Efficacy and safety of intraoperative esketamine for postoperative sleep quality: a systematic review and meta-analysis of RCTs.

Abstract

To evaluate the efficacy and safety of intraoperative esketamine in improving postoperative sleep quality based on evidence from randomized controlled trials (RCTs). A systematic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline (via Ovid), and EMBASE. Eligible studies were RCTs comparing the effects of esketamine versus placebo on postoperative sleep quality in surgical patients. Statistical analyses were performed using Cochrane Review Manager version 5.4.1. A total of 10 RCTs comprising 1,287 patients were included. Esketamine significantly improved postoperative sleep quality compared to placebo on postoperative day (POD) 1 (SMD =  - 0.52, 95% CI [- 0.69, - 0.34], <i>P</i> < 0.00001, I² = 61%), POD 2 (SMD =  - 0.60, 95% CI [- 1.16, - 0.03], <i>P</i> = 0.04, I² = 77%), POD 3 (SMD =  - 0.44, 95% CI [- 0.71, - 0.18], <i>P</i> = 0.001, I² = 76%), and POD 7 (SMD =  - 0.31, 95% CI [- 0.58, - 0.04], <i>P</i> = 0.03, I² = 0%). While the incidence of adverse events did not differ significantly between groups, elevated odds ratios indicated a potential trend toward a higher incidence with esketamine. Intraoperative esketamine may improve postoperative sleep quality. However, it is not yet possible to conclude whether this agent is suitable for clinical use in improving sleep targeting postoperative patients. Further high-quality RCTs are needed to confirm efficacy and evaluate long-term safety.<h4>Supplementary information</h4>The online version contains supplementary material available at 10.1007/s41105-025-00595-8.

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