TY - JOUR

T1 - Postoperative Sleep Disturbances after Zolpidem Treatment in Fast-Track Hip and Knee Replacement

AU - Krenk, Lene

AU - Jennum, Poul

AU - Kehlet, Henrik

PY - 2014/3/15

Y1 - 2014/3/15

N2 - STUDY OBJECTIVES: Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days.METHODS: Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the first night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual.RESULTS: Objective sleep data did not show a significant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed significantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups.CONCLUSIONS: Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would significantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals.CITATION: Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.

AB - STUDY OBJECTIVES: Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days.METHODS: Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the first night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual.RESULTS: Objective sleep data did not show a significant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed significantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups.CONCLUSIONS: Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would significantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals.CITATION: Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.

KW - Aged

KW - Aged, 80 and over

KW - Analgesics, Opioid

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Double-Blind Method

KW - Fatigue

KW - Female

KW - Humans

KW - Hypnotics and Sedatives

KW - Male

KW - Middle Aged

KW - Pain, Postoperative

KW - Polysomnography

KW - Postoperative Complications

KW - Pyridines

KW - Sleep Disorders

KW - Sleep, REM

U2 - 10.5664/jcsm.3540

DO - 10.5664/jcsm.3540

M3 - Journal article

C2 - 24634631

VL - 10

SP - 321

EP - 326

JO - Journal of Clinical Sleep Medicine

JF - Journal of Clinical Sleep Medicine

SN - 1550-9389

IS - 3

ER -