Personalized Music and Dreaming During Propofol Sedation

Personalized Music Increases Dreaming During Propofol Sedation: A Randomized Trial Comparing Preferred Music, Matched Non-Preferred Music, and Silence

Many patients report dreams during intravenous (IV) propofol sedation, but it is uncertain whether listening to music changes how often dreams occur or how pleasant they feel. This single-center randomized study compared three auditory conditions during propofol sedation for elective surgery under spinal anesthesia or peripheral nerve block: (1) patient-selected preferred music, (2) matched non-preferred music, and (3) silence (headphones only). Music or silence was delivered through identical closed-back headphones starting 1-2 minutes before sedation and continuing until the end of sedation.

The main outcomes were (1) whether a dream occurred (yes/no) assessed by a neutral modified Brice interview in the post-anesthesia care unit (PACU), and (2) dream pleasantness rated on a 0-10 scale among participants who reported a dream. Additional outcomes included coded dream content features, patient satisfaction, sedative dose, hemodynamic variability, early recovery measures, postoperative symptoms, and adverse events.

Study Overview

• Status: Completed
• Conditions: Propofol; Conscious Sedation; Dreams
• Intervention / Treatment: Behavioral: Preferred Music; Behavioral: Matched Non-Preferred Music; Behavioral: Silence (Headphones Only)

Detailed Description

This is a single-center, parallel-group, three-arm randomized controlled trial evaluating the effects of auditory stimulation and music personalization on dreaming during IV propofol sedation. Adults (≥19 years) undergoing elective procedures under spinal anesthesia or peripheral nerve block with propofol sedation were eligible (ASA I-III). Participants were excluded for planned general anesthesia, severe hearing impairment, major psychiatric instability, expected significant bleeding, inability to complete interviews, or contraindication to sedative agents.

Randomization and blinding: Participants were randomized 1:1:1 to Preferred Music, Matched Non-preferred Music, or Silence using computerized randomization with variable block sizes, stratified by procedure category and preoperative anxiety (STAI-State tertiles). Allocation was concealed. An audio technician (non-assessor) set up the assigned condition. PACU interviewers, dream-content coders, and statisticians were blinded. Standardized closed-back headphones were used for all groups, with scripted staff interactions and calibrated volume (50-60 dB(A)) to support blinding; blinding integrity was assessed by questionnaire.

Interventions:

• Preferred Music: Participants selected one personally meaningful track preoperatively. The track was played continuously on loop through closed-back headphones starting 1-2 minutes before sedative infusion and continued until the end of sedation.

Final-The effect of Auditory St…

• Matched Non-preferred Music: Participants listened to a pleasant non-selected track matched to the preferred selection for tempo (±10 bpm), genre family, and loudness to separate preference effects from acoustic features; playback timing was identical.
• Silence Control: Participants wore identical headphones for the same duration without audio playback.

Sedation protocol and monitoring: Propofol was administered per a standardized regimen (initial bolus 0.5-1 mg/kg followed by infusion 25-75 µg/kg/min) titrated to maintain BIS 65-85. Sedation depth was assessed using MOAA/S (primary) and RASS (secondary), with routine physiologic monitoring and supplemental oxygen.

Outcomes: Co-primary outcomes were (1) dream incidence (yes/no) assessed by a neutral modified Brice interview in PACU, with the primary contrast of Music-pooled (Preferred or Non-preferred) versus Silence; and (2) dream pleasantness (0-10 numeric scale) among recallers, with the primary contrast of Preferred versus Matched Non-preferred music. PACU interview timing used prespecified readiness criteria and was initiated at approximately 15 minutes (±5) after PACU arrival, repeated every 5-10 minutes if needed up to 60 minutes. Secondary outcomes included blinded coded dream content features, patient satisfaction, sedative dose, hemodynamic variability, recovery endpoints (e.g., Aldrete-based recovery and PACU length of stay), postoperative symptoms (pain, nausea/vomiting, shivering), and adverse events.

• Study Type: Interventional
• Enrollment (Actual): 300
• Phase: Not Applicable

Contacts and Locations

Study Locations

• South Korea
  • Iksan, South Korea, 54538
    • IRB of Wonkwnag University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged ≥ [19] years and ≤ [70] years.
• Scheduled for an elective procedure under intravenous propofol sedation at Wonkwang University Hospital.
• American Society of Anesthesiologists (ASA) physical status I-III.
• Able to understand the study procedures and provide written informed consent.

Exclusion Criteria:

• Known hearing impairment that would interfere with headphone-based auditory intervention.
• Pre-existing cognitive impairment or delirium at baseline (e.g., diagnosed dementia or active delirium).
• Use of sedatives, hypnotics, or psychoactive medications that could confound dreaming assessment, per protocol.
• Significant neurologic or psychiatric disorder that may affect dream recall/reporting.
• Inability to complete the postoperative PACU interview or inability to communicate reliably.
• Any condition judged by the investigator to make participation unsafe or data uninterpretable.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Preferred Music; Participants listen to their self-selected preferred music through standardized closed-back headphones during intravenous propofol sedation. Music starts at the beginning of sedation and continues until the end of the procedure/recovery period per protocol.	Behavioral: Preferred Music; Standardized closed-back headphones are used to deliver music during IV propofol sedation. Depending on randomization, participants receive self-selected preferred music. Playback begins shortly before sedation and continues until the end of sedation; volume is calibrated per protocol.
Experimental: Matched Non-Preferred Music; Participants listen to non-preferred music matched to the preferred-music selection (e.g., comparable tempo/energy/genre characteristics) through standardized closed-back headphones during intravenous propofol sedation. Playback timing and volume are standardized as in the preferred-music arm.	Behavioral: Matched Non-Preferred Music; Standardized closed-back headphones are used to deliver music during IV propofol sedation. Depending on randomization, participants receive e matched non-preferred music. Playback begins shortly before sedation and continues until the end of sedation; volume is calibrated per protocol.
Placebo Comparator: Silence (Headphones Only); Participants wear standardized closed-back headphones during intravenous propofol sedation, but no audio is played (silence condition). Procedures, timing, and staff interactions are otherwise identical to the music arms.	Behavioral: Silence (Headphones Only); Participants wear identical closed-back headphones during IV propofol sedation, but no audio is played. Procedures, timing, and staff interactions are otherwise identical to the music arms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dream Incidence (Yes/No) by Modified Brice Interview	Dream occurrence (yes/no) assessed using a neutral modified Brice interview during early recovery in the PACU. Primary comparison: Music-pooled (Preferred or Non-preferred) vs Silence.	PACU: primary at 15 minutes (±5) after arrival; if not ready, repeated every 5-10 minutes up to 60 minutes (first valid interview within 60 minutes).
Dream Pleasantness (0-10 Numeric Rating Scale) Among Recallers	Dream pleasantness rated on a 0-10 Dream Pleasantness Numeric Rating Scale (minimum 0, maximum 10), where higher scores indicate more pleasant dreams (0 = not pleasant at all, 10 = extremely pleasant).	Same PACU interview window as above: 15 minutes (±5) after PACU arrival; repeated every 5-10 minutes up to 60 minutes until readiness is met (first valid interview within 60 minutes).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dream Content Metrics (Blinded Coding) Among Recallers	Among participants with dream recall, dream content is assessed using prespecified blinded coding. Metrics include: (a) music-thematic incorporation (present/absent); (b) auditory salience score (0-3; 0 = none, 3 = strong; higher scores indicate greater auditory incorporation); (c) affect valence score (-2 to +2; -2 = very negative, +2 = very positive; higher scores indicate more positive affect); (d) vividness score (0-10; 0 = not vivid, 10 = extremely vivid; higher scores indicate more vivid dreams); and (e) sense of control/agency score (0-10; 0 = no control, 10 = complete control; higher scores indicate greater perceived control/agency). Narratives are double-coded with adjudication for disagreements.	PACU interview window: first valid interview within 60 minutes after PACU arrival.
Patient Satisfaction (1-5 Scale)	Patient satisfaction is assessed during early recovery in the PACU using a 5-point Likert satisfaction scale (minimum 1, maximum 5), where higher scores indicate greater satisfaction (1 = very dissatisfied, 5 = very satisfied).	PACU (early recovery; within the PACU assessment period).
Intraoperative Mean Arterial Pressure Variability (Standard Deviation)	Variability in mean arterial pressure (MAP) is quantified as the standard deviation (SD) of continuously recorded MAP values during the propofol sedation period. Unit: mmHg. Higher SD indicates greater blood pressure variability. as standard deviation during the sedation period.	During sedation (intraoperative period).
Intraoperative Heart Rate Variability (Standard Deviation)	Variability in heart rate (HR) is quantified as the standard deviation (SD) of continuously recorded HR values during the propofol sedation period. Unit: beats per minute (bpm). Higher SD indicates greater heart rate variability.	During sedation (intraoperative period).
Total Propofol Dose Administered	Total propofol administered during the procedure is recorded. Dose is expressed as mg/kg (weight-adjusted total dose). Higher values indicate greater propofol exposure.	During procedure and immediate recovery period.
Total Opioid Consumption (Morphine Milligram Equivalents)	Total opioid consumption during the procedure and immediate recovery is converted to morphine milligram equivalents (MME) and recorded in mg. Higher values indicate greater opioid exposure	During procedure and immediate recovery period.
Vasopressor Use (Yes/No)	Any vasopressor administration during the procedure and immediate recovery is recorded as yes/no. Higher values (yes) indicate that vasopressor support was required.	During procedure and immediate recovery period.
Time to Recovery (Aldrete Score ≥ 9) and PACU Length of Stay	Time to achieve Aldrete score ≥9 and total PACU time (minutes).	From PACU arrival until discharge criteria met / PACU discharge.
Postoperative Pain Intensity (0-10 Numeric Rating Scale)	Postoperative pain intensity is assessed during early recovery in the PACU using a 0-10 Numeric Rating Scale (NRS; minimum 0, maximum 10), where higher scores indicate worse pain (0 = no pain, 10 = worst imaginable pain).	PACU stay (early recovery).
Postoperative Nausea and Vomiting Severity (0-3 Ordinal Scale)	Postoperative nausea and vomiting (PONV) severity is assessed during early recovery in the PACU using a 0-3 ordinal PONV severity scale (minimum 0, maximum 3), where higher scores indicate worse symptoms (0 = none, 1 = mild nausea, 2 = moderate/severe nausea or retching, 3 = vomiting).	PACU stay (early recovery).
Postoperative Shivering (Yes/No)	Postoperative shivering during early recovery in the PACU is recorded as present/absent (yes/no).	PACU stay (early recovery).
Unplanned Hospital Admission (Yes/No)	Any unplanned hospital admission from procedure start through PACU discharge is recorded as yes/no (higher = yes indicates admission occurred).	From procedure start through PACU discharge.
dverse Events (Number of Events)	The total number of adverse events occurring from procedure start through PACU discharge is recorded per protocol (higher values indicate more events).	From procedure start through PACU discharge.
Any Adverse Event (Yes/No)	Occurrence of any adverse event from procedure start through PACU discharge is recorded as yes/no (higher = yes indicates an event occurred).	From procedure start through PACU discharge.

Collaborators and Investigators

• Sponsor: Wonkwang University Hospital
• Investigators: Principal Investigator: Cheol Lee, M.D.,Ph.D, Department of anesthesiology and pain medicine, Wonkwang University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): December 19, 2025
• Primary Completion (Actual): January 16, 2026
• Study Completion (Actual): January 16, 2026

Study Registration Dates

• First Submitted: January 19, 2026
• First Submitted That Met QC Criteria: January 28, 2026
• First Posted (Actual): February 5, 2026

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: January 28, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Procedural Sedation; Intravenous Sedation; Personalized Music; Preferred Music; Dream Recall; Dream Pleasantness
• Other Study ID Numbers: Wonkwang UH 24

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No