Effect of Zolpidem on Sleep Quality and Other Parameters in Patients During the Perioperative Period

Introduction

Most patients undergoing extensive surgical procedures, such as hip or knee arthroplasty, experience a significant deterioration in sleep quality in the postoperative period, which significantly affects functional outcomes, recovery speed, pain intensity, and satisfaction with the surgical procedure. Sleep quality may also be disrupted by the underlying condition itself. For example, nighttime pain associated with reduced sleep quality and duration is typical for advanced forms of osteoarthritis.

Therapy aimed at improving sleep quality during the perioperative period should not be overlooked. A prospective study by Chinese authors evaluated the effect of zolpidem on sleep quality and other parameters in hospitalized patients undergoing unilateral total hip arthroplasty for advanced osteoarthritis.

Study Methodology

A total of 160 patients were included in a prospective randomized double-blind placebo-controlled single-center clinical study. They were randomized in a 1:1 ratio to receive zolpidem at a dose of 10 mg or placebo. Therapy was started 2 days before the procedure and continued for 5 days postoperatively. The medications were administered 30 minutes before bedtime.

Postoperative pain was assessed using the visual analog scale (VAS), and the use of analgesics and antiemetics was recorded. Sleep quality was measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSSI). Quality of life was assessed using the QoR-40 questionnaire, performance using the Hip Disability and Osteoarthritis Outcome Score (HOOS), and the occurrence of anxiety and depression using the Hamilton scale.

Results

The average age of participating patients was 66.06 ± 8.44 years, with women making up 82% of the sample. Basic demographic indicators and initial values of individual parameters did not significantly differ between the groups, except for the length of hospitalization. In the treated group, a significantly shorter hospital stay was observed (5.44 ± 1.76 vs. 7.24 ± 3.23 days; p < 0.05), as well as a shorter time to first mobilization and independent walking.

In the treated group, a significant reduction in postoperative VAS scores was observed compared to the placebo group (1st postoperative day 7.43 vs. 9.48; 3rd postoperative day 6.37 vs. 8.98; 5th postoperative day 4.75 vs. 7.00). The treated group also showed a significant reduction in the use of analgesics and antiemetics, improved quality of life assessed by QoR-40, and better postoperative outcomes assessed by HOOS (p < 0.05).

A significant difference was also observed in sleep quality and daytime sleepiness parameters (p < 0.05), with better results for patients in the treated group in all aspects of the Pittsburgh Sleep Quality Index and low daytime sleepiness assessed by the Epworth Sleepiness Scale. The treated group also achieved significantly better results on the Hamilton Anxiety and Depression Scale.

Conclusion

The study results indicated that the administration of zolpidem before sleep led to improved sleep quality, quality of life, higher satisfaction with the surgical procedure, improved functional outcomes, and shorter hospital stays in patients during the perioperative period.

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Source: Shakya H., Wang D., Zhou K. et al. Prospective randomized controlled study on improving sleep quality and impact of zolpidem after total hip arthroplasty. J Orthop Surg Res 2019 Sep 3; 14 (1): 289, doi: 10.1186/s13018-019-1327-2.