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

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. 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). 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. 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. Many older adults sleep poorly after major abdominal surgery, which can slow recovery. Dexmedetomidine is a commonly used sedative during anesthesia that also promotes natural sleep. We tested whether giving dexmedetomidine during surgery helps them sleep better. We randomly assigned 210 patients aged 65 or older to receive either saline or one of two doses of dexmedetomidine during their operation. We then measured their sleep quality after surgery. About two-thirds of patients receiving saline had poor sleep on the first night. Those receiving dexmedetomidine slept much better, with sleep problems dropping by 70% to 80%. They also recovered faster without side effects. This suggests that adding this medicine during surgery could help older patients sleep and recover better. Larger studies are needed to confirm this. Peng, Hu, Fan et al. conduct a randomized trial testing whether intraoperative dexmedetomidine improves sleep after major abdominal surgery in older adults. They find that dexmedetomidine significantly reduces first-night sleep disturbance without increasing adverse events.