sufentanil 0.02 μg/kg/h	I
Qin et al, 2017^Citation24	RCT	60	58/59	Partial laryngectomy	PCIA: DEX 4 μg/mL with sufentanil 1 μg/mL	PCIA: sufentanil 1 μg/mL	II
Lu et al, 2017^Citation27	Cohort study	20	52/45	Abdominal surgery	After surgery: 0.2–0.7 μg/kg/h during first night after surgery (20:00–8:00)	Placebo	II
Shi et al, 2017^Citation23	RCT	46	48/49	Radical mastectomy	15 mins before surgery: 1 μg/kg; During surgery: 0.4 μg/kg/h	Placebo	II
Wu et al, 2016^Citation11	RCT pilot study	76	76/74	Non-cardiac surgery	DEX 0.1 μg/kg/h from 5:00 PM on the day of surgery to 8:00 AM on the 1st day after surgery	Placebo	I
Jiang et al, 2018^Citation25	RCT	99	65/64/64	Abdominal surgery	PCIA D1: DEX 2.4 μg/kg with oxycodone 0.6 mg/kg; PCIA D2: DEX 4.8μg/kg with oxycodone 0.6 mg/kg	PCIA: oxycodone 0.6 mg/kg	II
Tan et al, 2016^Citation7	RCT	66	71/70/73	TURP	During surgery: DEX 1.2 μg/kg/h	Placebo or midazolam 0.225 mg/kg/h	I
Tan et al, 2016^Citation26	RCT	161	56/53/56	Thoracic surgery	During surgery: DEX 1μg/kg/h	Placebo	II
Chen et al, 2016^Citation10	RCT	60	60/57	Laparoscopic colorectal resection	10 mins before surgery: DEX 1 μg/kg; During surgery: DEX 0.3 μg/kg/h	Placebo	I
Author	Type of study	Sample size	Age (Con/Dex)	Surgery	Interventions	Control	Level of evidence
Ghali et al, 2015^Citation22	RCT	60	62/61	Vitreoretinal surgery	Regional anesthesia: DEX 20μg with 0.75% levobupivacaine 4mL and 15 IU hyaluronidase	Regional anesthesia: 0.75% levobupivacaine 4mL and 15 IU hyaluronidase	I
Yang et al, 2015^Citation9	RCT	79	51/50	Microvascular free flap surgery	During surgery: DEX 0.5 μg/kg/h; After surgery: DEX 0.2–0.7 μg/kg/h to the 6:00 AM next morning	Placebo	I
Corbett et al, 2005^Citation8	RCT	89	62/64	CABG	After surgery: DEX 0.4 μg/kg/h	After surgery: propofol 0.2–0.7 μg/kg/h	II

Abbreviations: RCT, randomized controlled trials; DEX, dexmedetomidine; FCIB, post-fascia iliaca compartment block; PCIA, patient-controlled intravenous analgesia; TURP, transurethral resection of the prostate; CABG, coronary artery bypass grafting.

Table 2 Objective and Subjective Evaluations of Sleep Quality of Patients in Perioperative Period

Evaluation	Evaluation Content	Result	Supporting Studies
Subjective tools
SMH	Subjective sleep quality, clear-headed after getting up in the morning, sleep satisfaction	DEX: improved sleep quality on POD2 and POD5; more clear-headed after getting up on POD5; no differences in sleep satisfaction	During and after surgery
PSQI	Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction	DEX: lower PSQI scores, improved subjective sleep quality	During surgery
NRS	Subjective sleep quality, a scale of 0–10	DEX: improved subjective sleep quality; better sleep quality in low dose group; lower incidence of sleep disturbance	During surgery
			After surgery
		DEX:	During and after surgery
RCSQ	Wake after sleep onset, sleep depth, sleep quality, the severity of sleep-onset, the severity of going back to sleep if awakened	DEX: higher subjective quality on POD 1, 2 and 3	After surgery
ISI	The severity of sleep-onset, sleep maintenance difficulties, satisfaction with current sleep pattern, interference with daily functioning, noticeability impairment and degree of distress or concern caused by sleep disorder	DEX: lower sleep score on POD2 not in POD7 or POD42	During surgery
AIS	Sleep latency, awakenings during the night, final awakening earlier than desired, sleep duration, sleep quality, sense of well-being functioning (physical and mental) and sleepiness during the day	DEX: improved subjective sleep quality on POD2 and 3 not on POD1 in day group	During and after surgery
CSD	The quality of sleep (very poor, poor, fair, good, very good)	DEX: higher rates of good sleep quality on POD1	During surgery
Other simple questions	Total sleep time; the quality of sleep	DEX: longer total sleep time on POD1	During surgery
Evaluation	Evaluation content	Result	Supporting studies
		DEX: more sleeping difficulty; less sleeping disturbance	After surgery
Objective tools
Portable sleep monitor	Sleep efficiency, the percentage of REM sleep, unstable and stable sleep	DEX: higher sleep efficiency, longer unstable sleep in day group; lower REM sleep and stable sleep in night group	During and after surgery
PSG	The sleep efficiency index, arousal index and percentage of REM, and stage 1, 2, and 3 sleep	DEX: improved sleep efficiency index, lower arousal index, higher N2 sleep, lower N1 sleep and no differences in REM and N3 sleep on POD 1 and 2	After surgery
BIS	The level of sedation, sleep depth, sleep efficiency index and total sleep time	DEX: higher sleep efficiency and longer total sleep time;	After surgery
		DEX: less sleep efficiency and shorter total sleep time; no differences in sleep efficiency on POD 1 and 2	During surgery

Abbreviations: SMH, St. Mary Hospital Sleep Questionnaire; PSQI, Pittsburgh Sleep Quality Index; NRS, Numeric Rating Scales; RCSQ, Richards Campbell Sleep Questionnaire; ISI, insomnia severity index; AIS, Athens Insomnia Scale; CSD, the consensus sleep diary; PSG, polysomnography; BIS, bispectral index.

Table 3 Other Perioperative Outcomes of Use of Dexmedetomidine in Perioperative Period

Other Perioperative Outcomes
Postoperative nausea and vomiting
Pain
Perioperative delirium
Adverse events
Bradycardia
Hypotension

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