Transcranial Auricular Vagus Nerve Stimulation Alleviates Postoperative Sleep Disturbance in Patients Undergoing Video-Assisted Thoracic Surgery: a Randomized Clinical Trial

Background: Postoperative sleep disturbance (PSD) frequently complicates recovery following lung surgery. This study evaluated transcutaneous auricular vagus nerve stimulation (taVNS), a non‐invasive neuromodulatory therapy, for mitigating PSD after video‐assisted thoracic surgery (VATS). Methods: A total of 108 patients scheduled for elective thoracoscopic anatomical lung resection were assigned to the taVNS or sham group. TaVNS was delivered to the auricular concha (4/20 Hz, 0·8‐1·5 mA individually titrated) on the day before surgery, and at 19:00‐20:00 on the night of surgery, and on the first postoperative night. Sham stimulation was applied to the auricular rim (0·1 mA). The primary outcome was PSD incidence on postoperative day (POD) 2, defined as Athens Insomnia Scale (AIS) ≥6 or Numeric Rating Scale for sleep (NRS‐sleep) ≥6. Secondary outcomes included PSD incidence on other days, postoperative pain, quality of recovery, inflammatory indicators, and length of stay in the intensive care unit (ICU). Findings: The incidence of PSD on POD 2 was lower in the taVNS group than in the sham group (35·2% vs 61·1%, [risk ratio (RR) 1·737, 95% confidence interval [CI]: 1·141‐2·643], P=0·007), accompanied by improved AIS and NRS‐sleep scores. Furthermore, taVNS attenuated postoperative pain, enhanced recovery quality, suppressed systemic inflammatory markers, and accelerated ICU discharge (all P<0·05). No serious treatment‐related adverse events were observed. Interpretation: Perioperative taVNS safely mitigates PSD, enhances analgesia, and accelerates overall recovery following VATS. These findings endorse taVNS as a highly effective, non‐pharmacological adjunct for multimodal postoperative rehabilitation.