Effect of Remimazolam versus Propofol Sedation on Postoperative Sleep Quality Following Gastroscopy: A Propensity Score-Matched Cohort Study.

PURPOSE: Postoperative sleep disturbance is a prevalent complication following painless gastroscopy. Remimazolam, an ultra-short-acting benzodiazepine with rapid metabolism, offers theoretical advantages in preserving the postoperative sleep architecture. This study compared the effects of remimazolam and propofol sedation on postoperative sleep quality in patients undergoing painless gastroscopy. PATIENTS AND METHODS: We conducted a retrospective cohort study of 802 patients who underwent painless gastroscopy. The participants received either remimazolam or propofol for procedural sedation. Propensity score matching balanced the baseline characteristics between the cohorts. The primary outcome was postoperative sleep quality, which was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The second outcomes included intraoperative hemodynamics, recovery parameters, and adverse events. Conditional linear regression was used to evaluate the association between anesthetic choice and sleep outcomes. Sensitive analysis employing inverse probability of treatment weighting (IPTW) validated the robustness of the results. RESULTS: The final analysis comprised 662 patients (331 patients per group). The post-matching baseline characteristics demonstrated excellent balance. The remimazolam cohort exhibited significantly superior postoperative RCSQ scores than the propofol cohort [median (IQR): 73.00 (64.00-80.00) vs 70.00 (59.00-80.00); P = 0.005], with notable improvements in sleep depth, nocturnal awakenings, and overall sleep quality. Remimazolam was associated with reduced intraoperative hypotension (5.4% vs 28.1%; P < 0.001) and injection pain (3.3% vs 18.7%; P < 0.001). Conversely, recovery time was prolonged and hiccup incidence increased with remimazolam (both P < 0.001). Multivariable analysis showed that remimazolam was independently associated with enhanced postoperative sleep (β = 7.985; 95% CI: 4.702-11.267; P < 0.001). The IPTW sensitivity analysis corroborated these findings. CONCLUSION: Remimazolam was associated with modestly improved postoperative sleep quality and hemodynamic stability compared with propofol, but also with longer recovery time and more hiccups than propofol.