Improve Postoperative Sleep: What Can We Do?

Su X and Wang DX

Current Opinion in Anesthesiology 2018, 31:83-88

Aim of Study

Review of evidence regarding occurence,risk factors, harmful effects, preventions and management of sleep disturbances in patients after surgery .

Design

Authors reviewed many papers and journals which involvedrandomized control trials , cross-sectional prospective cohort study

Key Points

Sleep disturbances frequently occur after surgery , especially after major surgery. Multiple factors are associated with occurrence of postoperative sleep disturbances:

• Elderly patients more prone
• Preoperative co-morbidities : Prior OSA & myocardial events show positive associations
• Choice of anesthesia : Regional less then GA
• Types of surgeries : More severe with major surgeries

Harmful Effects Of Sleep Disturbances on Post-operative Outcomes

• Delirium : Important risk factor for delirium development
• Pain : Relationship between sleep and pain found to be reciprocal
• Cardiovascular events : Increased risk of cardiovascular events in high risk patients
• Post-operative recovery : Delayed hospital discharge in patients with sleep disturbances

Measures to improve post-operative sleep disturbances

Non pharmacological measures : Minimising surgical insult resulted in better post operative sleep

Pharmacological :

• Zolpidem : First night after surgery zolpidem administration enhanced quality sleep and reduced fatigue feelings
• Melatonin : Improved sleep quality without significant side effects
• Dexmedetomidine : On mechanically ventilated pts dexmedetomidine preserved day-night sleep cycle and sleep architecture , increasing sleep efficency and stage N2 sleep
• In non mechanically ventilated elderly pts in ICU after surgery : Dexmedetomidine infusion 0.1mcg/kg/hr on night after surgery prolonged total sleep time, increased N2 stage, improved subjective sleep quality

Effects of sleep promotion on patients outcome after surgery : Usage of ear plugs, eye masks reduced delirium in post-operative period

Low dose Dexmedetomidine infusion significantly decreased the incidence of post operative delirium.

Conclusion

Sleep disturbances frequently occur after surgery, especially major surgery. Factors responsible are elderly age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative painand environmental stress. Development of sleep disturbances produces harmful effects on postoperative patients, that is, higher delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery. Both non pharmacological and pharmacolgical measures can be used to improve postoperative recovery .

Limitations from the study

Low numbers of patients in the study group

Further study is required to prove the long term effects of sleep promotion therapy .

Discussion from Journal Club Meeting

Importance of post opearative sleep disturbances discussed. Both non pharmacological and pharmacological measures discussed .

Use of Dexmedetomidine infusion in postoperative patients admitted in Kingston Hospital ITU discussed.

Summary by Dr D Dhanda. Journal club meeting 09 May 2019.