Effects Of Intranasal Spray Dexmedetomidine On Postoperative Sleep Quality In Elderly Sleep Disorder Patients

Objective:The purpose of this study was to investigate the effect of dexmedetomidine on postoperative sleep quality in elderly patients with sleep disorders by intranasal spray dexmedetomidine,and to provide a new reference for the treatment of perioperative sleep disorders..Methods:The study was a prospective randomized controlled trial involving 110 elderly patients with sleep disorders who underwent total joint arthroplasty.The Pittsburgh Sleep Quality Index(PSQI)and Insomnia Severity Indeex(ISI)were used to assess the Sleep Quality of the subjects at admission.And the sleep of patients was monitored by the acti-graph,which can provide sleep data such as total sleep time,sleep efficiency,wake after sleep onset,n-wake.After the 1-night adaptation period,sleep monitoring data on the second night of admission were taken as baseline,and the time point was recorded as T0.Demographic data,medical history,preoperative CRP,Il-6 and ESR were collected.The anesthesia operation was performed according to the standardized anesthesia management plan,and the data such as the amount of drugs used and the amount of drugs in and out during the operation were collected,and the postoperative analgesia management plan of patients was unified.After surgery,subjects were randomly assigned to dexmedetomidine group or placebo group to enter the intervention period.Dexmedetomidine group was given 2.0ug/kg intranasal spray dexmedetomidine at 21:00 from the night after surgery to the night before discharge,while control group was given the same amount of normal saline.And the sleep of patients was monitored by acti-graph.At the same time,LSEQ was used to assess sleep improvement of patients everyday.PSQI and ISI were used to evaluate the overall sleep quality of patients before and after hospitalization.Acute delirium was assessed with the 3minute delirium Scale daily after surgery,and cognitive function was assessed with the simple intelligent mental state Scale(MMSE)before and after hospitalization.The incidence of postoperative acute complications,postoperative length of hospital stay,and CRP,IL-6,ESR)were recorded during hospitalization.Telephone follow-up was conducted 30 days after discharge,and PSQI was used to evaluate sleep quality and patient recovery 1 month after surgery.Results:1.There was no statistical difference in basic information and anesthesia operation data between the two groups(P>0.05).2.objective sleep monitoring results:There were no statistical differences in sleep monitoring indicators,including total sleep time、sleep efficiency,sleep latency,WASO,wake times,between the two groups(P>0.05).After treatment,total sleep time、sleep efficiency,sleep latency,WASO,wake times in the Dexmedetomidine group were significantly improved compared with the placebo group3.Comparison of overall sleep quality:there were no statistically significant differences in PSQI score and ISI score between the two groups before treatment.After treatment,PSQI and ISI scores in DEX group were significantly lower than those in placebo group(P<0.01).PSQI:Dex group 8.87±2.97 vs placebo group 12.91±2.11;ISI:Dex group:8.89±2.11 vs placebo group 12.78±2.82.LSEQ was used to evaluate the improvement of sleep quality per night:in the comparison of GTS,QOS,BFW,the score of DEX group was significantly higher than that of placebo group(P<0.05).In AFS,there was no statistical significance between the two groups(P>0.05).It proved that the subjective sleep quality was significantly improved in the dexmedetomidine group.4.Secondary outcome measures:Inflammatory factor levels:There were no significant differences in the levels of CRP,IL-6 and ESR between the two groups before surgery(P>0.05).and the levels of inflammatory markers in both groups were significantly increased after surgery,among which the levels of CRP and IL-6 in the DEX group were lower than the placebo group(P<0.05).There was no significant difference in ESR level between the two groups(P>0.05).Pain:There was no statistically significant difference in the overall postoperative pain degree between the two groups(P>0.05).The additional utilization rate of opioid analgesics in the DEX group was significantly lower than that in the placebo group(P<0.05).Cognitive function:The incidence of postoperative acute delirium was no significant difference between the two groups(P>0.05).There was no statistical significance in the incidence of adverse reactions and postoperative complications in the two groups(P>0.05),and the median length of postoperative hospital stay in both groups was 5 days,and there was no statistical significance in the difference between the two groups(P>0.05).Conclusions:This study found that dexmedetomidine 2ug/kg nasal spray administration can effectively can improve the perioperative sleep quality of elderly sleep disorders,effectively reduce postoperative inflammatory stress and the use of opioids.