Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium

Evans, Janice Perry; Nadler, Jacob W.; Preud’homme, Xavier; Fang, Eric; Daughtry, Rommie L.; Chapman, Joseph B.; Attarian, David E.; Wellman, Samuel S.; Krystal, Andrew D.

doi:10.1016/j.clinph.2017.05.004

Cited by 46 publications

(46 citation statements)

References 17 publications

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“…These data were synthesized in a recent systematic review and meta-analysis involving 12 studies, which suggested a pooled odds ratio of POD of 4.75 for patients with OSA, and 5.60 for unspecified sleep disorders [71]. While prior studies on POD were limited by lack of sleep measurement, a recent pilot study involving EEG recordings suggested an association of lower sleep time and higher sleep latency on postoperative day 1 and higher prevalence and severity of POD [72]. The underlying POD-sleep mechanism remains unclear and may involve factors such as hypoxia and stress.…”

Section: The Sleep-delirium Connectionmentioning

confidence: 99%

Sleep and Delirium in Older Adults

Farasat

Dorsch

Pearce

et al. 2020

Curr Sleep Medicine Rep

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Purpose of Review Poor sleep and delirium are common in older patients but recognition and management are challenging, particularly in the intensive care unit (ICU) setting. The purpose of this review is to highlight current research on these conditions, their interrelationship , modes of measurement, and current approaches to management. Recent Findings Sleep deprivation and delirium are closely linked, with shared clinical characteristics, risk factors, and neurochemical abnormalities. Acetylcholine and dopamine are important neurochemicals in the regulation of sleep and wakefulness and their dysregulation has been implicated in development of delirium. In the hospital setting, poor sleep and delirium are associated with adverse outcomes; non-pharmacological interventions are recommended, but tend to be resource intensive and hindered by a lack of reliable sleep measurement tools. Delirium is easier to identify, with validated tools available in both ICU and non-ICU settings; however, an optimal treatment approach remains unclear. Antipsychotics are used widely to prevent and treat delirium, although the efficacy data are equivocal. Bundled non-pharmacologic approaches represent a promising framework for prevention and management. Summary Poor sleep and delirium are common problems in older patients. While these phenomena appear linked, a causal relationship is not clearly established. At present, there are no established sleep-focused guidelines for preventing or treating delirium. Novel interventions are needed that address poor sleep and delirium, particularly in older adults.

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Section: The Sleep-delirium Connectionmentioning

confidence: 99%

Sleep and Delirium in Older Adults

Farasat

Dorsch

Pearce

et al. 2020

Curr Sleep Medicine Rep

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“…[1][2][3][4][5][6][7][8][9][10] Postoperative sleep disturbance may worsen a patients' physical condition by increasing the risk of postoperative delirium or cognitive dysfunction, and delaying recovery. 3,4,[10][11][12] Numerous attempts have been made to relieve severe sleep disturbances after surgery through eliminating noise and light in surgical wards with blinders or earplugs, the consolidation of patient care interactions. 3,4,[13][14][15][16] Pharmacological intervention such as short-acting non-benzodiazepine 17,18 or multimodel analgesia [19][20][21] is other methods used to improve postoperative sleep quality.…”

Section: Introductionmentioning

confidence: 99%

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Duan¹,

Wang²,

Peng³

et al. 2020

NSS

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The study aimed to investigate the effects of intraoperative dexmedetomidine on postoperative sleep disturbance for different surgical patients and compare such effects between different dose of dexmedetomidine. Methods: A total of 7418 patients undergoing nine types of non-cardiac major surgeries were retrospectively studied. Patients were separated into DEX (dexmedetomidine) or Non-DEX (Non-dexmedetomidine) groups based on the use of dexmedetomidine during surgery. The patients who reported they could not fall asleep during the night or woke up repeatedly during the most of the night at the day of the surgery and whose NRS were >6 were defined as cases with severe sleep disturbance. Propensity score matched analysis based on all preoperative baseline data was performed along with logistic regression analysis including different surgery types and dosage of dexmedetomidine use. Results: In both of the unmatched cohort (OR, 0.49 [95% CI: 0.43-0.56]) and matched cohort (0.49 [95% CI: 0.42-0.58]), the DEX group had a significantly lower incidence of severe sleep disturbance than the Non-DEX group. In the subgroup analysis, for gynecological and urological surgery population, the ORs for DEX-group reached 0.21 (95% CI, 0.13-0.33; P<0.0001) and 0.30 (95% CI,0.19-0.47; P<0.0001), respectively. In addition, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) showed the greatest effect with an odds ratio of 0.38 (95% CI: 0.31-0.44; P<0.0001), and the incidence of severe sleep disturbance in the low-dose group was significantly lower (11.5% vs. 17.7% vs. 16.5%, P<0.0001) than that in the medium-(0.4-0.6 μg•kg −1 •h −1) and high-dose (0.6-0.8 μg•kg −1 •h −1) groups. Conclusion: Intraoperative dexmedetomidine use can significantly decrease the incidence of severe sleep disturbance on the day of surgery for patients undergoing non-cardiac major surgery, and the effects were most significant in patients receiving gynecological and urological surgery. Furthermore, low-dose dexmedetomidine (0.2-0.4 μg•kg −1 •h −1) is most effective for prevention of postoperative sleep disturbance.

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“…Although this study was not powered to test efficacy, based on a power analysis of prior research, a sample of 20 participants was determined to be sufficient to demonstrate a moderate Cohen's effect size with 60% power (Evans et al, ; Vacas et al, ). Assuming a 10% rate of attrition, we anticipate 18 of the consented participants will complete all 4 study days.…”

Section: Methodsmentioning

confidence: 99%

“…Assuming a 10% rate of attrition, we anticipate 18 of the consented participants will complete all 4 study days. We estimate approximately 15 participants (50 paired assessments) will screen positive for delirium, providing enough data for a valid analysis (Evans et al, ; Vacas et al, ). Therefore, approximately 70 paired assessments should provide ample data for pilot testing of specific aims.…”

Section: Methodsmentioning

confidence: 99%

Methods of identifying delirium: A research protocol

Mulkey

Hardin

Munro

et al. 2019

Research in Nursing & Health

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Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10‐fold increase in cognitive impairment, triples the rate of in‐hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium‐related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited‐lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited‐lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data.

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Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium

Cited by 46 publications

References 17 publications

Sleep and Delirium in Older Adults

Sleep and Delirium in Older Adults

<p>The Effects of Intraoperative Dexmedetomidine Use and Its Different Dose on Postoperative Sleep Disturbance in Patients Who Have Undergone Non-Cardiac Major Surgery: A Real-World Cohort Study</p>

Methods of identifying delirium: A research protocol

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