Acute Delirium as a Manifestation of Obstructive Sleep Apnea Syndrome

Muñoz, Xavier; Martí, Sergi; Sumalla, J; Bosch, J.; Sampol, Gabriel

doi:10.1164/ajrccm.158.4.9801005

Cited by 38 publications

(12 citation statements)

References 13 publications

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“…Two case studies have reported reversibility of delirium after treatment with nCPAP [23,24]. The present study did not confirm these preliminary findings, nor did the authors find any significant effects of nCPAP treatment on MMSE, or Barthel-ADL index.…”

Section: Discussioncontrasting

confidence: 99%

Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study

et al. 2001

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The authors have investigated whether treatment of sleep apnoea with nasal continuous positive airway pressure (nCPAP) improves depressive symptoms, personal activities of daily living (ADL), cognitive functioning and delirium in patients that have suffered a stroke.Sixty-three patients consecutively admitted to a stroke rehabilitation unit 2–4 weeks after a stroke, with an apnoea/hypopnoea index ≥15, were randomized to either nCPAP treatment (n=33) or a control group (n=30). Four patients dropped out after randomization. Both groups were assessed at baseline and after 7 and 28 nights using the Montgomery-Åsberg Depression Rating Scale (MADRS), Barthel-ADL index, and the Mini-Mental State Examination (MMSE) scale.Compared to the control group, depressive symptoms (MADRS total score) improved in patients randomized to nCPAP treatment (p=0.004). No significant treatment effect was found with regard to delirium, MMSE or Barthel-ADL index. Delirium and low cognitive level (MMSE score) explained poor compliance with nCPAP.Depressive symptoms are reduced through nasal continuous positive airway pressure treatment in patients with severe stroke and sleep apnoea. Compliance with nasal continuous positive airway pressure treatment is a problem in stroke patients, especially when delirium and severe cognitive impairment occur.

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Section: Discussioncontrasting

confidence: 99%

Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study

et al. 2001

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“…We found a preliminary trend suggesting a decreased chance of delirium among CPAP-treated patients, consistent with case reports in which delirium was resolved using positive airway pressure for both OSA and central sleep apnea. [52][53][54] The mechanism by which OSA increases the risk for POD remains unknown, though there is reason to believe that the reduced oxygen metabolism that occurs with OSA might be playing a role. OSA is a sleep disorder characterized by the recurrent collapse of the pharynx, causing upper airway obstruction and leading to recurrent arousals during sleep and episodes of oxygen desaturation, 31,55 and hypoxia is a known cause of delirium.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea and Incidence of Postoperative Delirium After Elective Knee Replacement in the Nondemented Elderly

Flink¹,

Rivelli²,

Cox³

et al. 2012

Survey of Anesthesiology

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“…Numerous studies reported that age, functional status, preoperative cognitive impairment, depression, smoking, alcohol abuse, drug abuse, history of stroke, diabetes, hematological changes (for example, anemia), low albumin level, intraoperative blood transfusion, and atrial fibrillation were associated with postoperative delirium [1,5,6,8-11]. Although obstructive sleep apnea syndrome (OSAS) appears to be associated with cardiovascular disease, stroke, and cognitive impairment (for example, deficits in memory, attention, vigilance, and learning) [12,13], sleep-disordered breathing (SDB) has only infrequently been considered as a potential risk factor for postoperative delirium [14,15]. The most prevalent form of SDB is OSAS, which is characterized by intermittent loss of airway patency during sleep with sleep fragmentation, increased nocturnal endogenous stress, intermittent oxygen desaturations and the loss of a normal sleep architecture.…”

Section: Introductionmentioning

confidence: 99%

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

et al. 2014

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IntroductionDelirium is a frequent complication after cardiac surgery. Although various risk factors for postoperative delirium have been identified, the relationship between nocturnal breathing disorders and delirium has not yet been elucidated. This study evaluated the relationship between sleep-disordered breathing (SDB) and postoperative delirium in cardiac surgery patients without a previous diagnosis of obstructive sleep apnea.MethodsIn this prospective cohort study, 92 patients undergoing elective cardiac surgery with extracorporeal circulation were evaluated for both SDB and postoperative delirium. Polygraphic recordings were used to calculate the apnea-hypopnea index (AHI; mean number of apneas and hypopneas per hour recorded) of all patients preoperatively. Delirium was assessed during the first four postoperative days using the Confusion Assessment Method. Clinical differences between individuals with and without postoperative delirium were determined with univariate analysis. The relationship between postoperative delirium and those covariates that were associated with delirium in univariate analysis was determined by a multivariate logistic regression model.ResultsThe median overall preoperative AHI was 18.3 (interquartile range, 8.7 to 32.8). Delirium was diagnosed in 44 patients. The median AHI differed significantly between patients with and without postoperative delirium (28 versus 13; P = 0.001). A preoperative AHI of 19 or higher was associated with an almost sixfold increased risk of postoperative delirium (odds ratio, 6.4; 95% confidence interval, 2.6 to 15.4; P <0.001). Multivariate logistic regression analysis showed that preoperative AHI, age, smoking, and blood transfusion were independently associated with postoperative delirium.ConclusionsPreoperative SDB (for example, undiagnosed obstructive sleep apnea) were strongly associated with postoperative delirium, and may be a risk factor for postoperative delirium.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0477-1) contains supplementary material, which is available to authorized users.

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Acute Delirium as a Manifestation of Obstructive Sleep Apnea Syndrome

Cited by 38 publications

References 13 publications

Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study

Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study

Obstructive Sleep Apnea and Incidence of Postoperative Delirium After Elective Knee Replacement in the Nondemented Elderly

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

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