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 (opens in new tab)
Study at a glance
AI-extracted from the abstract| 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 Surgical recovery Post-surgery care Enhanced recovery Surgical outcomes Sleep management Sleep disturbance Sleep quality Insomnia Sleep improvement Postoperative sleep Pain management Analgesia Pain relief Opioid reduction Postoperative pain Microbiome Oral microbiota Microbial communities Gut-brain axis |
| Citations | 1 |
| Key findings | 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.