[News in Anesthesia] Related factors affecting perioperative sleep disorders

In clinical work, we often encounter cases of large circulatory fluctuations, delayed awakening, poor postoperative analgesia, or changes in cognitive function. So, have you ever thought about whether the patient may have a sleep disorder?

In recent years, as the anesthesia discipline has paid more attention to perioperative management and postoperative rehabilitation, it is no longer limited to anesthesia safety, but pays more attention to the quality of perioperative management. Among them, it is found that sleep disorders are closely related to anesthesia. For example, patients with sleep disorders before surgery can lead to unstable circulation, delayed awakening, and even cognitive problems during surgical anesthesia. For some patients, this also affects the effectiveness of the analgesic regimen.

So, how do we prevent patients from experiencing perioperative sleep disorders?

Below, we specifically explain the relevant influencing factors:

It should be noted that since it is the perioperative period, it means that attention needs to be paid before, during and after the operation. Only by controlling each link of the perioperative period can we truly "avoid".

1. Preoperative factors:

1. Psychological factors

The psychological state before surgery is also one of the important factors that affect sleep. Facing the upcoming surgery, it is common for patients to feel nervous, anxious and fearful. This high level of psychological pressure will increase the secretion of hormones involved in maintaining wakefulness, causing an imbalance between wakefulness and sleep, which is extremely detrimental to sleep.

2. Environmental factors

Due to the obvious change in the sleeping environment, most patients experience difficulty falling asleep and sleep interruptions, mainly because of the smell, noise, lighting, and frequent examinations and treatments in the ward. Living in a general ward also involves the impact on other patients.

3. Disease factors

Patients with preoperative complications of Alzheimer's disease, traumatic brain injury, and sleep abnormalities are more likely to experience abnormal sleep rhythms during the perioperative period, and the incidence of sleep disorders during hospitalization is higher than that of other patients. In addition, the incidence of sleep disorders in patients with traumatic brain injury is also higher than that of general patients. If the disease itself causes pain or discomfort, it will also affect sleep.

2. Intraoperative Factors

1. Anesthetic factors

Studies have shown that the incidence of sleep disorders on the first day after surgery is significantly higher in patients with general anesthesia than in patients with spinal anesthesia, and pointed out that this difference is mainly affected by the dosage of perioperative opioids.

2. Surgical factors

Surgery has been proven to affect postoperative sleep quality in many ways, especially for surgeries with large trauma and long duration. If cerebral hemorrhage, cerebral infarction or other neurological dysfunction events occur during surgery, they may induce postoperative sleep disorders, and their severity is closely related to gender, age and stroke site.

Postoperative factors

1. Pain factors

Related studies show that postoperative pain seriously affects patients' sleep quality.

2. Drug factors

Studies have found that reduced sleep time can induce patients' hyperalgesia and increase their demand for opioids, while the increased use of opioids further worsens patients' postoperative sleep structure.

3. Environmental factors

Patients who need to be admitted to the ICU for further observation and treatment after surgery often have to face strong lighting and noise, and the incidence of sleep disorders is further increased. Even if they enter the general ward, they face various environmental problems just like before the operation.

In short, sleep disorders may seem like a small problem, but they actually have a big impact. As the saying goes, "details determine success or failure." A good anesthesia and good perioperative management must be the result of a combination of many details.

Thank you for reading, please like and share, thank you!

Ma Minghua, Harbin First Hospital

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