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已发表论文
亚麻醉剂量艾氯胺酮对乳腺癌患者术后睡眠质量影响的脑电图分析：一项随机临床试验
Authors Zhan Y, Zhang Y, Liu Z , Yin Z, Wang D, Xie X, Wang L
Received 16 September 2025
Accepted for publication 6 December 2025
Published 12 December 2025 Volume 2025:19 Pages 11057—11071
DOI https://doi.org/10.2147/DDDT.S567980
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Tuo Deng
Yuening Zhan,1,* Yanmei Zhang,1,* Zhaohui Liu,1 Zheng Yin,2 Dan Wang,1 Xin Xie,1,* Lingfei Wang1,*
1Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, People’s Republic of China; 2Department of Orthopedics, Anshan Hospital, The First Hospital of China Medical University, Anshan, Liaoning, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Lingfei Wang, Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18900918433, Email wanglingfei.good@163.com Xin Xie, Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18940236751, Email xiexin@cancerhosp-ln-cmu.com
Background: Postoperative sleep disturbance (POSD) is prevalent following breast cancer surgery, impairing postoperative recovery. However, effective interventions and underlying mechanisms remain unclear. This study aims to evaluate whether intravenous subanesthetic esketamine improves postoperative sleep quality and its association with electroencephalogram (EEG) frequency band changes in breast cancer patients.
Methods: In this randomized, double-blind, placebo-controlled trial, patients undergoing breast cancer surgery received either intravenous esketamine (0.2 mg/kg induction, 0.4 mg/kg/h maintenance) or placebo during anesthesia. Both groups received intraoperative EEG monitoring. The primary outcome was POSD incidence at 24 hours assessed by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included PSQI scores at 72 hours, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, Visual Analog Scale (VAS) pain scores, and intraoperative EEG parameters.
Results: POSD incidence was significantly reduced in the esketamine group compared with the control group (27.3% [16/58] vs 51.7% [30/58]; odds ratio, 0.36; 95% CI, 0.16– 0.77; P = 0.014). Moreover, the esketamine group demonstrated significantly lower PSQI scores at both 24 hours (median [IQR], 2 [1– 5] vs 4 [4– 8]; P < 0.001) and 72 hours (1 [0– 2.5] vs 3.5 [2.75– 5]; P < 0.001). The esketamine group exhibited significantly higher intraoperative gamma-band relative power spectral density (mean [SD], 0.74 [0.25] vs 0.52 [0.18]; P < 0.001), which was independently associated with reduced POSD risk in multivariate analysis (odds ratio, 0.63; 95% CI, 0.40– 0.97; P = 0.039).
Conclusion: Subanesthetic esketamine significantly reduced the incidence of POSD and lowered PSQI scores. Importantly, esketamine was associated with enhanced intraoperative gamma-band EEG activity, which was independently associated with reduced POSD risk, suggesting that modulation of specific cortical oscillations may underlie its sleep-enhancing effects.
Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2400092257.
Keywords: subanesthetic esketamine, electroencephalogram, gamma oscillations, postoperative sleep disturbance, breast cancer surgery
1Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, People’s Republic of China; 2Department of Orthopedics, Anshan Hospital, The First Hospital of China Medical University, Anshan, Liaoning, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Lingfei Wang, Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18900918433, Email wanglingfei.good@163.com Xin Xie, Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18940236751, Email xiexin@cancerhosp-ln-cmu.com
Background: Postoperative sleep disturbance (POSD) is prevalent following breast cancer surgery, impairing postoperative recovery. However, effective interventions and underlying mechanisms remain unclear. This study aims to evaluate whether intravenous subanesthetic esketamine improves postoperative sleep quality and its association with electroencephalogram (EEG) frequency band changes in breast cancer patients.
Methods: In this randomized, double-blind, placebo-controlled trial, patients undergoing breast cancer surgery received either intravenous esketamine (0.2 mg/kg induction, 0.4 mg/kg/h maintenance) or placebo during anesthesia. Both groups received intraoperative EEG monitoring. The primary outcome was POSD incidence at 24 hours assessed by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes included PSQI scores at 72 hours, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores, Visual Analog Scale (VAS) pain scores, and intraoperative EEG parameters.
Results: POSD incidence was significantly reduced in the esketamine group compared with the control group (27.3% [16/58] vs 51.7% [30/58]; odds ratio, 0.36; 95% CI, 0.16– 0.77; P = 0.014). Moreover, the esketamine group demonstrated significantly lower PSQI scores at both 24 hours (median [IQR], 2 [1– 5] vs 4 [4– 8]; P < 0.001) and 72 hours (1 [0– 2.5] vs 3.5 [2.75– 5]; P < 0.001). The esketamine group exhibited significantly higher intraoperative gamma-band relative power spectral density (mean [SD], 0.74 [0.25] vs 0.52 [0.18]; P < 0.001), which was independently associated with reduced POSD risk in multivariate analysis (odds ratio, 0.63; 95% CI, 0.40– 0.97; P = 0.039).
Conclusion: Subanesthetic esketamine significantly reduced the incidence of POSD and lowered PSQI scores. Importantly, esketamine was associated with enhanced intraoperative gamma-band EEG activity, which was independently associated with reduced POSD risk, suggesting that modulation of specific cortical oscillations may underlie its sleep-enhancing effects.
Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2400092257.
Keywords: subanesthetic esketamine, electroencephalogram, gamma oscillations, postoperative sleep disturbance, breast cancer surgery