Interactions Between Anesthesia and Sleep: Optimizing Perioperative Care to Improve Sleep Quality and Surgical Recovery Outcomes

Abstract

Sleep is a fundamental physiological process that supports immunity, cognition, memory, and metabolism, making it essential for overall health and well-being. Poor-quality sleep is associated with the onset of many diseases, including cardiovascular and mental health disorders. When using anesthesia, it is essential to have a thorough understanding of the metabolic dysfunction and immunosuppression linked to sleep loss to ensure appropriate perioperative management. Commonly used agents like propofol, sevoflurane, and ketamine affect consciousness, pain levels, and autonomic responses. Inhaled anesthetics (e.g., sevoflurane and isoflurane) and intravenous anesthetics (propofol) act on gamma-aminobutyric acid (GABA) receptors and influence stages of sleep and circadian rhythms. Ketamine may uniquely preserve some aspects of restorative sleep, while most anesthetics affect rapid eye movement (REM) and slow wave sleep (SWS), altering cognitive and physical recovery. Modifying anesthetic regimes depending on the patient's sleep history and risk factors can maximize sleep health and postoperative patient outcomes. The physiological effects of anesthesia on the central nervous system persist beyond the perioperative period by influencing sleep quality, circadian regulation, and postoperative outcomes. Effective pain management is a significant component in addressing sleep quality. Opioids, while effective for pain relief, disrupt sleep architecture by reducing REM and SWS, increasing awakening frequency, and potentially causing respiratory depression. Multimodal pain therapy, including non-opioid analgesics, can reduce dependence, improve sleep quality, and lower adverse effects. Anesthetic agents can influence the body's internal clock, leading to mood changes, fatigue, and cognitive deficits. This review exploits the relationship between sleep and anesthesia, detailing the effect of anesthetic agents on the quality, architecture, and recovery of sleep patterns post-surgery. It also explores how these agents influence sleep stages, such as REM and non-REM sleep, and their implications for patient outcomes. Incorporating sleep optimization techniques can enhance recovery timelines and patient well-being. Researching anesthetic techniques that support postoperative sleep health is essential for further improving patient outcomes.

Keywords: anesthesia; anesthetic agent; circadian rhythm; general anesthesia; sleep; sleep wake cycle.

Figure 1. Similarities and differences in the mechanism of action of general anesthesia and sleep.

LC: locus coeruleus, DRN: dorsal raphe nuclei, PPT: pedunculopontine tegmental nucleus, LDT: laterodorsal tegmental nucleus, VTA: ventral tegmental area, PB: parabrachial nucleus, TMN: tuberomammillary nuclei, LH: lateral hypothalamus, BF: basal forebrain, VLPO: ventrolateral preoptic area, PZ: parafacial zone, nNOS: neuronal nitric oxide synthase (nNOS)-containing neurons in the cortex, PPT: pedunculopontine tegmental nucleus, LDT: laterodorsal tegmental nucleus, SLD: sublaterodorsal nucleus. Copyright/license: This figure has been adapted from [20], which is an open-source article distributed under the terms and conditions of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)