Circadian Rhythm, Postoperative Sleep Disturbance
Conditions
Keywords
Esketamine, Circadian Rhythm, Melatonin, Postoperative Sleep Disturbance, Postmenopause
Brief summary
The prevalence of sleep disturbance among postmenopausal women has been reported to reach 51.6%. Epidemiological studies consistently show that the incidence of sleep disorders increases with age and menopausal transition. Compared with premenopausal women, postmenopausal women demonstrate reduced circadian rhythm stability and a higher prevalence of sleep disturbance. In this population, levels of melatonin, total sleep time, sleep latency, N3 stage sleep, and the circadian amplitude of alertness are all diminished. Sleep disturbance can adversely affect both the mental and physical health of women and significantly impair their social functioning. Poor sleep is associated with decreased cognitive performance and heightened emotional distress, contributing to diminished quality of life. Circadian rhythms are endogenous physiological and behavioral cycles that oscillate over approximately 24 hours, governing critical processes such as sleep-wake cycles, hormonal fluctuations (e.g., cortisol and melatonin). These rhythms are regulated by the suprachiasmatic nucleus (SCN). Disruptions in circadian rhythms have been associated with sleep disturbances. Esketamine is the S (+) enantiomer of ketamine and has a higher affinity for the NMDA receptor than the R-enantiomer. Previous studies have demonstrated that intraoperative administration of esketamine can improve postoperative sleep quality and reduce the incidence of postoperative sleep disturbances, through its antidepressant efficacy, anti-inflammatory properties, analgesic efficacy, neurocognitive and anxiolytic effects. However, few studies have investigated whether esketamine can regulate perioperative circadian rhythms and subsequently affect sleep, especially in postmenopausal women. The objective of this multi-center, prospective, randomized controlled clinical trial is to investigate the effects of esketamine on postoperative sleep in postmenopausal women.
Interventions
DRUGEsketamine
Participants in Group E are administered esketamine with an infusion dose of 0.1 ml·kg-¹·h-¹ (0.2 mg·kg-¹·h-¹, diluted with 0.9% sodium chloride in a 2 mg/mL.
DRUGNormal Saline
In Group C, 0.9% sodium chloride with a maintenance dose of 0.1 ml·kg-¹·h-¹ are administered intravenously.
Sponsors
Zhuan Zhang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. American Society of Anesthesiologists (ASA) physical status I-III. 2. Aged ≥ 45 years. 3. Women with natural menopause (aged ≥ 45 years and postmenopause for more than 12 months without surgical or medical intervention) . 4. Scheduled to undergo elective lower-limb fracture surgery with an expected duration of more than 60 min under general anesthesia. 5. Body Mass Index (BMI) between 18 and 28 kg/m².
Exclusion criteria
1. Presence of preoperative sleep-related disorders, such as obstructive sleep apnea or restless legs syndrome. 2. History of drug or alcohol abuse or dependence. 3. Known contraindications or allergies to esketamine or other anesthetic agents. 4. Use of psychotropic medications or sex hormones within the past 3 months. 5. Shift work or taking medications affecting melatonin. 6. Severe comorbid conditions, including but not limited to uncontrolled hypertension, coronary artery disease, cardiac insufficiency, pulmonary hypertension, intracranial hypertension or elevated intraocular pressure, hyperthyroidism, severe hepatic or renal dysfunction. 7. History of cerebral infarction, intracerebral hemorrhage, or residual central nervous system deficits. 8. Impairments of language, hearing, vision, or cognitive function that would prevent completion of questionnaires or cooperation with sleep monitoring. 9. Active oral pathologies. 10. Transfer to ICU postoperatively.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of postoperative sleep disturbance (PSD) on postoperative day 1. | Postoperative day 1. | The primary outcome is the incidence of PSD, evaluated using the Numeric Rating Scale (NRS) and the Athens Insomnia Scale (AIS) on postoperative day 1. PSD is defined as an NRS score of 6 or higher or an AIS score of 6 or higher. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Biological rhythm detection | From preoperative day 1 to postoperative day 3. | Melatonin and cortisol rhythm profiles are analyzed using saliva samples every 6 h for 48 h: at 10:00 PM on the night of surgery; 4:00 AM, 10:00 AM, 4:00 PM, and 10:00 PM on postoperative day 1; and 4:00 AM and 10:00 AM on postoperative day 2. Expression of core circadian clock genes, serum melatonin and cortisol concentrations are assessed on preoperative day 1, postoperative day 1 and postoperative day 3. |
| Objective sleep parameters recorded by actigraphy | From preoperative night 1 to postoperative night 3. | Objective sleep parameters are recorded using actigraphy.The parameters include total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), proportion of WASO (WASO%), and sleep efficiency (SE%). |
| Subjective sleep quality | From preoperative day 1 to postoperative day 30. | The Pittsburgh Sleep Quality Index (PSQI) is assessed on the day before surgery and 30 days postoperatively. Self-rated sleep quality is evaluated using the NRS and the AIS on the day before surgery and on postoperative days 2 and 3. |
| Anxiety and Depression assessments | From preoperative day 1 to postoperative day 3. | Anxiety and depression are measured using the Hospital Anxiety and Depression Scale (HADS). It comprises two subscales: the Anxiety subscale (HADS-A) and the Depression subscale (HADS-D). For each item, respondents select the degree of severity, ranging from 0 to 3, representing none, mild, moderate, and severe. The total score for each subscale ranges from 0 to 21, with higher scores indicating more severe anxiety or depression symptoms. Scores of 0-7 are considered normal, 8-10 suggest the possibility of mild anxiety or depression, 11-14 indicate the possibility of moderate anxiety or depression, and 15-21 signify the possibility of severe anxiety or depression. |
| Frontal electroencephalography | From entering the operating room to surgery ending. | Electroencephalogram (EEG) data is collected using the ConView Anesthesia Depth Monitoring System (ConView YY-105, Zhejiang Puke Medical Technology Co., Ltd., China). The analysis includes the power spectrum of EEG energy across various frequency bands, the peak frequencies in the α-β band, and key electrocorticogram indices such as the left α-index (Aileft), right α-index (Airight), electromyographic index (EMG), and burst suppression ratio (BSR). |
| Postoperative cognitive function and biomarkers | From preoperative day 1 to postoperative day 3. | Delirium assessments is conducted twice daily on postoperative days 1, 2, and 3 with at least 6 hours interval between evaluations, using the Chinese version of the 3-Minute Diagnostic Confusion Assessment Method (3D-CAM). Brain-derived neurotrophic factor (BDNF) and S100-β are measured from blood samples collected on preoperative day 1, postoperative day 1 and postoperative day 3. |
| Inflammatory markers | From preoperative day 1 to postoperative day 3. | Inflammatory biomarkers including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 are measured. |
| Postoperative pain assessment | From postoperative day 1 to day 3. | Pain levels, including both rest and exercise pain, are measured using the Visual Analogue Scale (VAS) at 24 hours, 48 hours, and 72 hours postoperatively. Data on the use of the Patient-Controlled Analgesia (PCIA) device, including trigger times for bolus doses within the first 24 hours post-surgery, the total number of bolus presses, and the use of the rescue analgesic flurbiprofen, are documented. |
Countries
China
Contacts
CONTACTZhuan Zhang, MD
Outcome results
None listed