Abstract
AIMS: Postoperative sleep disturbance (PSD) is a common complication following surgical procedures. We aimed to evaluate the effect of prefrontal transcranial alternating current stimulation (tACS) in preventing PSD among patients undergoing gynecological laparoscopic surgery. METHODS: A total of 176 eligible patients, aged 18-65 years, with ASA Class I to III, and scheduled for gynecological laparoscopic surgery, were randomly allocated to receive either a single 20-min session of prefrontal tACS (2 mA, 7 Hz) or sham stimulation immediately after extubation. The primary outcome was the occurrence of PSD on postoperative day (POD) 1. RESULTS: The intention-to-treat analysis showed a statistically significant reduction in PSD incidence on POD 1 in the active tACS group (23.9%) compared to the sham group (43.2%), with an odds ratio of 0.41 (95% CI, 0.22-0.79; p = 0.007). Additionally, patients in the active tACS group reported significantly lower anxiety scores on POD 1 (p < 0.001), while depression scores were comparable between the groups. The active tACS group also reported significantly lower pain scores, both on PODs 1 (movement: p = 0.002; rest: p < 0.001) and 3 (movement: p = 0.028; rest: p < 0.001). CONCLUSIONS: A single session of prefrontal tACS significantly reduces the incidence of PSD on POD 1 and may offer additional benefits in reducing early postoperative anxiety and pain, with a favorable safety and tolerability profile. TRIAL REGISTRATION: China Clinical Trial Registration Center: ChiCTR2300078658.