| Background:Sleep is a spontaneous and reversible resting state that occurs periodically,manifested as a decrease in the body’s responsiveness to external stimuli and a temporary interruption of consciousness.Sleep occupies one-third of life,has important physiological functions,can eliminate fatigue,improve memory,enhance immunity,regulate emotions,promote children’s growth and development,accelerate skin regeneration,etc.Severe sleep disorders can lead to impaired neural reflexes,decreased pain threshold,decreased memory,impaired glucose tolerance,hormone secretion disorders,weakened immunity,increased sympathetic nerve activity,etc.Surgery and anesthesia are noxious stimuli to the body.For patients undergoing general anesthesia and surgery,preoperative emotional anxiety,pain in the affected area,and ambient noise can easily lead to preoperative sleep deprivation.The sleep compensation effect of intraoperative sedative drugs,postoperative pain,nausea and vomiting and other symptoms can also lead to postoperative sleep disorders.However,there is still a lack of relevant clinical studies on the evaluation and treatment of perioperative sleep disorders in plastic surgery patients.This study focuses on clinical observations of perioperative sleep in patients undergoing plastic surgery,and explores safe and effective treatments for postoperative sleep disorders.Objective:1.To observe the effects of the number and duration of general anesthesia exposure on the sleep quality of 6 to 15-year-old school-going children who undergo plastic surgery procedures.2.To evaluate the changes in sleep patterns of patients the night before general anesthesia in maxillofacial plastic surgery.3.To study the efficacy and safety of dexmedetomidine nasal spray in the treatment of postoperative sleep disturbance.Methods and Results:Part 1:Effects of Multiple Exposures to General Anesthesia on the Sleep Quality of Children after Plastic SurgeryMethods:The study was conducted on 688 children who underwent plastic surgery between the ages of 6 and 15 years using the Sleep Disorder Scale for Children(SDSC).The children were divided into two groups according to their exposure to general anesthesia:No General Anesthesia and General Anesthesia groups.The General Anesthesia group was further divided into three subgroups according to the number of exposures:Single-exposure,Double-exposure,and Multiple-exposure groups.The General Anesthesia group was also divided into two groups according to the cumulative total time of anesthesia exposure:<3 h and≥3 h groups.Multivariate logistic regression analysis was used to confirm the potential factors(gender,number of anesthesia exposures,duration of anesthesia exposure,age of first anesthesia exposure,age of last anesthesia exposure,time from first anesthesia exposure to assessment,time from last anesthesia exposure to assessment)that affect children with sleep disturbance(The Sleep Disturbance Scale for Children scores>39)after the general anesthesia exposure.Linear regression was used to analyze the correlation of the factors with The Sleep Disturbance Scale for Children scores.Results:The total Sleep Disturbance Scale for Children scores was higher in the General Anesthesia group[35.4±4.3 vs.34.0±3.6,P<0.0001]as compared to No Anesthesia Group.The number of children with Sleep Disturbance Scale for Children scores>39 was also higher in the General Anesthesia group[80(17.5%)vs.17(7.4%),P<0.0001].SDSC score and sleep disturbance(SDSC>39)were positively correlated with the number of anesthesia exposures.More anesthesia exposure was correlated with higher total Sleep Disturbance Scale for Children scores[34.5±4.3 for single exposure vs 35.1±3.9 for double exposure vs 37.5±4.5 for multiple exposures,P<0.0001]and a higher proportion of sleep disturbance[24(12.0%)for single exposure vs 24(15.5%)for double exposure vs 32(31.1%)for multiple exposures,P<0.0001].Longer anesthesia exposure was also correlated with higher total Sleep Disturbance Scale for Children scores[34.4±4.5 for<3 h vs.35.8±4.2 for>3 h,P=0.002].The number of exposures to general anesthesia was a risk factor in sleep disturbance among children based on logistic regression.Part 2:Changes in sleep patterns of patients undergoing general anesthesia for maxillofacial plastic surgeryMethods:A total of 200 consecutive craniofacial plastic surgery patients were enrolled in this study,aged 18-40 years,regardless of gender,ASA Ⅰ or Ⅱ grade.PSQI was used to evaluate sleep quality 1 month before surgery(baseline)and on the night before surgery.According to the baseline sleep quality score,patients were assigned to the sleep disorder group(SD group,PSQI score>5)or non-sleep disorder group(NSD group,PSQI score≤5).The PSQI score on the night before the operation was compared with the baseline score.Multivariate logistic regression was used to analyze possible predictors of sleep disorders and PSQI score changes.Variables included age,gender,BMI,baseline sleep quality,and surgical complexity.Results:Sixteen patients who did not stay in the craniofacial ward on the night before surgery were excluded,providing a final total of 184 patients,including 19 males and 165 females,aged 18-40 years.Among the 184 patients,51 cases had sleep disturbance(27.7%),133 cases had no sleep disturbance(72.3%)in the baseline.On the night before surgery,there were 89 patients with sleep disorders(48.4%),and the incidence was significantly higher than the baseline level(89,48.4%vs 51,27.7%,P=0.03 7).On the night before surgery,the PSQI score of the NSD group was significantly higher than the baseline(5.6±3.2 vs 2.4±1.4,P<0.0001),but it was still lower than that of the SD group(5.6±3.2 vs 7.4±4.1,P=0.009).On the night before surgery,the time to fall asleep was significantly prolonged.The sleep duration,the total time in bed,and the sleep efficiency was significantly reduced compared with the baseline in the NSD group.On the night before surgery,the sleep duration and the total time in bed were also reduced in the SD group,however,with no significant change in PSQI score.Based on multivariate logistic regression analysis,baseline sleep quality was a potential factor affecting sleep quality on the night before surgery,gender was a potential factor affecting PSQI score changes significantly on the night before surgery compared to baseline.Men were 2.909 times more likely to change their sleep quality on the night before surgery than women.Part 3:Feasibility of dexmedetomidine intranasal atomisation in the treatment of first night sleep disturbance after maxillofacial plastic surgeryMethods:A total of 117 patients with maxillofacial surgery under general anesthesia and endotracheal intubation were enrolled,including 16 males and 101 females,aged 18-40 years,with ASA I or II grades.The patients were randomly divided into three groups:blank control group(BC group),1.0 μg/kg dexmedetomidine group(1.0 Dex group)and 1.5 μg/kg dexmedetomidine group(1.5 Dex group),each group 39 cases.At 21:30 on the night after the operation,the 1.0 Dex group and the 1.5 Dex group were given dexmedetomidine 1 μg/kg and 1.5 μg/kg nasal spray,respectively.The Pittsburgh Sleep Quality Index(PSQI)scale was used to evaluate the baseline sleep status of patients 1 month before surgery and the sleep status on the night after surgery,polysomnography(PSG)was used to record the sleep status on the night after surgery.Record the night after the operation of rescue sedative and analgesic drugs and adverse reactions,total hospital stay and total cost.Results:Compared with the BC group,the 1.0 Dex group and the 1.5 Dex group had prolonged N2 sleep,shortened wake-up time,decreased number of awakenings,and significantly improved sleep efficiency(P<0.05).Compared with the BC group and the 1.0 Dex group,the N3 stage sleep in the 1.5Dex group was prolonged(P<0.05).Compared with the BC group,the PSQI scores of the 1.0 Dex group and the 1.5 Dex group were significantly lower on the night after surgery,and the proportion of PSQI>5 was significantly lower(P<0.05).Conclusion:1.Among plastic surgery children aged 6 to 15 years,children who had experienced general anesthesia exposure had poor sleep quality and a high incidence of sleep disorders.And the more anesthesia exposure times,the longer the cumulative anesthesia exposure time,the worse the sleep quality of children,and the higher the incidence of sleep disorders.The number of anesthesia exposure might be a potential factor in inducing sleep disturbance in children.2.In maxillofacial plastic surgery patients,the incidence of sleep disturbance on the night before surgery was significantly higher than the baseline level.For those without sleep disorders,the incidence of sleep disorders on the night before surgery was significantly higher.For those with sleep disorders,there was no significant change in the incidence of sleep disorders on the night before surgery compared with the baseline level.Baseline sleep quality was a potential factor that affects sleep disturbances on the night before surgery;gender was a potential factor that affects the significant changes in PSQI scores on the night before surgery.Men were more likely to have large changes in sleep quality on the night before surgery than at baseline.3.1 μg/kg and 1.5 μg/kg dexmedetomidine atomized nasal spray can safely and effectively prolong N2 sleep,shorten the wake-up time,reduce the number of wake-ups,and improve the sleep quality of patients with maxillofacial surgery on the night after surgery.1.5 μg/kg dexmedetomidine atomized nasal spray can prolong N3 period sleep reduce the number of postoperative rescue use of sufentanil,reduce the incidence of postoperative sore throat,and shorten the length of hospital stay. |
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