The glymphatic system, which provides clearance for CNS metabolites, plays a key role in maintaining brain homeostasis, especially during sleep. Its dysfunction induced by prolonged general anesthesia can cause persistent postoperative sleep disorders. The paper describes in detail the pathophysiological mechanisms of this process, including the inhibition of aquaporin-4 activity, the development of oxidative stress and neuroinflammation, as well as the alteration of neurovascular and circadian regulation. Particular attention is paid to the effect of anesthetics on the suprachiasmatic nucleus and melatonin secretion, which leads to the disorganization of the normal sleep pattern. The role of genetic factors, particularly the APOE4 allele, in increasing vulnerability to anesthetic effects is demonstrated. Chronotherapy, using melatonin, antioxidants, and glymphatic function modulators to restore physiological sleep patterns, is considered a promising therapeutic approach. The data obtained emphasize the need to develop personalized anesthesia protocols, considering the effect on the glymphatic system and circadian rhythms to prevent postoperative chronopathological disorders.
Kicherova et al. (Thu,) studied this question.