Circadian distribution of sleep phases after major abdominal surgery
01 Jan 2008-BJA: British Journal of Anaesthesia (Oxford University Press)-Vol. 100, Iss: 1, pp 45-49
TL;DR: Patients have significantly increased REM sleep, LS, and reduced time awake during the daytime period after surgery compared with before surgery, suggesting disturbances in the circadian regulation of the sleep-wake cycle may be involved in the development of postoperative sleep disturbances.
Abstract: Background It is believed that the severely disturbed night-time sleep architecture after surgery is associated with increased cardiovascular morbidity with rebound of rapid eye movement (REM). The daytime sleep pattern of patients after major general surgery has not been investigated before. We decided to study the circadian distribution of sleep phases before and after surgery. Methods Eleven patients undergoing elective major abdominal surgery were included in the study. Continuous ambulatory polysomnographic monitoring was made 24 h before surgery and 36 h after surgery, thus including two nights after operation. Sleep was scored independently by two blinded observers and the recordings were reported as awake, light sleep (LS, stages I and II), slow wave sleep (SWS, stages III and IV), and REM sleep. Results There was significantly increased REM sleep ( P =0.046), LS ( P =0.020), and reduced time awake ( P =0.016) in the postoperative daytime period compared with the preoperative daytime period. Five patients had REM sleep during the daytime after surgery. Three of these patients did not have REM sleep during the preceding postoperative night. There was significantly reduced night-time REM sleep for two nights after surgery compared with before surgery ( P =0.001). Conclusions Patients have significantly increased REM sleep, LS, and reduced time awake during the daytime period after surgery compared with before surgery. Disturbances in the circadian regulation of the sleep–wake cycle may be involved in the development of postoperative sleep disturbances.
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TL;DR: The pathophysiology of OSA is reviewed, the effects of anesthesia and opioids on the sleep architecture of the OSA patients are discussed, the results of postoperative complications are described, and the perioperative management principles for patients with OSA are reviewed.
15 citations
TL;DR: It is hypothesised that abnormal EEG patterns of sleep and wakefulness may serve as predictive and diagnostic markers for postoperative delirium and mechanistically link disrupted thalamocortical connectivity to this important clinical syndrome.
Abstract: Introduction Delirium is a potentially preventable disorder characterised by acute disturbances in attention and cognition with fluctuating severity. Postoperative delirium is associated with prolonged intensive care unit and hospital stay, cognitive decline and mortality. The development of biomarkers for tracking delirium could potentially aid in the early detection, mitigation and assessment of response to interventions. Because sleep disruption has been posited as a contributor to the development of this syndrome, expression of abnormal electroencephalography (EEG) patterns during sleep and wakefulness may be informative. Here we hypothesise that abnormal EEG patterns of sleep and wakefulness may serve as predictive and diagnostic markers for postoperative delirium. Such abnormal EEG patterns would mechanistically link disrupted thalamocortical connectivity to this important clinical syndrome. Methods and analysis P-DROWS-E (Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography) is a 220-patient prospective observational study. Patient eligibility criteria include those who are English-speaking, age 60 years or older and undergoing elective cardiac surgery requiring cardiopulmonary bypass. EEG acquisition will occur 1–2 nights preoperatively, intraoperatively, and up to 7 days postoperatively. Concurrent with EEG recordings, two times per day postoperative Confusion Assessment Method (CAM) evaluations will quantify the presence and severity of delirium. EEG slow wave activity, sleep spindle density and peak frequency of the posterior dominant rhythm will be quantified. Linear mixed-effects models will be used to evaluate the relationships between delirium severity/duration and EEG measures as a function of time. Ethics and dissemination P-DROWS-E is approved by the ethics board at Washington University in St. Louis. Recruitment began in October 2018. Dissemination plans include presentations at scientific conferences, scientific publications and mass media. Trial registration number NCT03291626.
13 citations
TL;DR: Patients given TEA may show reduced sleep disturbances on the first night after surgery, perhaps due to better pain management and inhibition of IL‐6 release.
Abstract: This study hypothesized that different types of anaesthesia management would result in similar postoperative sleep quality. In this prospective single-blind investigation, 219 patients undergoing elective thoracic surgery were randomized into three arms: general anaesthesia, as the control group (group C); general anaesthesia combined with thoracic epidural anaesthesia (TEA) (group E); and general anaesthesia combined with infusion of 1 μg/kg dexmedetomidine (group D). Plasma samples were obtained to measure the amine and inflammatory cytokine concentrations. All patients underwent assessment with the bispectral index (BIS) for sleep quality and the visual analogue scale (VAS) for pain. The primary outcomes were inflammatory cytokine [interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α)] secretion and postoperative sleep quality on the first and second postoperative nights. The secondary outcomes were amine (adrenaline and noradrenaline) secretion during the surgical period and haemodynamic stability. The postoperative BIS area under the curve was significantly lower in group E (75.7%) than in group C (87.3%) or group D (86.5%). Patients in group E had the highest BIS of sleep efficiency index (29.2%, P < 0.05) and the lowest VAS scores (3.5, P < 0.05). Group E had lower IL-6 levels than the other two groups 24 h after surgery (P < 0.05). Patients given TEA may show reduced sleep disturbances on the first night after surgery, perhaps due to better pain management and inhibition of IL-6 release.
13 citations
TL;DR: The properties, possible mechanisms, and function of melatonin in chronic pain are described and chronotherapy may be beneficial for the treatment of chronic pain.
Abstract: Melatonin is an endogenous neurohormone that is produced in most living organisms, including unicellular and multicellular organisms, plants, vertebrates, and nonvertebrate animals. In diurnal animals, endogenous melatonin functions as a neurohormone and contributes to circadian rhythms. In nocturnal animals, endogenous melatonin no longer functions as a contributor to circadian rhythms. Circadian rhythms control the timing, quantity, and quality of hormones and neurotransmitters that the body produces and eventually secretes. An imbalance of these events creates disturbances in circadian rhythm. During disturbances of circadian rhythm, the body produces hormones, chemicals, and neurotransmitters in aberrant amounts or at the wrong time of day. The human circadian system is synchronized with physiological functions and metabolism. Many studies have reported that exogenous melatonin has analgesic and neuroprotective effects in chronic pain. Considering that chronotherapy may be beneficial for the treatment of chronic pain, the present review describes the properties, possible mechanisms, and function of melatonin in chronic pain.
12 citations
TL;DR: Systematic education and training of nurses in sleep, sleep anamneses and sleep hygienic principles enhances nurses ’ awareness on sleep problems, and as a result makes nurses able to propose appropriate interventions to improve patients’ sleep during hospitalization, and after discharged.
Abstract: Background and Objective : Cardiac surgical patients experience sleep problems in the early post-operative period and after hospital discharged. Restorative sleep is important to be able to handle the challenges of rehabilitation, but often remains untreated. Pharmacological treatment has been preferred, but studies conclude a longer lasting effect of cognitive behavioural therapy (CBT). Few clinical trials have been conducted on nurse led sleep promoting interventions during hospitalization. The hypothesis of this study is that systematic training and education in sleep, sleep anamneses and sleep hygiene enhances nurses ’ awareness on sleep problems, and as a result makes nurses able to propose appropriate interventions to improve patients’ sleep during hospitalization, and after discharged. The aim is to examine the effect on patients’ self-reported sleep quality. Methods : The study design is a controlled intervention study. Patients in the control group received usual care. Patients in the intervention group received nursing focused on improving sleep by use of sleep-anamneses and sleep hygienic principles. Patients ’ sleep-quality was measured preoperatively, and one and two month post-operatively by use of PSQI-questionnaire and sleep diaries. Results : There was no significant effect of the intervention, though there were several signs that had some effect after two months in terms of global PSQI, total sleep time, sleep efficiency, sleep medication and sleep quality. Conclusions : Systematic education and training of nurses in sleep, sleep anamneses and sleep hygienic principles has some effect on patients self-reported sleep quality two months after heart surgery.
12 citations
Cites background from "Circadian distribution of sleep pha..."
...[2–7, 11–16] Major surgery is known to cause severe changes in sleep patterns with a reduction of deep sleep and a reduction or total lack of REM sleep, but with rebound of REM sleep the following nights and days.[15, 17] A lack of REM sleep and deep sleep is associated with poor physical functioning, affecting the rehabilitation with decreased cognitive capability and bad remembrance, which is of great importance due to the amount of information given during hospitalization....
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...The general increase in SOL in both groups after 1 month is probably due to the effects of surgical stress.[15, 17] The larger increase in SOL in the IG can be a result of patients that are more elderly and therefore more “bad sleepers”, and thus it may imply that the operation is harder to overcome for elderly persons....
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References
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Book•
01 Jan 1968
11,993 citations
TL;DR: Techniques of recording, scoring, and doubtful records are carefully considered, and Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.
Abstract: With the vast research interest in sleep and dreams that has developed in the past 15 years, there is increasing evidence of noncomparibility of scoring of nocturnal electroencephalograph-electroculograph records from different laboratories. In 1967 a special session on scoring criteria was held at the seventh annual meeting of the Association for the Psychophysiological Study of Sleep. Under the auspices of the UCLA Brain Information, an ad hoc committee composed of some of the most active current researchers was formed in 1967 to develop a terminology and scoring system for universal use. It is the results of the labors of this group that is now published under the imprimatur of the National Institutes of Health. The presentation is beautifully clear. Techniques of recording, scoring, and doubtful records are carefully considered. Recommendations for abbreviations, types of pictorial representation, order of polygraphic tracings are suggested.
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01 Jan 1968
3,002 citations
01 Jan 1968
2,439 citations
TL;DR: REM sleep is associated with profound sympathetic activation in normal subjects, possibly linked to changes in muscle tone and the hemodynamic and sympathetic changes during REM sleep could play a part in triggering ischemic events in patients with vascular disease.
Abstract: Background The early hours of the morning after awakening are associated with an increased frequency of events such as myocardial infarction and ischemic stroke. The triggering mechanisms for these events are not clear. We investigated whether autonomic changes occurring during sleep, particularly rapid-eye-movement (REM) sleep, contribute to the initiation of such events. Methods We measured blood pressure, heart rate, and sympathetic-nerve activity (using microneurography, which provides direct measurements of efferent sympathetic-nerve activity related to muscle blood vessels) in eight normal subjects while they were awake and while in the five stages of sleep. Results The mean (±SE) amplitude of bursts of sympathetic-nerve activity and levels of blood pressure and heart rate declined significantly (P<0.001), from 100 ±9 percent, 90 ±4 mm Hg, and 64 ±2 beats per minute, respectively, during wakefulness to 41 ±9 percent, 80 ±4 mm Hg, and 59 ±2 beats per minute, respectively, during stage 4 of non-REM sl...
1,378 citations