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<b>Background</b>: <p>Postoperative sleep disturbance (PSD) after major abdominal surgery in older adults is common and impairs recovery. Dexmedetomidine is a selective α<sub>2</sub>-adrenergic agonist with sedative, analgesic, and anti-inflammatory properties that promotes natural sleep. We hypothesized that intraoperative dexmedetomidine would reduce PSD in this population.</p> <b>Methods</b>: <p>In this randomized, double-blind, placebo-controlled trial, 210 older adults undergoing major abdominal surgery were randomly assigned (1:1:1) to receive intraoperative normal saline, dexmedetomidine 0.3 μg/kg/h, or 0.6 μg/kg/h. The primary outcome was PSD on the first postoperative night (Athens Insomnia Scale score ≥ 6). Secondary outcomes included PSD on until nights 30; pain at 24 and 48 h; delirium and depressive symptoms within 7 days; and recovery quality on postoperative days 1‒3. Sleep patterns on nights 1 and 2 were assessed using wrist actigraphy. This trial was registered on the Chinese Clinical Trial Registry (Identifier: ChiCTR2300073163; principal investigator: Ke Peng; dated July 23, 2023; <a href="https://www.chictr.org.cn/showproj.html?proj=199410">https://www.chictr.org.cn/showproj.html?proj=199410</a>).</p> <b>Results:</b> <p>203 patients (median age 71 years; 67.5% male) completed this trial. Compared with normal saline (<i>n</i> = 67), both low-dose (<i>n</i> = 68) and high-dose dexmedetomidine (<i>n</i> = 68) significantly reduced first-night PSD (20.6% vs 65.7%; relative risk 0.31, 95% CI 0.19–0.50; NNT 2.2; <i>P</i> &lt; 0.001; and 11.8% vs 65.7%; relative risk 0.18, 95% CI 0.09–0.34; NNT 1.8; <i>P</i> &lt; 0.001, respectively). The two doses did not differ. Dexmedetomidine was associated with lower sleep disturbance on night 2 and higher recovery quality, without between-group differences in hypotension, bradycardia, delirium, or 30-day mortality. Exploratory actigraphy analysis (<i>n</i> = 20 per group) showed longer total sleep time and lower wake-time percentage associated with dexmedetomidine.</p> <b>Conclusions</b>: <p>Intraoperative dexmedetomidine infusion reduced the relative risk of first-night PSD by 70–80% among older adults undergoing major abdominal surgery. These findings require confirmation in multicenter trials.</p>

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Intraoperative dexmedetomidine reduces postoperative sleep disturbance in older adults undergoing major abdominal surgery: a single-center, randomized, double-blind, placebo-controlled trial

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  • 发表日期：

    2026年7月3日

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  • Hui-ping Peng,
  • Jing-hui Hu,
  • Li-ping Fan,
  • Xiu Yang,
  • Hua-yue Liu,
  • Xi-sheng Shan,
  • Hong Liu,
  • Nazneen Sudhan,
  • Fu-hai Ji,
  • Ke Peng

摘要

Background:

Postoperative sleep disturbance (PSD) after major abdominal surgery in older adults is common and impairs recovery. Dexmedetomidine is a selective α2-adrenergic agonist with sedative, analgesic, and anti-inflammatory properties that promotes natural sleep. We hypothesized that intraoperative dexmedetomidine would reduce PSD in this population.

Methods:

In this randomized, double-blind, placebo-controlled trial, 210 older adults undergoing major abdominal surgery were randomly assigned (1:1:1) to receive intraoperative normal saline, dexmedetomidine 0.3 μg/kg/h, or 0.6 μg/kg/h. The primary outcome was PSD on the first postoperative night (Athens Insomnia Scale score ≥ 6). Secondary outcomes included PSD on until nights 30; pain at 24 and 48 h; delirium and depressive symptoms within 7 days; and recovery quality on postoperative days 1‒3. Sleep patterns on nights 1 and 2 were assessed using wrist actigraphy. This trial was registered on the Chinese Clinical Trial Registry (Identifier: ChiCTR2300073163; principal investigator: Ke Peng; dated July 23, 2023; https://www.chictr.org.cn/showproj.html?proj=199410).

Results:

203 patients (median age 71 years; 67.5% male) completed this trial. Compared with normal saline (n = 67), both low-dose (n = 68) and high-dose dexmedetomidine (n = 68) significantly reduced first-night PSD (20.6% vs 65.7%; relative risk 0.31, 95% CI 0.19–0.50; NNT 2.2; P < 0.001; and 11.8% vs 65.7%; relative risk 0.18, 95% CI 0.09–0.34; NNT 1.8; P < 0.001, respectively). The two doses did not differ. Dexmedetomidine was associated with lower sleep disturbance on night 2 and higher recovery quality, without between-group differences in hypotension, bradycardia, delirium, or 30-day mortality. Exploratory actigraphy analysis (n = 20 per group) showed longer total sleep time and lower wake-time percentage associated with dexmedetomidine.

Conclusions:

Intraoperative dexmedetomidine infusion reduced the relative risk of first-night PSD by 70–80% among older adults undergoing major abdominal surgery. These findings require confirmation in multicenter trials.