【罂粟摘要】手术和全身麻醉对睡眠-觉醒时间的影响:一项CLOCKS法观察研究
手术和全身麻醉对睡眠-觉醒时间的影响:一项CLOCKS法观察研究
贵州医科大学 麻醉与电生理课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
手术和全身麻醉可能扰乱身体的昼夜节律系统，从而影响术后预后。动物研究表明，麻醉可引起昼夜相移，但临床研究较少。假设手术及全身麻醉会导致患者围手术期昼夜睡眠-觉醒模式改变；在此项单中心前瞻性队列研究中，招募年龄≥18岁，计划行择期手术且全身麻醉时长≥30分钟的患者。慕尼黑时间型问卷和匹兹堡睡眠质量指数用于确定基线时型，睡眠特征和睡眠质量；记录围手术期睡眠模式，本研究纳入94例患者，平均年龄52±17岁，56例(60%)为女性。术前3晚平均入睡时间为03.33 ±55 min，术后3晚平均入睡时间为02.53 ±67 min)，平均入睡时间提前40分钟(p<0.001)。睡眠-觉醒时间与手术前三晚的平均入睡时间相关，与年龄、性别、全身麻醉持续时长或术中是否使用地塞米松无关。围术期患者主观睡眠质量较低，睡眠效率；睡眠干扰从手术前一晚开始，直到手术后6天恢复正常。我们研究结果表明，患者围术期平均入睡时间提前；研究假设得到证实，即手术和全身麻醉扰乱患者昼夜节律系统，患者主观睡眠质量下降，睡眠效率下降，日间疲劳感增加。
原始文献来源：
van Zuylen ML, Meewisse AJG, Ten Hoope W, et al. Effects of surgery and general anaesthesia on sleep-wake timing: CLOCKS observational study[J]. Anaesthesia. 2021 Aug 21. DOI: 10.1111/anae.15564.
Effects of surgery and general anaesthesia on sleep-wake timing: CLOCKS observational study
Summary
Surgery and general anaesthesia have the potential to disturb the body's circadian timing system, which may affect postoperative outcomes. Animal studies suggest that anaesthesia could induce diurnal phase shifts, but clinical research is scarce. We hypothesised that surgery and general anaesthesia would result in peri-operative changes in diurnal sleep-wake patterns in patients. In this single-centre prospective cohort study, we recruited patients aged ≥18 years scheduled for elective surgery receiving ≥30 min of general anaesthesia. The Munich Chronotype Questionnaire and Pittsburgh Sleep Quality Index were used to determine baseline chronotype, sleep characteristics and sleep quality. Peri-operative sleeping patterns were logged. Ninety-four patients with a mean (SD) age of 52 (17) years were included; 56 (60%) were female. The midpoint of sleep (SD) three nights before surgery was 03.33 (55 min) and showed a phase advance of 40 minutes to 02.53 (67 min) the night after surgery (p < 0.001). This correlated with the midpoint of sleep three nights before surgery and was not associated with age, sex, duration of general anaesthesia or intra-operative dexamethasone use. Peri-operatively, patients had lower subjective sleep quality and worse sleep efficiency. Disruption started from one night before surgery and did not normalise until 6 days after surgery. We conclude that there is a peri-operative phase advance in midpoint of sleep, confirming our hypothesis that surgery and general anaesthesia disturb the circadian timing system. Patients had decreased subjective sleep quality, worse sleep efficiency and increased daytime fatigue.