Sleep Medicine Publisher



Eikermann M^{1, 2} ; Fassbender P^{1, 3} ; Azimaraghi O^{1, 4}
Source: Miller's Anesthesia, 2 Volume Set Published:2024

Abstract

Sleep is a fundamental dynamic physiological process crucial for individual and public health. Sleep has important implications for the recovery of patients after surgery. This chapter provides an overview of sleep measurement, the relationship between sleep and anesthesia, sleep apnea, and insomnia. The temporal order of different sleep stages, known as sleep architecture, is an important determinant of sleep quality. Polysomnography describes its cortical characteristics and immediate physiological consequences based on multiple physiological measurements, including electrocorticography, electromyography, and airflow. Actigraphy, self-reported sleep diaries, and questionnaires offer valuable insights into nocturnal activity while in bed, and subjective sleep quality. Physiologic sleep and anesthesia share some clinical features (such as loss of consciousness and a modulation of brainstem autonomic function). However, there are distinct mechanisms for arousable states (sleep, sedation) and unarousable unconsciousness (anesthesia). Anesthesia and surgery impact sleep and circadian rhythms, leading to postoperative sleep disturbances. Conversely, pre-existing sleep disorders can influence anesthetic requirements and recovery. Even short periods of insomnia in otherwise healthy young subjects can affect glucose tolerance and insulin resistance. Cognitive impairment after short-term sleep deprivation conditions is intuitive. Sleep deprivation causes bidirectional changes in brain activity and connectivity, primarily affecting attention and working memory, and increasing vulnerability to delirium in critically ill patients. Realignment of the sleep-wake cycles through pharmacologic and chronotherapeutic methods is essential in reducing the risk of delirium in these patients. New strategies are currently being examined to help mitigate insomnia after surgery and critical illness. Sleep apnea is a common sleep-related breathing disorder, and its main features, apneas and hypopneas, are similar to and aggravated during anesthesia. Patients with OSA can generally be safely treated in inpatient and ambulatory surgery centers that are run by well-trained anesthesiologists. Appropriate management strategies need to be applied depending on the severity of OSA, comorbidities, and the procedural risk. In conclusion, integrating principles of sleep medicine into anesthesia and perioperative care is essential for optimizing patient outcomes. By recognizing and addressing sleep-related considerations, healthcare providers can improve intraoperative safety, patient satisfaction, and postoperative recovery. Patients with OSA should have access to ambulatory surgery. © 2025 Elsevier Inc. All rights reserved.