November 29, 2025
Study objective: Sleep disturbances are common in older patients following major surgery. Both propofol and sevoflurane are frequently used anesthetics. This study compared the effect of propofol-based versus sevoflurane-based anesthesia on postoperative sleep quality in this patient population.
Design: A randomized clinical trial.
Setting: A university hospital.
Patients: Patients aged 65 to 90 years who were scheduled for elective major abdominal surgery.
Interventions: Enrolled patients were randomized to receive either propofol-based intravenous anesthesia or sevoflurane-based inhalational anesthesia.
Measurements: The primary endpoint was total sleep time monitored by actigraphy on the first postoperative night. Secondary endpoints included plasma orexin-A concentrations at various time points from baseline (before anesthesia) until the second postoperative morning.
Main results: From May 23, 2022, to April 3, 2023, 144 patients (mean age 72.9 years; 58.3% male) were enrolled and randomly assigned. Total sleep time on the first postoperative night was longer with propofol anesthesia (median 150 min [interquartile range 99 to 200]) than with sevoflurane anesthesia (111 min [80 to 160]; median difference 29 min [95% CI 4 to 53]; P = 0.025). Plasma orexin-A concentration was lower in the propofol group at 1 h after anesthesia induction (median difference -31.3 pg/mL [95% CI -58.1 to -2.2]; P = 0.033) and at 6:00 on the first postoperative morning (median difference -29.8 pg/mL [95% CI -58.3 to -2.3]; P = 0.036).
Conclusions: Among older patients undergoing major abdominal surgery, propofol anesthesia, compared with sevoflurane anesthesia, was associated with a longer total sleep time on the first postoperative night. This difference may be partially attributable to lower plasma orexin-A levels.
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