Chen Na-Ping, Sun Pei, Li Chun-Jing, Xing Xi-Xi, Li Mo, Sun Zhu-Jun, Li Huai-Jin, Mu Dong-Liang, Wang Dong-Xin
Department of Anesthesiology, Peking University First Hospital, Beijing, China.
Department of Anesthesiology, the Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, China.
J Clin Anesth. 2025 Jul;105:111875. doi: 10.1016/j.jclinane.2025.111875. Epub 2025 Jun 2.
Sleep disturbances are common in older patients following major surgery. Both propofol and sevoflurane are frequently used anesthetics. In this study, we compared the effect of propofol- versus sevoflurane-based anesthesia on postoperative sleep quality in this patient population.
A randomized clinical trial.
A university hospital.
Patients aged 65 to 90 years who were scheduled for elective major abdominal surgery.
Enrolled patients were randomized to receive either propofol-based intravenous anesthesia or sevoflurane-based inhalational anesthesia.
Primary endpoint was total sleep time monitored by actigraphy on the first postoperative night. Secondary endpoints included plasma orexin-A concentrations at various timepoints from baseline (before anesthesia) until the second postoperative morning.
From May 23, 2022 to April 3, 2023, 144 patients (mean age 72.9 years; 58.3 % male) were enrolled and randomly assigned. Total sleep time on the first postoperative night was longer with propofol anesthesia (median 150 min [interquartile range 99 to 200]) than with sevoflurane anesthesia (111 min [80 to 160]; median difference 29 min [95 % CI 4 to 53]; P = 0.025). Plasma orexin-A concentration was lower in the propofol group at 1 h after anesthesia induction (median difference - 31.3 pg/mL [95 % CI -58.1 to -2.2]; P = 0.033) and 6:00 on the first postoperative morning (median difference - 29.8 pg/mL [95 % CI -58.3 to -2.3]; P = 0.036).
Among older patients undergoing major abdominal surgery, propofol anesthesia, compared with sevoflurane anesthesia, was associated with a longer total sleep time on the first postoperative night. This difference may be partially attributable to lowered plasma orexin-A level.
This randomized trial was approved by Biomedical Research Ethical Committee of Peking University First Hospital (No.2022-155) on April 26, 2022. Chinese Clinical Trial Registry (No. ChiCTR2200060120) URL: https://www.chictr.org.cn/showproj.html?proj=169584, May 19, 2022.
睡眠障碍在老年患者接受大手术后很常见。丙泊酚和七氟醚都是常用的麻醉剂。在本研究中，我们比较了丙泊酚麻醉与七氟醚麻醉对该患者群体术后睡眠质量的影响。
一项随机临床试验。
一家大学医院。
年龄在65至90岁之间、计划接受择期腹部大手术的患者。
入选患者被随机分配接受丙泊酚静脉麻醉或七氟醚吸入麻醉。
主要终点是术后第一晚通过活动记录仪监测的总睡眠时间。次要终点包括从基线（麻醉前）到术后第二天早上不同时间点的血浆食欲素-A浓度。
从2022年5月23日至2023年4月3日，144例患者（平均年龄72.9岁；58.3%为男性）入选并随机分组。丙泊酚麻醉组术后第一晚的总睡眠时间（中位数150分钟[四分位间距99至200]）长于七氟醚麻醉组（111分钟[80至160]；中位数差异29分钟[95%CI 4至53]；P = 0.025）。丙泊酚组在麻醉诱导后1小时（中位数差异-31.3 pg/mL[95%CI -58.1至-2.2]；P = 0.033）和术后第一天早上6:00时血浆食欲素-A浓度较低（中位数差异-29.8 pg/mL[95%CI -58.3至-2.3]；P = 0.036）。
在接受腹部大手术的老年患者中，与七氟醚麻醉相比，丙泊酚麻醉与术后第一晚更长的总睡眠时间相关。这种差异可能部分归因于血浆食欲素-A水平降低。
本随机试验于2022年4月26日获得北京大学第一医院生物医学研究伦理委员会批准（编号2022-155）。中国临床试验注册中心（编号ChiCTR2200060120）网址：https://www.chictr.org.cn/showproj.html?proj=169584，2022年5月19日。
