[Effect of intraoperative dexmedetomidine on postoperative sleep disturbance in elderly surgical patients: a prospective multicenter cohort study].

OBJECTIVES

To investigate the association between intraoperative dexmedetomidine administration and postoperative sleep disturbance in elderly patients undergoing noncardiac surgeries.

METHODS

This prospective observational study included patients aged ≥65 years undergoing noncardiac surgeries between April, 2020 and April, 2022 in multiple hospitals. The primary outcome was the incidence of postoperative sleep disturbance within 3 days after surgery, assessed using the Sleep Quality-Numeric Rating Scale. The secondary outcomes included the incidences of sleep disturbance on the night of surgery and two subsequent nights, postoperative severe pain, postoperative delirium, acute kidney injury, stroke and pulmonary infection. Univariate and multivariate logistic regression analyses were conducted to explore the relationship between dexmedetomidine and postoperative sleep disturbance. Propensity score matching was used to balance the baseline characteristics, and subgroup analyses were performed to explore the association between dexmedetomidine and postoperative sleep disturbance.

RESULTS

Among the 5245 patients, 1352 (25.78%) developed postoperative sleep disturbance within 3 days after surgery. The incidence of postoperative sleep disturbance was significantly lower in dexmedetomidine group than in the non-dexmedetomidine group (unadjusted: 21.0% vs 27.9%, P<0.001; PSM: 20.7% vs 25.4%, P<0.001). Dexmedetomidine was significantly associated with a reduced risk of postoperative sleep disturbance (unadjusted: OR=0.69, 95% CI: 0.60-0.79, P<0.001; Model I: OR=0.76, 95% CI: 0.66-0.87, P<0.001; Model II: OR=0.75, 95% CI: 0.65-0.87, P<0.001; PSM: OR=0.77, 95% CI: 0.65-0.91, P<0.001), and the association remained significant in subgroup analyses for gender, ASA classification, surgery duration, and surgical types). The incidences of severe postoperative pain, postoperative delirium and pulmonary infection were all significantly lower in dexmedetomidine group.

CONCLUSIONS

Intraoperative dexmedetomidine administration is associated with reduced postoperative sleep disturbance in elderly patients undergoing noncardiac surgery and lowers the incidences of severe postoperative pain, postoperative delirium and pulmonary infections.