Intraoperative dexmedetomidine reduces postoperative sleep disturbance in older adults undergoing major abdominal surgery: a single-center, randomized, double-blind, placebo-controlled trial.

Summary

In a randomized, double-blind, placebo-controlled trial of 210 older adults, intraoperative dexmedetomidine (0.3 or 0.6 μg/kg/h) reduced first-night postoperative sleep disturbance by 70–80% versus saline. Benefits extended to night 2 sleep and early recovery quality, without increases in hypotension, bradycardia, delirium, or 30-day mortality.

Key Findings

• Both 0.3 and 0.6 μg/kg/h dexmedetomidine reduced first-night PSD versus saline (relative risk 0.31 and 0.18; NNT ≈2).
• Dexmedetomidine improved night-2 sleep metrics and QoR-15 scores on POD1.
• No significant differences in hypotension, bradycardia, delirium, or 30-day mortality across groups; actigraphy subset showed longer total sleep time.

Clinical Implications

Consider low-dose intraoperative dexmedetomidine infusion to reduce early postoperative sleep disturbance (PSD) in older adults after major abdominal surgery, while monitoring for standard hemodynamic effects. Multicenter validation and evaluation of longer-term cognitive outcomes are warranted.

Limitations

• Single-center study may limit generalizability.
• Actigraphy assessed a subset (n≈20 per group) and long-term outcomes were limited to 30 days.

Future Directions

Multicenter pragmatic trials to confirm effectiveness, define optimal dosing, and assess downstream outcomes (delirium, cognition, readmissions) and cost-effectiveness.