Pharmacological Management of Acute Sleep Disorders During the First 48 hours of the Postoperative Period. A Narrative Review

Author(s): Jairo R Moyano A, Jairo Urrego, Laura Camargo

Abstract
Introduction: The positive effects of restorative sleep must be carefully considered during the early postoperative period. The literature on the treatment of acute sleep disorders taking place during the postoperative period is scarce. Most pharmacological therapies are based on the administration of benzodiazepines; however, a personalized approach is strongly recommended, due to their side effects. The objective of this narrative review was to evaluate rational pharmacological therapies for the management of acute sleep disorders during the first 48 hours of the postoperative period in patients undergoing scheduled surgery procedures.

Methods: A narrative review was conducted in the Embase, PubMed, and Cochrane databases. Only controlled randomized trials and systematic reviews were considered for inclusion.

Outcome: The primary outcome was the improvement of sleep patterns after pharmacological treatments for acute sleep disorders, its administration routes, and its impact on postoperative descents.

Results: The initial search yielded 271 studies, however only 7 met the eligibility criteria. Pharmacological therapies based on the administration of Zolpidem at a dose of 5 milligrams at night, Gabapentin at doses> 900 mg/day, and Dexmedetomidine intravenous infusion at a 0.05 mcg/kg/h dose were reported as being effective for the treatment of these disorders during the early postoperative period.

Conclusions: The oral administration of Zolpidem and Gabapentin and the intravenous administration of Dexmedetomidine are effective for the management of acute sleep disorders in carefully selected postoperative patients. Somehow, due to drug side effects, non-pharmacological management alone or combined with pharmacological therapy should be always considered.