Critical Care Medicine  |   November 2016
Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit: A Pilot Randomized Controlled Trial
Author Notes
  • From the Departments of Anesthesiology and Critical Care Medicine (X.-H.W., F.C., Z.-T.M., D.-X.W.), Respiratory Disease and Critical Care Medicine (C.Z., J.M., G.-F.W.), and Biostatistics (S.-N.Z.), Peking University First Hospital, Beijing, China; and Section of Anaesthetics, Pain Management and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom (D.M.). Current position: Department of Anesthesiology, Peking University Shenzhen Hospital, Shenzhen, China (X.-H.W.).
  • Submitted for publication November 30, 2015. Accepted for publication July 19, 2016.
    Submitted for publication November 30, 2015. Accepted for publication July 19, 2016.×
  • Corresponding article on page 835.
    Corresponding article on page 835.×
  • Part of the work presented in this article has been presented at the 2015 annual meeting of the European Society of Anaesthesiology (Euroanaesthesia 2015, Berlin, Germany, May 30 to June 2, 2015).
    Part of the work presented in this article has been presented at the 2015 annual meeting of the European Society of Anaesthesiology (Euroanaesthesia 2015, Berlin, Germany, May 30 to June 2, 2015).×
  • Address correspondence to Dr. Wang: Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China. wangdongxin@hotmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Clinical Science / Cardiovascular Anesthesia / Critical Care / Geriatric Anesthesia / Pharmacology / Respiratory System / Sleep Medicine
Critical Care Medicine   |   November 2016
Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit: A Pilot Randomized Controlled Trial
Anesthesiology 11 2016, Vol.125, 979-991. doi:10.1097/ALN.0000000000001325
Anesthesiology 11 2016, Vol.125, 979-991. doi:10.1097/ALN.0000000000001325
Abstract

Background: Patients admitted to the intensive care unit (ICU) after surgery often develop sleep disturbances. The authors tested the hypothesis that low-dose dexmedetomidine infusion could improve sleep architecture in nonmechanically ventilated elderly patients in the ICU after surgery.

Methods: This was a pilot, randomized controlled trial. Seventy-six patients age 65 yr or older who were admitted to the ICU after noncardiac surgery and did not require mechanical ventilation were randomized to receive dexmedetomidine (continuous infusion at a rate of 0.1 μg kg−1 h−1; n = 38) or placebo (n = 38) for 15 h, i.e., from 5:00 pm on the day of surgery until 8:00 am on the first day after surgery. Polysomnogram was monitored during the period of study-drug infusion. The primary endpoint was the percentage of stage 2 non–rapid eye movement (stage N2) sleep.

Results: Complete polysomnogram recordings were obtained in 61 patients (30 in the placebo group and 31 in the dexmedetomidine group). Dexmedetomidine infusion increased the percentage of stage N2 sleep from median 15.8% (interquartile range, 1.3 to 62.8) with placebo to 43.5% (16.6 to 80.2) with dexmedetomidine (difference, 14.7%; 95% CI, 0.0 to 31.9; P = 0.048); it also prolonged the total sleep time, decreased the percentage of stage N1 sleep, increased the sleep efficiency, and improved the subjective sleep quality. Dexmedetomidine increased the incidence of hypotension without significant intervention.

Conclusions: In nonmechanically ventilated elderly patients who were admitted to the ICU after noncardiac surgery, the prophylactic low-dose dexmedetomidine infusion may improve overall sleep quality.