The effects of morning/afternoon surgeries on the early postoperative sleep quality of patients undergoing general anesthesia

Haitao Hou, Shujing Wu, Yuxue Qiu, Fenxiang Song, Liqin Deng, Haitao Hou, Shujing Wu, Yuxue Qiu, Fenxiang Song, Liqin Deng

Abstract

Objective: This study aimed to investigate the effects of morning and afternoon surgeries on the early postoperative sleep function in patients undergoing general anesthesia.

Methods: Fifty nine patients, aged 18-60 years, American society of anaesthesiologists (ASA) grade I or II, Body mass index of 18.5-28 kg/m2, undergoing laparoscopic myomectomy under total intravenous anesthesia, were included in the study. These patients were divided into two groups according to the start time of anesthesia: morning surgery group (group A, 8:00-12:00) and afternoon surgery group (group P, 14:00-18:00). The sleep conditions of the two groups of patients were evaluated by the Athens Insomnia Scale (AIS) one day before and one day after the operation. A total score of > 6 was regarded as postoperative sleep disturbance. The incidences of sleep disturbance one day after the operation in two groups were compared. The bispectral Index assessed the patient's total sleep duration, sleep efficiency, and overall quality of sleep from 21:00 to 6:00 on the first night after surgery. Plasma concentrations of melatonin and cortisol at 6:00 am 1 day before surgery, 1 day after surgery were measured by ELISA, and rapid random blood glucose was measured.

Results: The total AIS score, overall quality of sleep, total sleep duration, and final awakening earlier than desired scores of the two groups of patients on the first night after surgery were significantly increased compared with preoperative scores (P < 0.01). In group P, the sleep induction and the physical and mental functioning during the day scores increased significantly after surgery compared with preoperative scores (P < 0.05). The postoperative AIS scores in group P increased significantly compared with those in group A (P < 0.01). The incidence of postoperative sleep disturbances (70.0%) in group P was significantly higher than that in group A (37.9%) (P < 0.05). Compared with group A, the total sleep duration under BIS monitoring in group P was significantly shorter, the sleep efficiency and the overall quality of sleep was significantly reduced (P < 0.01). Compared with those in group A, the level of melatonin on 1 d after surgery in group P was significantly decreased, and the level of cortisol in group P was significantly increased. There were no significant differences between the two groups in the levels of postoperative blood glucose and pain.

Conclusion: Both morning and afternoon surgeries have significant impacts on the sleep function in patients undergoing general anesthesia, while afternoon surgery has a more serious impact on sleep function.

Trial registration: ClinicalTrials, NCT04103528. Registered 24 September 2019-Retrospectively registered, http://www.

Clinicaltrials: gov/ NCT04103528.

Keywords: Circadian rhythm; Early postoperative sleep; General anesthesia; Morning and afternoon surgeries.

Conflict of interest statement

All authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram showing the patients that were included and excluded in this study
Fig. 2
Fig. 2
Typical trends of BIS and electromyogram changes in group A patients on the first night under BIS monitoring
Fig. 3
Fig. 3
Typical trends of BIS and electromyogram changes in group P patients on the first night under BIS monitoring

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