Efficacy and safety of perioperative esketamine in improving postoperative sleep disturbances: A systematic review and meta-analysis.

Abstract

<h4>Study objective</h4>This systematic review and meta-analysis aimed to explore the effects of perioperative esketamine on postoperative sleep disturbances in adult patients.<h4>Design</h4>Systematic review and meta-analysis.<h4>Interventions</h4>Intravenous infusion of esketamine during the perioperative period.<h4>Measurements</h4>The primary outcomes were the scale score of postoperative sleep disturbances on the first postoperative night and the incidence of postoperative sleep disturbances (PSD%) on the first postoperative night. Secondary outcomes included PSD% and sleep rating scale scores on other postoperative days, the postoperative rescue analgesia rate, pain scores, and adverse events.<h4>Main results</h4>A total of 14 randomized controlled trials (RCTs) involving 1956 patients were included in the analysis. The results demonstrated that esketamine significantly reduced PSD% on postoperative day 1 (POD1) (OR = 0.38, 95% CI [0.29, 0.50], P < 0.00001) and improved subjective sleep quality on POD1 (SMD = -0.63, 95% CI [-1.09, -0.16], P = 0.009), though the latter outcome showed substantial heterogeneity (I² = 88%). Subgroup analysis indicated that both single-dose and continuous intraoperative administration of esketamine consistently improved postoperative sleep quality. Moreover, no statistically significant difference was found in postoperative pain scores between the esketamine group and the control group. However, the incidence of postoperative rescue analgesia was significantly lower in the esketamine group. Regarding adverse events, only the incidence of drowsiness was markedly increased in the esketamine group, while no significant intergroup differences were observed for other adverse reactions.<h4>Conclusions</h4>Perioperative esketamine effectively reduces the incidence of early postoperative sleep disturbances and improves subjective sleep quality in adult surgical patients, with the timing of administration being the primary source of heterogeneity. It also decreases the requirement for rescue analgesia, and its overall safety profile is acceptable.<h4>Trial registration</h4>PROSPERO identifier: CRD420251122315.

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