Abstract
<title>Abstract</title> <p>Background Patients with insomnia may exhibit altered pharmacodynamics to anesthetics. This study aimed to explore the changes in propofol dosage in patients with insomnia undergoing digestive endoscopy, compared to patients with normal sleep patterns. Methods A multicenter prospective cohort study was conducted. Propensity score matching (1:3) was applied to balance baseline characteristics. The primary outcome was the total propofol consumption during digestive endoscopy, and gender/age/BMI subgroup analysis was performed. The secondary outcome included the propofol dosage required for successful endoscopic insertion and gender/age/BMI subgroup analysis, the recovery time, the correlation between propofol dosage requirements and insomnia severity, as well as perioperative adverse events. Results After matching (140 patients in the insomnia group vs 420 patients in the normal sleep group), the insomnia group required significantly higher total propofol consumption (3.8 ± 0.8 vs 3.3 ± 0.6 mg/kg, P = 0.003) and propofol dosage required for successful endoscopic insertion (2.4 ± 0.3 vs 2.1 ± 0.3 mg/kg, P = 0.043). Subgroup analyses of total propofol consumption and propofol dosage required for successful endoscopic insertion confirmed these findings across gender and age. The recovery time and the incidence of perioperative adverse events were comparable in both groups. A positive correlation was observed between propofol dosage and insomnia severity (P < 0.001). Conclusions Patients with insomnia require higher propofol dosages during digestive endoscopy, suggesting the need for individualized anesthesia protocols in this population. Trial registration: ClinicalTrials.Gov (NCT06376760, Principal investigator: Fang Luo, Date of registration: 17 April, 2024)</p>