Krenk Lene, Jennum Poul, Kehlet Henrik
Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark.
Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, and Centre for Healthy Ageing, Faculty of Health, University of Copenhagen, Denmark.
J Clin Sleep Med. 2014 Mar 15;10(3):321-6. doi: 10.5664/jcsm.3540.
Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days.
Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the first night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual.
Objective sleep data did not show a significant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed significantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups.
Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would significantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals.
Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.
既往研究表明，大手术后的头几晚快速眼动睡眠（REM睡眠）显著减少，这可能会影响疼痛、镇痛药物使用及恢复情况。本项安慰剂对照、随机、双盲研究旨在评估唑吡坦对接受快速康复全髋关节和膝关节置换术（THA/TKA）且住院时间<3天的老年人群睡眠结构的影响。
纳入20例（≥60岁）接受THA或TKA手术的患者，手术采用标准化设置，行脊髓麻醉及多模式非阿片类术后镇痛。在术前一晚在家中及术后第一晚（患者接受安慰剂或10mg唑吡坦）进行两晚的多导睡眠图测量。记录镇痛药物使用情况、疼痛程度以及疲劳和睡眠质量的主观指标。根据美国睡眠医学学会手册对睡眠数据进行分析。
客观睡眠数据显示，两组在任何睡眠阶段均无显著差异。然而，睡眠质量和疲劳的主观数据显示，唑吡坦组的疲劳感明显减轻，睡眠质量更好（p<0.05），且客观记录的觉醒次数减少（p = 0.004）。两组的疼痛程度和阿片类药物使用水平相似。
我们的客观数据不支持主要假设，即唑吡坦一晚的治疗会显著改善大手术后的睡眠结构，尽管睡眠质量和疲劳感有所改善，且术后觉醒次数减少。
Krenk L; Jennum P; Kehlet H. 快速康复髋关节和膝关节置换术后唑吡坦治疗后的睡眠障碍
