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Peer-reviewedCC BY-NC-ND 4.0Communications Medicine

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

  • Hui-ping Peng1,2
  • Jing-hui Hu1,2
  • Li-ping Fan1,2,3
  • Xiu Yang1,2
  • Hua-yue Liu1,2
  • Xi-sheng Shan1,2
  • Hong Liu4
  • Nazneen Sudhan5
  • Fu-hai Ji1,2
  • Ke Peng1,2
5 affiliations
  1. 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China
  2. 2Institute of Anesthesiology, Soochow University, Suzhou, China
  3. 3Jintan Traditional Chinese Medicine Hospital, Changzhou, China
  4. 4Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA USA
  5. 5Anesthesia and Critical Care, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
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Abstract

Background:: Postoperative sleep disturbance (PSD) after major abdominal surgery in older adults is common and impairs recovery. Dexmedetomidine is a selective α2-adrenergic agonist with sedative, analgesic, and anti-inflammatory properties that promotes natural sleep. We hypothesized that intraoperative dexmedetomidine would reduce PSD in this population.

Methods:: In this randomized, double-blind, placebo-controlled trial, 210 older adults undergoing major abdominal surgery were randomly assigned (1:1:1) to receive intraoperative normal saline, dexmedetomidine 0.3 μg/kg/h, or 0.6 μg/kg/h. The primary outcome was PSD on the first postoperative night (Athens Insomnia Scale score ≥ 6). Secondary outcomes included PSD on until nights 30; pain at 24 and 48 h; delirium and depressive symptoms within 7 days; and recovery quality on postoperative days 1‒3. Sleep patterns on nights 1 and 2 were assessed using wrist actigraphy. This trial was registered on the Chinese Clinical Trial Registry (Identifier: ChiCTR2300073163; principal investigator: Ke Peng; dated July 23, 2023; https://www.chictr.org.cn/showproj.html?proj=199410).

Results:: 203 patients (median age 71 years; 67.5% male) completed this trial. Compared with normal saline (n = 67), both low-dose (n = 68) and high-dose dexmedetomidine (n = 68) significantly reduced first-night PSD (20.6% vs 65.7%; relative risk 0.31, 95% CI 0.19–0.50; NNT 2.2; P < 0.001; and 11.8% vs 65.7%; relative risk 0.18, 95% CI 0.09–0.34; NNT 1.8; P < 0.001, respectively). The two doses did not differ. Dexmedetomidine was associated with lower sleep disturbance on night 2 and higher recovery quality, without between-group differences in hypotension, bradycardia, delirium, or 30-day mortality. Exploratory actigraphy analysis (n = 20 per group) showed longer total sleep time and lower wake-time percentage associated with dexmedetomidine.

Conclusions:: Intraoperative dexmedetomidine infusion reduced the relative risk of first-night PSD by 70–80% among older adults undergoing major abdominal surgery. These findings require confirmation in multicenter trials.

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Cite

BibTeXRIS
BibTeX
@article{peng2026intraoperative,
  title = {{Intraoperative dexmedetomidine reduces postoperative sleep disturbance in older adults undergoing major abdominal surgery: a single-center, randomized, double-blind, placebo-controlled trial}},
  author = {Hui-ping Peng and Jing-hui Hu and Li-ping Fan and Xiu Yang and Hua-yue Liu and Xi-sheng Shan and Hong Liu and Nazneen Sudhan and Fu-hai Ji and Ke Peng},
  journal = {Communications Medicine},
  year = {2026},
  month = jul,
  doi = {10.1038/s43856-026-01769-2},
  url = {https://doi.org/10.1038/s43856-026-01769-2},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Intraoperative dexmedetomidine reduces postoperative sleep disturbance in older adults undergoing major abdominal surgery: a single-center, randomized, double-blind, placebo-controlled trial
AU  - Hui-ping Peng
AU  - Jing-hui Hu
AU  - Li-ping Fan
AU  - Xiu Yang
AU  - Hua-yue Liu
AU  - Xi-sheng Shan
AU  - Hong Liu
AU  - Nazneen Sudhan
AU  - Fu-hai Ji
AU  - Ke Peng
PY  - 2026
DA  - 2026/07/03
JO  - Communications Medicine
DO  - 10.1038/s43856-026-01769-2
UR  - https://doi.org/10.1038/s43856-026-01769-2
AB  - Background:: Postoperative sleep disturbance (PSD) after major abdominal surgery in older adults is common and impairs recovery. Dexmedetomidine is a selective α2-adrenergic agonist with sedative, analgesic, and anti-inflammatory properties that promotes natural sleep. We hypothesized that intraoperative dexmedetomidine would reduce PSD in this population.  Methods:: In this randomized, double-blind, placebo-controlled trial, 210 older adults undergoing major abdominal surgery were randomly assigned (1:1:1) to receive intraoperative normal saline, dexmedetomidine 0.3 μg/kg/h, or 0.6 μg/kg/h. The primary outcome was PSD on the first postoperative night (Athens Insomnia Scale score ≥ 6). Secondary outcomes included PSD on until nights 30; pain at 24 and 48 h; delirium and depressive symptoms within 7 days; and recovery quality on postoperative days 1‒3. Sleep patterns on nights 1 and 2 were assessed using wrist actigraphy. This trial was registered on the Chinese Clinical Trial Registry (Identifier: ChiCTR2300073163; principal investigator: Ke Peng; dated July 23, 2023; https://www.chictr.org.cn/showproj.html?proj=199410).  Results:: 203 patients (median age 71 years; 67.5% male) completed this trial. Compared with normal saline (n = 67), both low-dose (n = 68) and high-dose dexmedetomidine (n = 68) significantly reduced first-night PSD (20.6% vs 65.7%; relative risk 0.31, 95% CI 0.19–0.50; NNT 2.2; P < 0.001; and 11.8% vs 65.7%; relative risk 0.18, 95% CI 0.09–0.34; NNT 1.8; P < 0.001, respectively). The two doses did not differ. Dexmedetomidine was associated with lower sleep disturbance on night 2 and higher recovery quality, without between-group differences in hypotension, bradycardia, delirium, or 30-day mortality. Exploratory actigraphy analysis (n = 20 per group) showed longer total sleep time and lower wake-time percentage associated with dexmedetomidine.  Conclusions:: Intraoperative dexmedetomidine infusion reduced the relative risk of first-night PSD by 70–80% among older adults undergoing major abdominal surgery. These findings require confirmation in multicenter trials.
SN  - 2730-664X
ER  -