ASA Open Forum

Sleep Disturbances in Perioperative Patients: A Call to Action

  

The deleterious effects of sleep deprivation on human physiology and psychology are well documented, yet we as anesthesiologists have yet to fully understand the implications. When considering behavioral factors affecting perioperative patients, sleep disturbance should not be overlooked. By Dr. Zulfiqar Ahmed, M.D. F.A.A.P.



“Doctor, I could not sleep at all last night” is a rather common phrase we hear on the morning of the surgery. It is also unsurprising – sleep disorders currently affect 50 to 70 million Americans.

A healthy sleep cycle has tremendous health benefits and disturbances in sleep are an important initiator and contributor to various pathological changes in normal humans. Negative effects can be short term (depression, weekly headaches, abdominal pain) or long term (affecting brain function and systemic physiology including metabolism and appetite regulation), and can impact immune, hormonal, and cardiovascular systems as well.

Specifically:

  • Sleep deprivation and sleep disruption can have deleterious effects on immune system response and functioning while several immune and proinflammatory cells also possess sleep-regulatory properties. The proinflammatory cytokines, interleukin-1, interleukin-6, and tumor necrosis factor α are classified as official sleep-regulatory substances. Sleep deprivation can lead to increased risk of immune compromise and increased circulating levels of inflammation markers. Immune system abnormalities have been shown in several primary sleep disorders (shift work disorder, OSA, insomnia), which may help to explain the increased morbidity (malignancy, heart disease, stroke) and mortality risk observed in these conditions.
  • Among the metabolic effects, a recent review has shown a variety of molecular and behavioral factors that may lead to an association between sleep disruption and metabolic disorders, including obesity and T2DM. Sleep loss appears to affect energy metabolism primarily by impairing insulin sensitivity and increasing food intake.

For hospitalized patients, the risks from sleep disturbance are compounded. About 70% of patients admitted to the hospital report waking up during the night due to external factors such as pain, alarms, medical procedures, and other patients’ voices.

It’s clear that sleep deprivation has significant effects on human body physiology, but we have yet to adequately study the effects of sleep disturbances on the perioperative patient. Research is needed in this area to identify the factors which can improve post-operative outcomes.


References:

Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151-161
https://doi.org/10.2147/NSS.S134864

Growdon ME, Inouye SK. Minimizing Sleep Disruption for Hospitalized Patients: A Wake-up Call. JAMA Intern Med. 2018;178(9):1208–1209. doi:10.1001/jamainternmed.2018.2679

Gamaldo, CE, Shaikh, AK, McArthur JC. The sleep-Immunity Relationship. Neurologic Clinics, 2012-11-01, Volume 30, Issue 4, Pages 1313-1343

Wesselius HM, van den Ende ES, Alsma J, et al. Quality and Quantity of Sleep and Factors Associated With Sleep Disturbance in Hospitalized Patients. JAMA Intern Med. 2018;178(9):1201–1208. doi:10.1001/jamainternmed.2018.2669


Dr. Zulfiqar Ahmed is Director of Pediatric Anesthesia and Education at Siromed/A4 and assistant program director of the Wayne State University Anesthesia Residency Program at St. Joseph Mercy Oakland Hospital in Pontiac, MI.


#PerioperativeMedicine

ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.

Permalink

Comments

27 days ago

I suggest Melatonin to my preop patients for night before surgery, its over the counter and no hangover. 
do u prescribe benzos to ur patients?