Effect of transcranial direct current stimulation on postoperative sleep disturbance in older patients undergoing lower limb major arthroplasty:a prospective,double-blind,pilot,randomised controlled trial  

作　　者：Jie Yang Mingshu Tao Rongguang Liu Jiaxing Fang Chunyan Li Dexian Chen Qi Wei Xingyu Xiong Wenxin Zhao Wen Tan Yuan Han Hongxing Zhang He Liu Song Zhang Junli Cao 

机构地区：[1]Department of Anesthesiology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,China [2]Department of Anesthesiology,Hospital of Chengdu University of Traditional Chinese Medicine&Traditional Chinese Medicine Hospital of Sichuan Province,Chengdu,Sichuan,China [3]NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs&Jiangsu Province Key Laboratory of Anesthesiology&Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia,Xuzhou Medical University,Xuzhou,Jiangsu,China [4]Department of Anesthesiology,Eye&ENT Hospital of Fudan University,Shanghai,China [5]Department of Anesthesiology&Clinical Research Center for Anesthesia and Perioperative Medicine&Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation,The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University||Huzhou Central Hospital||The Affiliated Huzhou Hospital,Zhejiang University School of Medicine||Affiliated Central Hospital Huzhou University,Huzhou,Zhejiang,China [6]Department of Anesthesiology,Renji Hospital School of Medicine,Shanghai Jiao Tong University,Shanghai,China

出　　处：《General Psychiatry》2024年第2期224-233,共10页综合精神医学（英文）

基　　金：This study was supported in part by grants from the National Key R&D Program of China(2021ZD0203100 to JC);National Natural Science Foundation of China(NSFC81720108013,NSFC31771161 and NSFC81230025 to JC,NSFC81300957 and NSFC82171227 to HL,NSFC81771453 and NSFC31970937 to HZ);Jiangsu Provincial Special Program of Medical Science(BL2014029 to JC);Basic and Clinical Research Center in Anesthesiology of Jiangsu Provincial'Science and Education for Health'Project(JC),Zhejiang Provincial Natural Science Foundation(LY22H090019 to HL);Jiangsu Provincial Natural Science Foundation(BK20190047 to HZ);the Priority Academic Program Development of Jiangsu Higher Education Institutions(19KJA610005 to HZ);Distinguished Professor Program of Jiangsu(HZ),Jiangsu Province Innovative and Entrepreneurial Talent Program and Jiangsu Province Innovative and Entrepreneurial Team Program(HZ),Xuzhou Medical University start-up grant for excellent scientist(D2018010 and D2019025D to HZ);the Natural Science Foundation of Shanghai(21ZR1411300 to YH);Shenkang Clinical Study Foundation of Shanghai(SHDC2020CR4061 to YH).

摘　　要：Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial direct current stimulation(tDCS)on PSD in older patients undergoing lower limb major arthroplasty.Methods In this prospective,double-blind,pilot,randomised,sham-controlled trial,patients 65 years and over undergoing lower limb major arthroplasty were randomly assigned to receive active tDCS(a-tDCS)or sham tDCS(s-tDCS).The primary outcomes were the objective sleep measures on postoperative nights(N)1 and N2.Results 116 inpatients were assessed for eligibility,and a total of 92 patients were enrolled;47 received a-tDCS and 45 received s-tDCS.tDCS improved PSD by altering the following sleep measures in the a-tDCS and s-tDCS groups;the respective comparisons were as follows:the promotion of rapid eye movement(REM)sleep time on N1(64.5(33.5-105.5)vs 19.0(0.0,45.0)min,F=20.10,p<0.001)and N2(75.0(36.0-120.8)vs 30.0(1.3-59.3)min,F=12.55,p<0.001);the total sleep time on N1(506.0(408.0-561.0)vs 392.0(243.0-483.5)min,F=14.13,p<0.001)and N2(488.5(455.5-548.5)vs 346.0(286.5-517.5)min,F=7.36,p=0.007);the deep sleep time on N1(130.0(103.3-177.0)vs 42.5(9.8-100.8)min,F=24.4,p<0.001)and N2(103.5(46.0-154.8)vs 57.5(23.3-106.5)min,F=8.4,p=0.004);and the percentages of light sleep and REM sleep on N1 and N2(p<0.05 for each).The postoperative depression and anxiety scores did not differ significantly between the two groups.No significant adverse events were reported.Conclusion In older patients undergoing lower limb major arthroplasty,a single session of anodal tDCS over the left dorsolateral prefrontal cortex showed a potentially prophylactic effect in improving postoperative short-term objective sleep measures.However,this benefit was temporary and was not maintained over time.

关 键 词：SLEEP STIMULATION POSTOPERATIVE 

分 类 号：R749[医药卫生—神经病学与精神病学]