Whether Nrf2 plays a key role in PSD after gastrointestinal (GI) surgery and the underlying mechanisms remain unclear. Other studies have shown that the expression of Nrf2 was reduced following oxidative stress after chronic sleep deprivation. demonstrated that corilagin ameliorates sleep deprivation and induces memory impairment by activating Nrf2. Moreover, Nrf2 is tightly regulated by sleep-related genes, suggesting an antioxidant and anti-inflammatory role of sleep through the regulation of Nrf2 signaling. Nrf2 induces the expression of antioxidant and cytoprotective genes under oxidative conditions including catalase (CAT), superoxide dismutase (SOD), glutathione S-transferases (GST), glutathione peroxidase (GSH-Px) and heme oxygenase-1 (HO-1). The transcription factor Nrf2 is best known as one of the main orchestrators of the cellular aerobic and oxidative stress response.

Serum levels of inflammatory cytokines and the expression of key factors of oxidative stress and key molecules of the nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE) signal pathway were measured.Īnti-oxidative factors, including nuclear factor erythroid 2-related factor 2 (Nrf2), are also downregulated in the setting of sleep deprivation. The incidences of abdominal distension, dizziness, postoperative nausea and vomiting (PONV) and pulmonary complications were recorded. Postoperative pain was assessed using visual analog scale (VAS) 72 h postoperatively. Sleep quality was assessed on the day before surgery (P1) and the first and third days after surgery (D1 and D3) using the Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS).

In the Sham group, electrodes were placed however, no current was given. Patients in the TEAS group received TEAS treatment (disperse-dense waves frequency, 2/100 Hz) on bilateral Shenmen (HT7), Neiguan (PC6) and Zusanli (ST36) points for 30 min each time, total three times in the perioperative period. Eighty-three patients were allocated to the TEAS or Sham group.

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