[Botanical sedatives]

Valerian and postoperative sleep: a retrospective cohort analysis of gynecological, urologic, and general surgical patients

Study Objectives

Postoperative sleep disturbances appear to be a common complication after surgery being treated with sleep-promoting medication such as valerian, but robust data and evidence of medicinal approaches are lacking.

Methods

We performed a retrospective cohort analysis of all 21 168 urological, gynecological, and general surgical patients of the University Medical Center Freiburg, Germany, who underwent surgery between 2015 and 2020. Target parameters were the usage of sleep-promoting medication to estimate the occurrence of postoperative sleep disturbances as well as the kind of sleep medication with a special focus on herbal medication such as valerian.

Results

Drug-treated sleep disturbances occurred in 15% (n = 3083) of the patients. Valerian was the second most applied drug (n = 814, 26.4%) after classic benzodiazepines (n = 1 138, 36.9%). The majority of patients got valerian as monotherapy. Age, length of stay, and comorbidities were associated with demand for sleep medication in general (p < .001). Valerian monotherapy was more common in women (OR 1.53, 95% CI: 1.33–1.77, p < .001), elderly patients (OR 1.50, 95% CI: 1.29–1.75, p < .001), and patients with prolonged hospital stay (OR 2.23, 95% CI: 1.91–2.61, p < .001).

Conclusions

Valerian plays an important role in the treatment of postoperative sleep disturbances clinically, and it appears to be a promising therapeutic approach especially in women, older and sicker patients, and those with prolonged hospital stay. Further research has to clarify the efficacy of valerian postoperatively.

Clinical trial registration

DRKS00027903, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027903

An Unsuccessful Attempt to Confirm the Occurrence of 4'-O-β- d-Glucosyl-9-O-(6″-deoxysaccharosyl)olivil in Valerian Root

The lignan 4'-O-β- d-glucosyl-9-O-(6″-deoxysaccharosyl)olivil had previously been discovered in a methanolic extract of valerian root (Valeriana officinalis agg.) and characterized as a potent partial agonist at the A₁ adenosine receptors. Today, countless scientific sources, webpages, and press articles mention this compound and discuss it as an active constituent for the sedative effect of this herbal drug. As no second report confirmed the occurrence of this lignan in valerian root during the 20 years since its first description in 1998, we intended to re-prove its presence by means of LCMS using other genuine or added lignans as a quantitative benchmark. Whilst those lignans were clearly detectable in methanolic valerian extracts of all six investigated batches of valerian root, no positive proof of 4'-O-β- d-glucosyl-9-O-(6″-deoxysaccharosyl)olivil was achieved. Our result suggests that this compound does not occur regularly in valerian root in the amounts expected from the single report on the occurrence of this compound.