title: Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.
abstract: OBJECTIVE
  Previous studies have demonstrated pronounced reduction of REM sleep on the first nights following major surgery which may influence pain, analgesic use, and recovery. This placebo-controlled, randomized, double-blind study set out to evaluate the effect of zolpidem on sleep architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay < 3 days.
  
  
  METHODS
  Twenty patients (≥ 60 years) undergoing THA or TKA in a standardized setup with spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included. Polysomnography measures were performed for 2 nights, 1 night at home prior to surgery and on the first night after surgery, when the patient received placebo or zolpidem 10 mg. Analgesic use, pain levels, and subjective measures of fatigue and sleep quality were recorded. Analysis of sleep data was performed according to the American Academy of Sleep Medicine manual.
  
  
  RESULTS
  Objective sleep data did not show a significant difference between groups in any of the sleep stages. However, subjective data on sleep quality and fatigue showed significantly less fatigue and better sleep quality in the zolpidem group (p < 0.05), and reduced objectively recorded number of arousals (p = 0.004). Levels of pain and opioid use were similar in the 2 groups.
  
  
  CONCLUSIONS
  Our objective data did not support the primary hypothesis that one night's treatment with zolpidem would significantly improve sleep architecture following major surgery, although there was improved feeling of sleep quality and fatigue associated with fewer postoperative arousals.
  
  
  BACKGROUND
  Krenk L; Jennum P; Kehlet H. Postoperative sleep disturbances after zolpidem treatment in fast-track hip and knee replacement.
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Krenk
authors.affiliation: Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, and Centre for Healthy Ageing, Faculty of Health, University of Copenhagen, Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Jennum
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark ; Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004311:Double-Blind Method; D005221:Fatigue / Q000517:prevention & control; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D017286:Polysomnography; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011725:Pyridines / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000209:etiology; D012895:Sleep, REM / Q000187:drug effects; D000077334:Zolpidem
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
keywords: Postoperative sleep; cognition; recovery; sleep deprivation; zolpidem