Propofol versus sevoflurane anesthesia on postoperative sleep quality in older patients after major abdominal surgery: A randomized clinical trial

STUDY OBJECTIVE: 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. DESIGN: A randomized clinical trial. SETTING: A university hospital. PATIENTS: Patients aged 65 to 90 years who were scheduled for elective major abdominal surgery. INTERVENTIONS: Enrolled patients were randomized to receive either propofol-based intravenous anesthesia or sevoflurane-based inhalational anesthesia. MEASUREMENTS: 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. MAIN RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: 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.