Intranasal low-dose dexmedetomidine alleviates propofol-associated postoperative sleep disturbance in female hysteroscopy patients: a randomized controlled trial

Postoperative sleep disturbance (PSD) significantly affects early recovery and is commonly associated with general anesthetics. This study investigated the incidence of PSD after propofol exposure and the preventive effect of low-dose dexmedetomidine. In this randomized, controlled trial, female patients undergoing hysteroscopy were allocated to receive intranasal dexmedetomidine (0.2 µg/kg or 0.5 µg/kg) or saline before propofol-based intravenous anesthesia. The primary outcome was the incidence of PSD via the brief version of the Pittsburgh Sleep Quality Index (B-PSQI) on postoperative days (PODs) 1 and 3. Secondary outcomes included postoperative pain (via NRS) and objective sleep parameters (TST, WASO, REM, and NREM) recorded using Huawei Smart Band 9. Of 318 screened patients, 284 completed the study. On POD 1, 36 patients (38.3%) in the 0.5 µg/kg dexmedetomidine group developed PSD, compared to 61 patients (64.2%) in the control group and 62 patients (65.3%) in the 0.2 µg/kg dexmedetomidine group (adjusted odds ratio [aOR], 0.54; 95% confidence interval, 0.39 to 0.76; P < 0.001). The 0.2 µg/kg dexmedetomidine group showed no obvious advantage over the control group. Objective data showed that propofol reduced TST and REM, and increased WASO. Dexmedetomidine (0.5 µg/kg) attenuated these changes. No significant group differences were observed in pain scores and other complications. Prophylactic administration of 0.5 µg/kg dexmedetomidine reduced early postoperative sleep disturbances associated with propofol, primarily by preserving REM sleep and mitigating TST and WASO fluctuations. Registered at ClinicalTrials.gov (Registration NCT06281561 Date of registration 06/02/2024).