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<p>Depth-of-anesthesia monitoring, particularly in functional neurosurgical procedures such as asleep deep brain stimulation, is critical for balancing individualized neurophysiological needs with perioperative safety. Parkinson’s disease (PD) patients with rapid-eye-movement sleep behavior disorder (RBD) demonstrate wakefulness electroencephalographic (EEG) abnormalities that may confound monitoring. Whether these RBD-associated EEG patterns persist under propofol anesthesia and distort monitoring indices remains to be elucidated. This study therefore aimed to determine if propofol anesthesia in PD-RBD patients disrupts coherence between anesthesia depth indices and true neurophysiological states. We retrospectively analyzed SedLine<sup>®</sup>-monitored prefrontal EEG data from 43 PD patients undergoing subthalamic nucleus deep brain stimulation, divided into non-RBD (<i>n</i> = 23) and RBD (<i>n</i> = 20) groups. Evaluations were conducted across awake, propofol anesthesia, and propofol light anesthesia states during microelectrode recording, including power spectral density analysis, derived parameter comparisons, and postoperative outcomes. Results showed RBD patients had lower patient state index values during wakefulness (<i>p</i> = 0.034) but displayed comparable patient state index, spectral edge frequency, and suppression ratio under anesthesia; notably stronger gamma suppression occurred in RBD patients during propofol anesthesia (<i>p</i> = 0.027) and light anesthesia states (<i>p</i> = 0.011), along with higher postoperative delirium incidence (65.00%). Logistic regression identified associations between postoperative delirium risk and RBD status, Mini-Mental State Examination scores, and propofol-induced theta power, with theta power emerging as a protective factor. Collectively, PD-RBD patients exhibit abnormal EEG under propofol anesthesia but maintain reliable depth-of-anesthesia indices, necessitating customized anesthesia care and delirium prevention. </p><p><i>Clinical Trial Number</i>: ChiCTR2400082770, 2024-04-07, ClinicalTrials.gov).</p>

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Impact of rapid-eye-movement sleep behavior disorder on propofol anesthesia depth monitoring in parkinson’s disease

  • 期刊论文

  • 发表日期：

    2025年12月9日

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  • Yuting Ling,
  • Lige Liu,
  • Qingyuan Xiao,
  • Libo Huang,
  • Qianqian Guo,
  • Simin Wang,
  • Bo Qu,
  • Zhishuang Wen,
  • Bin Wu,
  • Changming Zhang,
  • Baoshu Xie,
  • Nengjin Zhu,
  • Jianping Chu,
  • Ling Chen,
  • Jinlong Liu,
  • Nan Jiang

摘要

Depth-of-anesthesia monitoring, particularly in functional neurosurgical procedures such as asleep deep brain stimulation, is critical for balancing individualized neurophysiological needs with perioperative safety. Parkinson’s disease (PD) patients with rapid-eye-movement sleep behavior disorder (RBD) demonstrate wakefulness electroencephalographic (EEG) abnormalities that may confound monitoring. Whether these RBD-associated EEG patterns persist under propofol anesthesia and distort monitoring indices remains to be elucidated. This study therefore aimed to determine if propofol anesthesia in PD-RBD patients disrupts coherence between anesthesia depth indices and true neurophysiological states. We retrospectively analyzed SedLine®-monitored prefrontal EEG data from 43 PD patients undergoing subthalamic nucleus deep brain stimulation, divided into non-RBD (n = 23) and RBD (n = 20) groups. Evaluations were conducted across awake, propofol anesthesia, and propofol light anesthesia states during microelectrode recording, including power spectral density analysis, derived parameter comparisons, and postoperative outcomes. Results showed RBD patients had lower patient state index values during wakefulness (p = 0.034) but displayed comparable patient state index, spectral edge frequency, and suppression ratio under anesthesia; notably stronger gamma suppression occurred in RBD patients during propofol anesthesia (p = 0.027) and light anesthesia states (p = 0.011), along with higher postoperative delirium incidence (65.00%). Logistic regression identified associations between postoperative delirium risk and RBD status, Mini-Mental State Examination scores, and propofol-induced theta power, with theta power emerging as a protective factor. Collectively, PD-RBD patients exhibit abnormal EEG under propofol anesthesia but maintain reliable depth-of-anesthesia indices, necessitating customized anesthesia care and delirium prevention.

Clinical Trial Number: ChiCTR2400082770, 2024-04-07, ClinicalTrials.gov).