Effects of intranasal dexmedetomidine on postoperative sleep quality: a systematic review and meta-analysis of randomized controlled trials

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Background Postoperative sleep disturbance is common in surgical patients and may slow recovery. Dexmedetomidine has a sleep like sedative effect, and intranasal administration provides a convenient and non-invasive route. The aim of our study was to evaluate the effect of intranasal dexmedetomidine on postoperative sleep quality in adult surgical patients. Methods We performed a systematic review and meta-analysis of randomized controlled trials. PubMed, the Cochrane Library and Embase were searched to May 20, 2026. Intranasal dexmedetomidine was compared with placebo or other controls. Subjective and objective sleep outcomes, sleep disturbance and adverse events were analysed using standard meta-analytic methods. Subgroup analyses were further performed according to the route, timing, and duration of administration, as well as patient characteristics, surgical type, anesthesia type, and evaluation scales. Results 15 trials were included. For subjective scores where a lower value means better sleep, intranasal dexmedetomidine improved postoperative sleep compared with controls (SMD = −1.29, 95% CI [−1.80, −0.77], I 2 = 90%, p < 0.00001). Subgroup analyses suggested that the timing of administration, sex distribution, and surgical type might be important sources of heterogeneity. For scores where a higher value means better sleep, postoperative scores were also higher in the dexmedetomidine group (SMD = 1.75, 95% CI [0.94, 2.57], I 2 = 94%, p < 0.0001). Sleep efficiency (SMD = 1.71, 95% CI [0.94, 2.48], I 2 = 93%, p < 0.0001) and total sleep time (SMD = 1.76, 95% CI [0.67, 2.84], I 2 = 91%, p = 0.002) increased, sleep latency (SMD = −1.07, 95% CI [−1.66, −0.49], I 2 = 86%, p = 0.0003) reduced, while REM sleep, N1 sleep, and N3 sleep did not change. The risk of sleep disturbance decreased (RR = 0.53, 95% CI [0.39, 0.73], I 2 = 74%, p < 0.0001). Adverse events such as delirium, nausea and vomiting, and anxiety were less common in the dexmedetomidine group. Conclusion Intranasal dexmedetomidine may improve short-term postoperative sleep, but evidence is limited and more high-quality trials are needed. Systematic review registration PROSPERO 2025 CRD420251186146, Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251186146 .

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