Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

Abstract

Background: Post-cardiac surgery patients exhibit a higher incidence of postoperative delirium (PD) compared to non-cardiac surgery patients. Patients with various cardiac diseases suffer from preoperative sleep disorder (SPD) induced by anxiety, depression, breathing disorder, or other factors. Objective: To examine the effect of sleep disorder on delirium in post-cardiac surgery patients. Methods: We prospectively selected 186 patients undergoing selective cardiac valve surgery. Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment, respectively. The Confusion Assessment Method for Intensive Care Unit was used to assess PD from the first to seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) No PD group and (2) the PD group. Results: Of 186 eligible patients, 29 (15.6%) were diagnosed with PD. A univariate analysis showed that gender (p = 0.040), age (p = 0.009), SPD (p = 0.008), intraoperative infusion volume (p = 0.034), postoperative intubation time (p = 0.001), and intensive care unit stay time (p = 0.009) were associated with PD. A multivariate logistic regression analysis demonstrated that age (odds ratio (OR): 1.106; p = 0.001) and SPD (OR: 3.223; p = 0.047) were independently associated with PD. A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of PD (area under curve: 0.706; 95% confidence interval: 0.595–0.816). A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and PD incidence (p = 0.009). Conclusions: Preoperative SPD was significantly associated with PD and a main predictor of PD.

Perioperative Sleep Disorder: A Review

“…According to the results of a meta-analysis, pre-existing sleep disturbances may be associated with post-operative delirium (POD) ( 63 ). A study about cardiac surgery found that pre-operative sleep disorder was significantly associated with POD and was the main predictor of POD ( 64 ), especially in older individuals ( 65 ). The risk of post-operative delirium is significantly higher in older adults with chronic sleep disturbance before hospitalization than in those without sleep disorders.…”

<p>Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery</p>

“…11,12 A prospective observational study in our center discovered that the incidence of preoperative poor sleep quality in patients with cardiac valve disease was about 57%. 13 Poor sleep quality can predispose individuals to pain conditions, and increasing pain severity further exacerbates their sleep quality. 14,15 There have been reports of an increased risk of postoperative pain sensitivity in patients with preoperative poor sleep quality who have undergone noncardiac surgery.…”

Perioperative Sleep Disturbances and Postoperative Delirium in Adult Patients: A Systematic Review and Meta-Analysis of Clinical Trials

“…In one retrospective trial, the control group was matched for age, sex, operated side, type of operation, mode of component fixation, year of operation, surgeon, and type of anesthesia ( 28 ). In seven trials, patients only underwent cardiac surgery ( 33 , 36 – 39 , 42 , 44 ), in 20 trials, only non-cardiac surgeries ( 17 , 18 , 27 – 30 , 32 , 34 , 35 , 40 , 41 , 43 , 45 – 52 ), and in two trials, both cardiac and non-cardiac surgeries ( 16 , 31 ). All the patients in the included RCTs underwent non-cardiac surgeries.…”

“…Nine trials focused on patients with sleep-disorder breathing or OSA ( 16 , 28 , 30 , 31 , 34 , 37 , 39 , 41 , 49 ), and the other trials studied patients with several sleep problems. Thirteen trials described the effect of preoperative sleep problems on the incidence of POD ( 16 , 27 , 28 , 30 , 31 , 33 – 35 , 37 , 39 – 42 ), and the other trials described postoperative sleep quality.…”

“…We used NOS to assess the risk of bias in observational studies (retrospective and prospective), and 15 trials obtained seven stars or more, indicating high quality ( Supplementary Table 2 ) ( 16 , 28 – 32 , 34 – 37 , 39 – 42 , 44 ). We used the Cochrane Collaboration Risk of Bias Assessment tool to assess the risk of bias in RCTs.…”