Improve postoperative sleep: what can we do?
TL;DR: It is shown that sleep promotion may improve patients’ outcome, but requires further evidences, and both nonpharmacological and pharmacological measures can be used to improve postoperative sleep.
Abstract: Purpose of reviewWe reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery.Recent findingsNormal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients afte
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TL;DR: This systematic review and meta-analysis explores the effect of melatonin and melatonin receptor agonist, ramelteon on delirium prevention in adult hospitalized patients and finds this effect seems confined to surgical and ICU patients.
42 citations
TL;DR: Results of the trial sequential analysis supported the interpretation that sleep and circadian interventions significantly diminished delirium compared to control, and currently only limited evidence suggests strategies targeted atSleep and circadian health as a useful way to prevent postoperative deliria.
26 citations
DOI•
12 Nov 2021TL;DR: In this article, a review of the current use, evidence base and reporting quality of mobile and wearable digital health interventions (DHI) following surgery is presented, with a focus on post-operative patient care.
Abstract: Complications following surgery are common and frequently occur the following discharge. Mobile and wearable digital health interventions (DHI) provide an opportunity to monitor and support patients during their postoperative recovery. Lack of high-quality evidence is often cited as a barrier to DHI implementation. This review captures and appraises the current use, evidence base and reporting quality of mobile and wearable DHI following surgery. Keyword searches were performed within Embase, Cochrane Library, Web of Science and WHO Global Index Medicus databases, together with clinical trial registries and Google scholar. Studies involving patients undergoing any surgery requiring skin incision where postoperative outcomes were measured using a DHI following hospital discharge were included, with DHI defined as mobile and wireless technologies for health to improve health system efficiency and health outcomes. Methodological reporting quality was determined using the validated mobile health evidence reporting and assessment (mERA) guidelines. Bias was assessed using the Cochrane Collaboration tool for randomised studies or MINORS depending on study type. Overall, 6969 articles were screened, with 44 articles included. The majority (n = 34) described small prospective study designs, with a high risk of bias demonstrated. Reporting standards were suboptimal across all domains, particularly in relation to data security, prior patient engagement and cost analysis. Despite the potential of DHI to improve postoperative patient care, current progress is severely restricted by limitations in methodological reporting. There is an urgent need to improve reporting for DHI following surgery to identify patient benefit, promote reproducibility and encourage sustainability.
21 citations
TL;DR: DX combined with oxycodone can improve sleep quality and provide good visceral analgesia, however, larger doses of DEX does not further improve sleep but increases the risk of hypotension.
Abstract: Objective:Oxycodone or dexmedetomidine (DEX) alone are widely used in clinical practice. The aim of this study was to observe the effect of 2 oxycodone and DEX combinations on postoperative sleep quality.Methods:This was a prospective and randomized clinical study. A total of 99 patients underwent l
19 citations
TL;DR: Wang et al. as discussed by the authors compared the impact of subarachnoid anaesthesia and general anaesthesia on the peak of melatonin secretion and postoperative delirium (POD) in older patients undergoing hip fracture surgery.
19 citations
References
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TL;DR: A critical review of the recent prospective and experimental research on the association of sleep and pain tries to identify trends suggestive of directionality and potential mechanisms to guide future clinical efforts to develop and augment treatments for chronic sleep disturbance and chronic pain.
956 citations
"Improve postoperative sleep: what c..." refers background in this paper
...This is also true for patients with chronic pain [27]....
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TL;DR: It is proposed that endogenous sleep pathways are causally involved in dexmedetomidine-induced sedation; dexmedETomidine's sedative mechanism involves inhibition of the LC, which disinhibits VLPO firing.
Abstract: BackgroundThe authors investigated whether the sedative, or hypnotic, action of the general anesthetic dexmedetomidine (a selective α2-adrenoceptor agonist) activates endogenous nonrapid eye movement (NREM) sleep-promoting pathways.Methodsc-Fos expression in sleep-promoting brain nuclei was assessed
727 citations
TL;DR: For patients aged over 65 years who are admitted to the intensive care unit after non-cardiac surgery, prophylactic low-dose dexmedetomidine significantly decreases the occurrence of delirium during the first 7 days after surgery.
497 citations
TL;DR: The grossly abnormal sleep pattern observed in patients after major non-cardiac surgery may suggest some fundamental disarrangement of the sleep-wake regulating mechanism.
Abstract: Sleep was studied in nine patients for two to four days after major non-cardiac surgery by continuous polygraphic recording of electroencephalogram, electrooculogram, and electromyogram. Presumed optimal conditions for sleep were provided by a concerted effort by staff to offer constant pain relief and reduce environmental disturbance to a minimum. All patients were severely deprived of sleep compared with normal. The mean cumulative sleep time (stage 1 excluded) for the first two nights, daytime sleep included, was less than two hours a night. Stages 3 and 4 and rapid eye movement sleep were severely or completely suppressed. The sustained wakefulness could be attributed to pain and environmental disturbance to only minor degree. Sleep time as estimated by nursing staff was often grossly misjudged and consistently overestimated when compared with the parallel polygraphic recording. The grossly abnormal sleep pattern observed in these patients may suggest some fundamental disarrangement of the sleep-wake regulating mechanism.
317 citations
TL;DR: OSA appears to be associated with stroke, but the relationship with ischemic heart disease and cardiovascular mortality needs further research.
Abstract: Background—The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear. We conducted a systematic review to determine the incident risk of cardiovascular events among patients with OSA. Methods and Results—We searched MEDLINE and EMBASE in January 2011 for prospective studies that followed up patients with OSA for incident ischemic heart disease, stroke, and cardiovascular mortality. Outcomes data were pooled using random effects meta-analysis and heterogeneity assessed with the I2 statistic. Regression analysis was performed to evaluate the effects of different gradations of OSA severity based on apnea-hypopnea index. We identified 9 relevant studies from 1731 citations. OSA was associated with incident stroke in a meta-analysis of 5 studies (8435 participants), odds ratio (OR) 2.24; 95% confidence interval (CI), 1.57–3.19; I2=7%. A significant association was seen in studies that were predominantly on men; OR, 2.87; 95% CI, 1.91–4.31, whereas data on women were spars...
304 citations
"Improve postoperative sleep: what c..." refers background in this paper
...As showed in a systematic review, OSA in nonsurgical patients is associated with increased risk of stroke [28]....
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