Intraoperative Dexmedetomidine Infusion Improved Postoperative Sleep Quality and Melatonin Secretion in Patients Undergoing Elective Thoracoscopic Lung Surgery: A Prospective, Randomized Study.

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Nature and Science of Sleep Pub Date : 2024-12-10 eCollection Date: 2024-01-01 DOI:10.2147/NSS.S491084

Bin Mei, Xiao Yang, Yue-Yue Yang, Jun-Tao Weng, San-Dong Cao, Rui Yang, Guanghong Xu

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Abstract

Background: Dexmedetomidine has been reported to improve postoperative sleep quality. However, the underlying mechanism remains unclear. This study aimed to investigate the effect of intraoperative dexmedetomidine infusion on postoperative sleep quality and changes in melatonin secretion in older patients undergoing elective thoracoscopic lung surgery.

Methods: A total of 126 older patients were randomly divided into two groups: dexmedetomidine group (Group D), which received continuous dexmedetomidine infusion at 0.3-0.5 µg/(kg·h) combined with propofol during surgery, and propofol group (Group P), which received propofol alone. The primary outcome was the postoperative sleep quality on the first postoperative night, assessed by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcomes included sleep quality scores on the second and third postoperative nights, melatonin concentrations postoperatively, and the incidence of delirium on the first and seventh postoperative days (discharge day).

Results: On the first postoperative night, Group D had a higher sleep quality score compared to Group P (57±11.4 vs 53±10.3; [95% CI, 1.1 to 8.7];P = 0.012), with no difference between the groups on the second and third postoperative nights. There was no statistically significant difference in the preoperative and postoperative night 3 urine 6-SMT concentrations between the two groups (P > 0.05); however, Group D had significantly higher urine 6-SMT concentrations on postoperative nights 1 and 2 compared to Group P (27 (24, 30) vs 21 (17, 24); [95% CI, -8.56 to -4.73]; P = 0.000. 28 (25, 30) vs 26 (21, 27); [95% CI, -4.37 to -1.65]; P = 0.000). There was no significant difference in the incidence of postoperative delirium between the two groups (P=0.65).

Conclusion: Continuous intraoperative infusion of dexmedetomidine can effectively improve sleep quality during the first postoperative night by promoting melatonin secretion over the first two postoperative nights.

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背景：据报道，右美托咪定可改善术后睡眠质量。然而，其潜在机制仍不清楚。本研究旨在探讨术中输注右美托咪定对择期接受胸腔镜肺部手术的老年患者术后睡眠质量和褪黑激素分泌变化的影响：将126名老年患者随机分为两组：右美托咪定组（D组）和丙泊酚组（P组），前者在术中持续输注0.3-0.5 µg/(kg-h)的右美托咪定，后者仅输注丙泊酚。主要结果是术后第一晚的睡眠质量，由理查兹-坎贝尔睡眠问卷（RCSQ）评估。次要结果包括术后第二晚和第三晚的睡眠质量评分、术后褪黑素浓度以及术后第一天和第七天（出院日）的谵妄发生率：术后第一晚，D 组的睡眠质量评分高于 P 组（57±11.4 vs 53±10.3；[95% CI，1.1 至 8.7]；P = 0.012），术后第二晚和第三晚各组间无差异。两组患者术前和术后第 3 晚的尿液 6-SMT 浓度差异无统计学意义（P > 0.05）；但与 P 组相比，D 组患者术后第 1 晚和第 2 晚的尿液 6-SMT 浓度明显更高（27（24，30） vs 21（17，24）；[95% CI，-8.56 to -4.73]；P = 0.000。28（25，30） vs 26（21，27）；[95% CI，-4.37 to -1.65]; P = 0.000）。两组术后谵妄发生率无明显差异（P=0.65）：结论：术中持续输注右美托咪定可在术后前两晚促进褪黑激素分泌，从而有效改善术后第一夜的睡眠质量。

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.