Esketamine prevents postoperative sleep disturbance in patients with preoperative sleep disorders: a role for oral microbiota.
Xin-Yu Li, Di Qiu, Ni Du, Kenji Hashimoto, Xing-Ming Wang, Jian-Jun Yang
Translational psychiatry November 24, 2025 DOI: 10.1038/s41398-025-03705-9 via PubMed
Summary
AI-generated from the abstractPatients with preexisting sleep disorders are at higher risk for postoperative sleep disturbance (PSD). In a randomized trial of 130 patients, intraoperative esketamine (0.3 mg/kg/h) reduced the incidence of PSD on postoperative day 1 (43.1% vs. 64.6%; odds ratio, 0.414) and lowered hydromorphone use. Preoperative oral microbiota profiles differed between patients who later developed PSD and those who did not, with specific bacterial taxa linked to sleep disturbance. The findings suggest esketamine may help prevent postoperative sleep disruption, possibly by modulating the oral microbiota.
Study at a glance
| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 130 |
| Population | Patients undergoing surgery |
| Intervention | Esketamine |
| Dose | 0.3 mg/kg/h |
| Duration | Postoperative days 1, 3, and 7 |
| Topics | Esketamine |
| Keywords | Ketamine derivative Anesthetic Analgesic Postoperative recovery |
| Citations | 1 |
| Key finding | Intraoperative esketamine reduced the incidence of postoperative sleep disturbance on day 1 and was associated with altered oral microbiota profiles. |
Abstract
Patients with preexisting sleep disorders face a significantly increased risk of postoperative sleep disturbance (PSD) due to heightened sensitivity to surgical stress, anesthesia, and hospital-related environmental factors. There is a critical unmet need for effective prophylactic medications to prevent PSD, as current treatment options are limited and often inadequate. This study investigated the prophylactic effect of intraoperative esketamine (0.3 mg/kg/h) on PSD in 130 patients randomized into control and esketamine groups. Preoperative sleep quality was assessed using the Pittsburgh Sleep Quality Index, while postoperative sleep was evaluated using the Numerical Rating Scale (NRS) and Athens Insomnia Scale (AIS) on postoperative days (PODs) 1, 3, and 7. PSD was defined as an NRS or AIS score ≥6. Saliva samples were collected for 16S rRNA sequencing to analyze the oral microbiota. On POD 1, the esketamine group showed a significantly lower incidence of PSD (43.1 vs. 64.6%; OR, 0.414; P = 0.014) and reduced hydromorphone consumption. Preoperative oral microbiota profiles differed between patients with and without PSD, with specific bacterial taxa associated with sleep disturbance. These findings suggest that esketamine may alleviate postoperative sleep disruption, potentially through modulation of the oral microbiota.