Perioperative sleep in geriatric cardiac surgical patients: a feasibility study using a wireless wearable device

Park

et al. 2022

Preprint

Background: Postoperative delirium (POD) is associated with adverse outcomes in elderly patients after surgery. Electroencephalography (EEG) is an effective tool for identifying degenerative cerebral dysfunctions, including mild cognitive impairment and dementia. Methods: We included 237 patients aged > 70 years who underwent spinal surgery. We measured the median dominant frequency (MDF), which is a resting-state EEG biomarker involving intrinsic alpha oscillations that reflect an idle cortical state, from the prefrontal regions. Additionally, the mini-mental state examination and Montreal cognitive assessment (MoCA) were performed before surgery as well as 5 days, 1 month, and 1 year after surgery. Results: Forty-eight (20.3%) patients were diagnosed with POD. A multivariable logistic regression analysis that included age, MoCA score, Charlson comorbidity index score > 4, anaesthesia duration > 4 hours, and the MDF as variables revealed that the MDF had a significant odds ratio of 0.4 (95% confidence interval 0.23–0.77). Among the patients with POD, the postoperative neurocognitive disorders could last up to 1 year.Conclusions: In conclusion, a low MDF on preoperative EEG was associated with POD in elderly patients undergoing surgery. Our findings suggest that EEG could be a novel tool for identifying patients at a high risk of POD.

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The predictive utility of preoperative electroencephalography for postoperative delirium

Park

et al. 2022

Preprint

“…A three-axis set of accelerometers in the device allows monitoring of movement patterns that aid in sleep staging, arousal detection, and determination of respiratory effort. In the perioperative setting, this device provides adequate signals for detecting sleep spindles and sleep slow waves, with a single night sufficient for establishing baseline sleep macrostructure ( 27 ).…”

Section: Methods and Analysismentioning

confidence: 99%

“…This device has previously been validated against polysomnography for monitoring sleep-related physiological signals and accurate sleep staging across broad age demographic ( 26 ). As the device has been suitable for longitudinal use in the perioperative setting ( 27 ), the Dreem device may be a feasible option for obtaining continuous sleep EEG data over an ECT course.…”

Section: Introductionmentioning

confidence: 99%

Correlating electroconvulsive therapy response to electroencephalographic markers: Study protocol

et al. 2022

IntroductionElectroconvulsive therapy (ECT) is an effective intervention for patients with major depressive disorder (MDD). Despite longstanding use, the underlying mechanisms of ECT are unknown, and there are no objective prognostic biomarkers that are routinely used for ECT response. Two electroencephalographic (EEG) markers, sleep slow waves and sleep spindles, could address these needs. Both sleep microstructure EEG markers are associated with synaptic plasticity, implicated in memory consolidation, and have reduced expression in depressed individuals. We hypothesize that ECT alleviates depression through enhanced expression of sleep slow waves and sleep spindles, thereby facilitating synaptic reconfiguration in pathologic neural circuits.MethodsCorrelating ECT Response to EEG Markers (CET-REM) is a single-center, prospective, observational investigation. Wireless wearable headbands with dry EEG electrodes will be utilized for at-home unattended sleep studies to allow calculation of quantitative measures of sleep slow waves (EEG SWA, 0.5–4 Hz power) and sleep spindles (density in number/minute). High-density EEG data will be acquired during ECT to quantify seizure markers.DiscussionThis innovative study focuses on the longitudinal relationships of sleep microstructure and ECT seizure markers over the treatment course. We anticipate that the results from this study will improve our understanding of ECT.

Anesthesia &Amp; Analgesia

“…Advances in wireless devices equipped with dry EEG electrodes that can be worn for hours at a time lend feasibility to this approach. 38…”

Section: Implications For Underlying Thalamocortical Circuitrymentioning

confidence: 99%

Postoperative Delirium Severity and Recovery Correlate With Electroencephalogram Spectral Features

Guay

Kafashan

Huels

et al. 2022

Self Cite

BACKGROUND: Delirium is an acute syndrome characterized by inattention, disorganized thinking, and an altered level of consciousness. A reliable biomarker for tracking delirium does not exist, but oscillations in the electroencephalogram (EEG) could address this need. We evaluated whether the frequencies of EEG oscillations are associated with delirium onset, severity, and recovery in the postoperative period. METHODS: Twenty-six adults enrolled in the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES; ClinicalTrials.gov NCT02241655) study underwent major surgery requiring general anesthesia, and provided longitudinal postoperative EEG recordings for this prespecified substudy. The presence and severity of delirium were evaluated with the confusion assessment method (CAM) or the CAM-intensive care unit. EEG data obtained during awake eyes-open and eyes-closed states yielded relative power in the delta (1-4 Hz), theta (4-8 Hz), and alpha (8-13 Hz) bands. Discriminability for delirium presence was evaluated with c-statistics. To account for correlation among repeated measures within patients, mixedeffects models were generated to assess relationships between: (1) delirium severity and EEG relative power (ordinal), and (2) EEG relative power and time (linear). Slopes of ordinal and linear mixed-effects models are reported as the change in delirium severity score/change in EEG relative power, and the change in EEG relative power/time (days), respectively. Bonferroni correction was applied to confidence intervals (CIs) to account for multiple comparisons. RESULTS: Occipital alpha relative power during eyes-closed states offered moderate discriminability (c-statistic, 0.75; 98% CI, 0.58-0.87), varying inversely with delirium severity (slope, -0.67; 98% CI, -1.36 to -0.01; P = .01) and with severity of inattention (slope, -1.44; 98% CI, -2.30 to -0.58; P = .002). Occipital theta relative power during eyes-open states correlated directly with severity of delirium (slope, 1.28; 98% CI, 0.12-2.44; P = .007), inattention (slope, 2.00; 98% CI, 0.48-3.54; P = .01), and disorganized thinking (slope, 3.15; 98% CI, 0.66-5.65; P = .01). Corresponding frontal EEG measures recapitulated these relationships to varying degrees. Severity of altered level of consciousness correlated with frontal theta relative power during eyes-open states (slope, 11.52; 98% CI, 6.33-16.71; P < .001). Frontal theta relative power during eyes-open states correlated inversely with time (slope, -0.05; 98% CI, -0.12 to -0.04; P = .002). CONCLUSIONS: Presence, severity, and core features of postoperative delirium covary with spectral features of the EEG. The cost and accessibility of EEG facilitate the translation of these findings to future mechanistic and interventional trials. (Anesth Analg 2023;136:140-51) KEY POINTS• Question: Can a small array of electroencephalogram (EEG) electrodes track postoperative delirium presence, severity, and resolution over time? • Findings: Relative power in a sparse array of occipital...