The Effects Of Dexmedetomidine-assisted Sedation On Postoperative Sleep Quality Of Patients Undergoing Spinal Anesthesia

Objective:To evaluate the effect of dexmedetomidine-assisted sedation on postoperative sleep quality in patients undergoing spinal anesthesia.Methods:There were 51 patients undergoing high ligation and stripping of the great saphenous vein under spinal anesthesia,using random number table method to divide patients into dexmedetomidine group（n₁=25）and control group（n₂=26）.After the anesthesia was stable,dexmedetomidine group started intravenous pumping of dexmedetomidine 6μg·kg^-1·h^-1 for 10 minutes,giving a loading dose,and then continued pumping at a rate of 0.6μg·kg^-1·h^-1 until the operation ended;Control group was injected intravenously with an equal amount of 0.9%sodium chloride solution.And recorded the patient’s preoperative Pittsburgh Sleep Quality Index（PSQI）scores,and the St.Mary’s Hospital Sleep Questionnaire（St.Mary’s Hospital Sleep Questionnaire,SMH）scale scores of 1 day before surgery,1st day after surgery,and 2nd day after surgery,and visual analogue scale（VAS）pain scores on the first and second days after surgery.We also recorded the patient’s 1 day before operation,1st day after operation and 2nd day after operation objective sleep parameters such as sleep efficiency（%）,latency to fall asleep（min）,total sleep time（min）,awakening time（min）,number of awakenings recorded by w GT3X-BT actigraphy（Actigraphy）,as well as preoperative serum melatonin,cortisol,serotonin levels and postoperative hospital stays.Results:In terms of the objective sleep quality parameters recorded by the actigraphy,there was no significant difference in sleep efficiency,total sleep time,awakening time,and number of awakenings between the two groups at each time point（P>0.05）.The change trends of objective sleep quality parameters of the two groups of were the same over time.Compared with the day before surgery（D₀）,the sleep efficiency,total sleep time,and number of awakenings on the 1st day after surgery（D₁）decreased,and the awakening time increased,and the difference was statistically significant（P<0.05）.And compared with the 1st day after surgery（D₁）,the two groups of patients had higher sleep efficiency,total sleep time,and lower awakening time on the 2nd day after surgery（D₂）,and the difference was statistically significant（P<0.05）.In addition,compared with the day before surgery（D₀）,the sleep efficiency and total sleep time of the two groups of patients on the 2nd day（D₂）after surgery were still low,and the awakening time was still high,the difference was statistically significant（P<0.05）.In terms of subjective sleep quality parameters recorded by the SMH scale,there was no statistically significant difference between the two groups of patients in the SMH scale total score,sleep quality score,sleep satisfaction score,daytime function score,sleep-onset disorder score,and night waking frequency score on the day before surgery（D₀）（P>0.05）.But on the first day after surgery（D₁）,the total score of SMH scale,sleep-onset disorder score of dexmedetomidine group were lower than those of control group,and the difference was statistically significant（P<0.05）.There was no significant difference in sleep quality score,sleep satisfaction score,daytime function score,and night awakening frequency score between the two groups（P>0.05）.On the second day after surgery（D₂）,the sleep-onset disorder score of dexmedetomidine group was still lower than that of control group,and the difference was statistically significant（P<0.05）,while the difference in other subjective sleep quality parameters between the two groups was not statistically significant（P>0.05）.The change trends of the subjective sleep quality parameters of the two groups of patients were similar over time.Among them,compared with the day before surgery（D₀）,the subjective sleep quality parameters of the1st day after surgery（D₁）were all decreased,and the difference was statistically significant（P<0.05）.And compared with the 1st day after surgery（D₁）,the subjective sleep quality parameters of the two groups of patients on the 2nd day after surgery（D₂）were increased,and the difference was statistically significant（P<0.05）.Moreover,compared with the day before surgery（D₀）,the sleep satisfaction scores of the two groups of patients on the 2nd day after surgery（D₂）were still low,while the sleep disorder scores increased,and the difference was statistically significant（P<0.05）,there was no statistically significant difference in other subjective sleep quality parameters（P>0.05）.At the same time,the postoperative VAS pain score has a strong negative correlation with the total score of the SMH scale and the sleep efficiency recorded by the Actigraphy.The correlation coefficients of VAS score and SMH scale score on the 1st day after surgery（D₁）and the 2nd day after surgery（D₂）were r₁=-0.793,P<0.05 and r₂=-0.562,P<0.05,and the correlation coefficients between VAS score and the sleep efficiency recorded by the Actigraphy were r₁=-0.645,P<0.05 and r₂=-0.353,P<0.05 on the 1st day after surgery（D₁）and the 2nd day after surgery（D₂）.However,there is no correlation between preoperative serum melatonin,cortisol and serotonin levels and sleep quality related parameters（P>0.05）.There was no significant difference in the number of days of hospitalization between the two groups of patients（P>0.05）.Conclusion:Intraoperative dexmedetomidine-assisted sedation in non-elderly patients undergoing high ligation and stripping of the great saphenous vein under spinal anesthesia can exacerbate the decline of subjective sleep quality in such patients after surgery,but there was no evidence that it will affect the objective sleep quality after surgery.