Effect of perioperative dexmedetomidine on sleep quality in adult patients after noncardiac surgery: A systematic review and meta-analysis of randomized trials

Lin Wang; Xin-Quan Liang; Yan-Xia Sun; Zhen Hua; Dong-Xin Wang

doi:10.1371/journal.pone.0314814

Peer Review History

Original SubmissionAugust 27, 2024
4 Sep 2024 Decision Letter - Jiawen Deng, Editor PONE-D-24-36740Effect of perioperative dexmedetomidine on sleep quality in adult patients after noncardiac surgery: a systematic review and meta-analysis of randomized trialsPLOS ONE Dear Dr. Wang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 19 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jiawen Deng Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: "The study was funded by National Natural Science Foundation of China (No. 82293644; Dong-Xin Wang), National High Level Hospital Clinical Research Funding (High Quality Clinical Research Project of Peking University First Hospital No. 2022CR78; Dong-Xin Wang)." Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction Confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. An explanation of how missing data were handled. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. Additional Editor Comments: I would like to applaud your submission as it exceeds the quality of many other systematic review submissions that we receive at PLOS ONE. However, there are several deficiencies that I would like you to address before I can send this out for further peer-review. 1) Please provide a clear and concrete rationale for your addition of the secondary outcomes and deviation from your original protocol, backed by literatures or clinical knowledge. It is very, very bad practice to include additional outcomes after data extraction because "these results were also investigated". 2) Some PRISMA 2020 items were checked off but not completed. Confidence of evidence (item 15 and item 22 on PRISMA 2020) is a major one. This will need to be done using the GRADE framework. Please review the GRADE methodology and add a GRADE summary of findings table, and please review the PRISMA checklist for any other items that you may have missed. 3) For imputing mean and SD from other summary and variance metrics, it is usually a good idea to perform tests of normality first. Please look into this and add this analysis. 4) You seem to be using the original risk of bias tool (RoB 1.0) from Cochrane. As you know, Cochrane is now recommending their latest tool, RoB-2, and your methods are out of date. Please re-conduct your risk of bias assessment using the updated RoB framework. Note that your submission will still be subjected to external peer-review upon resubmission. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0314814.r001
Revision 1
22 Oct 2024 Author Response Point-by-point response to editor Journal Requirements: Requirement 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: We rechecked and revised the manuscript again to ensure that it meets PLOS ONE’s style requirements. Requirement 2. Please state what role the funders took in the study. If the funders had no role, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Response: The funders had no role in the study. We clarified this in the submission system: “Funded by National Natural Science Foundation of China (Major Program No. 82293644) and National High Level Hospital Clinical Research Funding (High Quality Clinical Research Project of Peking University First Hospital No. 2022CR78). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Requirement 3. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: #1. A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. Response: In the supplementary information, we provide S1 Table which listed all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, we listed the reason for exclusion. No unpublished study was included. #2. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction and confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. Response: In the manuscript and supplementary information, we provide Table 1 and S2 Table which listed all data extracted from the primary research sources for the systematic review and meta-analysis, including name of data extractors, date of data extraction, confirmation that the study was eligible to be included in the review, and all data extracted from each study for the reported systematic review and/or meta-analysis. All data were obtained from original article. #3. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. Response: In the supplementary information, we provide S3 Table which listed the risk of bias of included studies, and S4 Table which listed the quality of evidence assessment for each outcome according to the GRADE system. #4. An explanation of how missing data were handled. Response: We clarified this in the revised manuscript: “The corresponding authors were contacted for missing data or un-reported information. If there were no responses after three contacts, we estimated data according to figures in the original articles.” (Page 7, lines 109-111). #5. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. Response: These data are included in the main text and supplementary information. Additional Editor Comments: I would like to applaud your submission as it exceeds the quality of many other systematic review submissions that we receive at PLOS ONE. However, there are several deficiencies that I would like you to address before I can send this out for further peer-review. Comment 1. Please provide a clear and concrete rationale for your addition of the secondary outcomes and deviation from your original protocol, backed by literatures or clinical knowledge. It is very, very bad practice to include additional outcomes after data extraction because "these results were also investigated". Response: Thank you for your comments. We realized that adding secondary outcomes after data extraction is not a good practice. In the revised “2.1 Protocol and registration” section, we changed “secondary outcomes” to “exploratory outcomes”: “We added exploratory and safety outcomes after data collection because these results were important to clarify the effects of dexmedetomidine.” (Page 6, lines 81-82). We also changed the corresponding expressions in the manuscript throughout. Comment 2. Some PRISMA 2020 items were checked off but not completed. Confidence of evidence (item 15 and item 22 on PRISMA 2020) is a major one. This will need to be done using the GRADE framework. Please review the GRADE methodology and add a GRADE summary of findings table, and please review the PRISMA checklist for any other items that you may have missed. Response: Thank you very much for reminding us. We reviewed and revised the PRISMA checklist carefully to ensure that we completed all items. We also reviewed the GRADE methodology and added a GRADE summary of findings in S4 Table. Comment 3. For imputing mean and SD from other summary and variance metrics, it is usually a good idea to perform tests of normality first. Please look into this and add this analysis. Response: We appreciate your valuable comments. When included studies reported only median and interquartile range, we contacted the authors to obtain the corresponding mean and standard deviation (SD). If there was no response after three contacts, mean and SD were estimated according to the reported formula. However, the original data were not available because the authors did not respond, so we could not perform tests of normality. We agree that mean (and SD) converted from median (and interquartile range) do not accurately reflect distribution of results for skewed data. We therefore performed sensitivity analysis after excluding studies with small sample sizes and outcomes expressed in medians. Results of sensitivity analysis did not change our primary conclusion (Table 3). We also discussed this in the “Discussion” section: “For skewed data, mean (and SD) converted from median (and interquartile range) do not accurately reflect distribution of results. In sensitivity analysis, we excluded studies with small sample sizes and outcomes expressed in medians or those at high risk of bias. Results of sensitivity analysis did not change our primary conclusion.” (Page 24, lines 312-316). Comment 4. You seem to be using the original risk of bias tool (RoB 1.0) from Cochrane. As you know, Cochrane is now recommending their latest tool, RoB-2, and your methods are out of date. Please re-conduct your risk of bias assessment using the updated RoB framework. Response: Thank you very much. We re-conducted the risk of bias assessment using the updated RoB framework (RoB-2). Results are presented in Fig 2 and S3 Table. Attachments Attachment Submitted filename: R15-Response to editor-R1.docx https://doi.org/10.1371/journal.pone.0314814.r002
18 Nov 2024 Decision Letter - Jiawen Deng, Editor Effect of perioperative dexmedetomidine on sleep quality in adult patients after noncardiac surgery: a systematic review and meta-analysis of randomized trials PONE-D-24-36740R1 Dear Dr. Wang, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jiawen Deng Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0314814.r003
Formally Accepted
22 Nov 2024 Acceptance Letter - Jiawen Deng, Editor PONE-D-24-36740R1 PLOS ONE Dear Dr. Wang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Jiawen Deng Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0314814.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .