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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

Authors Duan G, Wang K, Peng T, Wu Z, Li H

Received 22 November 2019

Accepted for publication 3 March 2020

Published 12 March 2020 Volume 2020:12 Pages 209—219


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Steven A Shea

Guangyou Duan,* Kai Wang,* Taotao Peng, Zhuoxi Wu, Hong Li

Department of Anesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Hong Li
Department of Anesthesiology, Second Affiliated Hospital, Army Medical University, Chongqing 400037, People’s Republic of China
Tel +8613608380123
Fax +862368774997

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

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