Effects of Dexmedetomidine on Postoperative Sleep Quality

A Systematic Review and Meta-analysis of Randomized Controlled Trials

Huizi Liu; Hanwei Wei; Shaojie Qian; Jintao Liu; Weicai Xu; Xiaopan Luo; Junbiao Fang; Qiaoyan Liu; Fang Cai


BMC Anesthesiol. 2023;23(88) 

In This Article

Abstract and Introduction


Study Objectives: To assess the effect of dexmedetomidine (DEX) on postoperative sleep quality using polysomnography (PSG) to identify possible interventions for postoperative sleep disturbances.

Methods: An electronic search of PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science was conducted from database inception to November 20, 2022. Randomized controlled trials (RCTs) on the effect of DEX administration on postoperative sleep quality using PSG or its derivatives were included. No language restrictions were applied. The sleep efficiency index (SEI), arousal index (AI), percentages of stage N1, N2 and N3 of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep were measured in our meta-analysis.

Results: Five studies, involving 381 participants were included. Administration of DEX significantly improved SEI, lowered AI, decreased the duration of stage N1 sleep and increased the duration of stage N2 sleep compared to placebo groups. There were no significant differences in the duration of stage N3 sleep and REM sleep. DEX administration lowered the postoperative Visual Analogue Scale (VAS) score and improved the Ramsay sedation score with no adverse effect on postoperative delirium (POD). However, high heterogeneity was observed in most of the primary and secondary outcomes.

Conclusions: Our study provides support for the perioperative administration of DEX to improve postoperative sleep quality. The optimal dosage and overall effect of DEX on postoperative sleep quality require further investigation using large-scale randomized controlled trials.


Sleep disturbances, including sleep deprivation, disruption, and abnormal architecture, are prevalent in postoperative patients.[1] Studies using polysomnography (PSG) have shown that the sleep pattern of patients is characterized by a disorganized circadian rhythm, prolonged sleep latency, fragmented sleep, decreased sleep efficiency, abnormally increased stages 1 and 2 of non-rapid eye movement (NREM) sleep (also called stage N1 and N2 sleep), decreased or absent stage 3 of NREM sleep (also called stage N3 sleep or slow-wave sleep) and rapid eye movement (REM) sleep.[2,3] Postoperative sleep disturbances can result in significant adverse outcomes, including delirium, cardiovascular events, impaired immune function, prolonged mechanical ventilation, and postoperative physical and mental health decline.[4–6] Therefore, interventions to improve postoperative sleep quality are attracting considerable attention from anesthesiologists.

Dexmedetomidine (DEX), an α-2 adrenergic agonist with high specificity, has been widely used as a sedative, anxiolytic, sympatholytic, and analgesic-sparing agent in clinics.[7] Compared to gamma-aminobutyric acid (GABA) agonists, DEX more closely resembles natural NREM sleep.[8,9] Several studies have reported favorable effects of DEX on sleep quality in patients after surgery or in the intensive care unit (ICU), as evaluated by objective tools, sleep questionnaires, or subjective assessments.[10–14] However, no meta-analysis of randomized controlled trials (RCTs) has focused on the effect of DEX on sleep quality in postoperative patients, and the optimal dosage and overall effect of DEX remain unclear.

To summarize the available evidence and guide clinical practice, we conducted this systematic review and meta-analysis to evaluate the effects of DEX on postoperative sleep quality using PSG or its derivatives to identify possible interventions for postoperative sleep disturbance. We aimed to provide aggregated data and make a more validated conclusion regarding the administration of DEX to improve postoperative sleep.