Yaozu Li,1– 4 Muyan Zuo,1– 4 Ruoguo Wang,2,3 Yongxiang Li,2,3 John P Williams,5 Jianxiong An1– 5 

1Medical School, University of Chinese Academy of Sciences, Beijing, People’s Republic of China; 2Center for Pain & Sleep Medicine, Affiliated Hospital of Shandong Second Medical University (Weifang Medical University), Weifang, People’s Republic of China; 3Institute for Innovation Diagnosis & Treatment in Anesthesiology, Shandong Second Medical University (Weifang Medical University), Weifang, People’s Republic of China; 4Brain Disease Institute & Department of Anesthesiology for the Integrated Traditional Chinese and Western Medicine Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 5Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Correspondence: Jianxiong An, Email anjianxiong@yeah.net

Background: Insomnia is a common symptom of depression, and their complex, bidirectional relationship poses significant challenges for treatment. Dexmedetomidine (Dex), an α2-adrenergic receptor agonist, shows unique advantages in inducing sleep closely resembling physiological sleep and is gaining interest as a potential therapy for insomnia.
Objective: This study aimed to determine the average effective Dex dose for inducing stage N2 sleep in patients with depression-related insomnia via polysomnography (PSG), and to identify factors affecting dose variability.
Methods: From April to August 2023, 91 patients with depression-related insomnia were recruited from the Center for Pain and Sleep Medicine at the Affiliated Hospital of Shandong Second Medical University. All patients received intravenous Dex infusion (diluted to 4 μg/mL and administered at 60 mL/h) under continuous PSG monitoring. The cumulative Dex dose required to induce stage N2 sleep was recorded. Clinical data were collected, and univariate and multiple linear regression analyses were performed to identify factors influencing Dex dose.
Results: A total of 82 patients were included in the final analysis. The mean effective dose of Dex required to induce stage N2 sleep was 49.0 ± 16.4 μg. Multivariate regression analysis identified age (P < 0.001) and body weight (P = 0.022) as independent predictors of Dex dose, with age exerting a stronger predictive effect. Simple linear regression further demonstrated a positive association between age and Dex dose (R² = 0.181). During titration, patients’ vital signs remained stable, with heart rate significantly decreasing (68.2 ± 10.0 vs 57.0 ± 13.3 bpm, P < 0.05), whereas mean arterial pressure and oxygen saturation showed no significant changes (P > 0.05).
Conclusion: Dex could effectively induces stage N2 sleep in patients with depression-related insomnia and has a favorable safety profile, with the required dose increasing with age.

Keywords: polysomnography, depression, insomnia, dexmedetomidine, stage N2 sleep