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)

Conclusion

In conclusion, our systematic review and meta-analysis provided support for the perioperative administration of DEX in improving postoperative sleep quality by increasing the percentage of stage N2 sleep and sleep efficiency, prolonging the duration of TST, and decreasing the percentage of stage N1 sleep and sleep arousals. In addition, DEX, used as an adjuvant for pain management, provided effective postoperative analgesia. Based on these results, future studies are needed to determine the optimal dosage and regimen, timing of administration, overall efficacy, and safety of DEX in a broad range of patient populations.

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Acknowledgements
Not applicable.

Funding
The present study was supported by the National Key Research and Development Program of China (No: 2018YFC2001904).

Data Availability
The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

Declarations
Ethics approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Competing interests
The authors declare that they have no competing interests.

Table 1. Baseline characteristics of included trials
First author, year of publication	Country	Type of surgery	Age range(yr)	Males(%)	Control group	No. randomized	No. in DEX group	No. in control group	ICU stay	DEX starting time	DEX dosage	Variables provided
Wu XH²⁰, 2016	China	Non-cardiac Surgery	≥ 65	57.9	Placebo	61	31	30	Yes	Postoperative	0.1 μg/kg/h, lasting 15 h	SEI, TST, AI, N1, N2, N3, REM
Chen ZC¹³, 2017	China	Abdominal hysterectomy	30–55	NR	Placebo	59	30	29	No	PCA	Continuous dose: 0.05 μg/kg/h Bolus dose: 0.05 μg/kg	SEI, AI, N1, N2, N3, REM, Ramsay, VAS
Jiang ZM¹⁸, 2018	China	Abdominal surgery	60–70	58.8	Placebo	97	Low dose group: 32 High dose group: 33	32	No	PCA	Low dose group: 0.072 μg/kg/h continuous dose, 0.024 μg/kg bolus dose High dose group: 0.144 μg/kg/h continuous dose, 0.048 μg/kg bolus dose	SEI, AI, N1, N2, N3, REM, VAS
Sun YM¹⁹, 2022	China	Non-cardiac surgery	≥ 18	51.4	Placebo	68	33	35	Yes	Postoperative	0.1–0.2 μg/kg/h, lasting 72 h	SEI, TST, AI, N1, N2, N3, REM
Wu Y¹⁴, 2022	China	Endoscopic sinus surgery	18–65	55	Placebo	96	48	48	No	Intraoperative	Loading dose: 0.5 μg/kg, continuous infusion: 0.2 μg/kg/h	SEI, AI, REM, Ramsay, VAS, PONV, POD

NR, not reported; PCA, patient controlled analgesia; SEI, sleep efficiency index; TST, total sleep time; AI, arousal index; N1, stage 1 of non-rapid eye movement sleep; N2, stage 2 of non-rapid eye movement sleep; N3, stage 3 of non-rapid eye movement sleep; REM, rapid eye movement sleep; VAS, visual analogue scale; PONV, postoperative nausea and vomiting; POD, postoperative delirium

Table 2. Subgroup analysis stratified by severity of illness
	Subgroup	Sample size		Weight (%)	MD with [95%CI]	Z	I ²(%)	P value
	Subgroup	DEX	Control	Weight (%)	MD with [95%CI]	Z	I ²(%)	P value
SEI	ICU	64	65	35.5	9.98 [3.48, 16.47]	3.01	0	0.003
SEI	Non-ICU	143	109	64.5	11.64 [-0.39, 23.66]	1.90	98	0.06
AI	ICU	64	65	21.9	-1.27 [-2.73, 0.18]	1.72	0	0.09
AI	Non-ICU	143	109	78.1	-2.51 [-4.17, -0.86]	2.98	96	0.003
N1	ICU	64	65	37.6	-8.09 [-14.93, -1.26]	2.32	0	0.02
N1	Non-ICU	95	61	62.4	-12.88 [-26.83, 1.08]	1.81	99	0.07
N2	ICU	64	65	24.4	7.21 [-7.88, 22.30]	0.94	39	0.35
N2	Non-ICU	95	61	75.6	17.82 [13.53, 22.12]	0.13	79	< 0.00001
N3	ICU	64	65	0	NE	NA	NA	NA
N3	Non-ICU	95	61	100	-2.09 [-7.51, 3.33]	0.76	92	0.45
REM	ICU	33	35	30.6	0 [-0.04, 0.04]	0	NA	1
REM	Non-ICU	143	109	69.4	-0.34 [-2.32, 1.64]	0.33	92	0.74

SEI, sleep efficiency index; AI, arousal index; N1, stage 1 of non-rapid eye movement sleep; N2, stage 2 of non-rapid eye movement sleep; N3, stage 3 of non-rapid eye movement sleep; REM, rapid eye movement sleep; MD, mean difference; CI, confidence interval; NE, not estimable; NA, not applicable