Effect of dexmedetomidine infusion on post-operative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial

Yu-Shan Dong; Mao-San Wang; Wen-Zhan Li; Kai Zhao; Xiao-Jie Cui; Yan-Ming Yang; Xing-Yu Geng; Yu-Tian Pu; Zi-Wei Hu; Can Fang; Gao-Chao Lv; Su Liu; Xiu-Xia Chen

doi:10.1016/j.accpm.2024.101358

Effect of dexmedetomidine infusion on post-operative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial

Anaesth Crit Care Pain Med. 2024 Feb 14:101358. doi: 10.1016/j.accpm.2024.101358. Online ahead of print.

Authors

Yu-Shan Dong¹, Mao-San Wang¹, Wen-Zhan Li¹, Kai Zhao², Xiao-Jie Cui¹, Yan-Ming Yang¹, Xing-Yu Geng¹, Yu-Tian Pu¹, Zi-Wei Hu¹, Can Fang¹, Gao-Chao Lv¹, Su Liu³, Xiu-Xia Chen⁴

Affiliations

¹ Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
² Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China.
³ Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
⁴ Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China. Electronic address: cxxlxy@sina.com.

PMID: 38365169
DOI: 10.1016/j.accpm.2024.101358

Abstract

Background: Most women with breast cancer are prone to post-operative sleep disturbances (POSD). Little is known about the differences between sevoflurane and propofol combined with dexmedetomidine on POSD in the same context. We investigated the effect of intra-operative sevoflurane or propofol combined with intravenous dexmedetomidine on the incidence of POSD and post-operative sleep structures.

Methods: A monocentric, randomized-controlled, double-blind trial. Female patients undergoing radical surgery for breast cancer were randomly assigned to receive sevoflurane and placebo, sevoflurane and dexmedetomidine, propofol and placebo, or propofol and dexmedetomidine. Dexmedetomidine was administered at 1.0 μg kg^-1 infusion 15 min before induction, then infused at 0.4 μg kg^-1 h^-1 until the surgical drain started to be placed. The primary outcome was the incidence of POSD within the postoperative first three days (defined as an Athens Insomnia Scale score ≥ 6 points on at least one day of post-operative first three days). The secondary outcome was the duration of sleep structures, collected from the Fitbit Charge 2® smart bracelet (Fitbit, Inc., San Francisco, CA, USA).

Results: There were 188 women analyzed with the modified intention-to-treat method. The incidences of POSD in the dexmedetomidine and placebo groups were similar (P = 0.649). In the sevoflurane sedation strategy, dexmedetomidine decreased nocturnal wakefulness on post-operative first day (P = 0.001). In the propofol sedation strategy, dexmedetomidine increased nocturnal deep sleep on post-operative first (P < 0.001) and third (P < 0.001) days.

Conclusion: Intra-operative infusion of dexmedetomidine had no significant effect on POSD but decreased nocturnal wakefulness in the sevoflurane group and increased nocturnal deep sleep in the propofol group.

Trial registration: Registered at www.chictr.org.cn (ChiCTR2300070136).

Keywords: Breast cancer; Dexmedetomidine; Propofol; Sevoflurane; Sleep disturbance.