Preoperative Sleep Disruption and Postoperative Delirium

Abstract

Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ 2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43-91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was signifi cantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the fi rst 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. D elirium is a major challenge facing geriatric practice due to its prevalence, complex etiology, and potential severe impact on patients. Postoperative delirium is associated with longer hospital stays, worse functional outcomes, higher healthcare costs, and increased mortality.1 Delirium develops through a complex interaction between the patient's baseline vulnerability (predisposing risk factors before hospitalization) and precipitating factors or insults (events that occur during hospitalization). Some of the vulnerability factors identifi ed include advanced age, cognitive impairment or dementia, and preexisting comorbidities.2,3 Over the last two decades, a large body of literature has focused on the clinical manifestations, risk factors and outcomes of postoperative delirium. Sleep disruption, in particular, has frequently been cited as an important etiological factor associated with the development of delirium. 4 Sleep disturbance, especially sleep fragmentation, and poor sleep quality are commonly observed in older adults. In the hospital, environmental factors and health care practices further contribute to sleep disruption. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Sleep disruption has frequently ...

Sleep Disruption at Home As an Independent Risk Factor for Postoperative Delirium

“…These results validate previous findings of the study of the temporal relationship between sleep disruption and delirium . The current study finding that the greatest risk of delirium is associated with sleep disruption at home is at odds with the previous study, which found that the greatest risk was associated with sleep disruption in the hospital—although there is some indication of an interaction effect in the current study data.…”

“…These results validate previous findings of the study of the temporal relationship between sleep disruption and delirium. 17 The current study finding that the greatest risk of delirium is associated with sleep disruption at home is at odds with the previous study, which found that the Figure 2. This figure shows the predicted probability of developing delirium (y-axis) depending on the immediate preoperative sleep disruption in hospital (x-axis), given presence or absence of a previous sleep disruption at home as dichotomized using the Pittsburgh Sleep Quality Index (PSQI).…”

“…16 Whether sleep disruption is an early symptom of evolving delirium or acts as a precipitant for delirium remains unknown. 6 A longitudinal study was conducted of individuals undergoing elective surgery to determine whether preoperative sleep disturbance predicts postoperative delirium, 17 but the sample population was relatively young (average age 66) and the sample size too small to consider potential covariates. The constellation of shared risk factors for sleep disruption and delirium makes it difficult to disentangle the direction of causation, that is, whether sleep disruption is a confounder or acts as an intermediate variable on the pathway to developing delirium.…”

Separability of calcium slow waves and functional connectivity during wake, sleep, and anesthesia

“…For example, our findings may have implications for understanding how sleep and Alzheimer's disease interact 66,67 or how anesthesia influences postoperative delirium. 68 6 Appendix A: Real-Time Data 6.1 Spontaneous Activity During Anesthesia, NREM, and Wake Data was processed as described above and visualized for the five experimental brain states included in the present study ( Fig. 6).…”

Incidence and Risk Factors of Postoperative Delirium following Pancreatic Surgery: Does the Administration of TJ-54 Reduce the Incidence of Delirium

“…According to the paper focusing on the relationship between preoperative sleep disruption and postoperative delirium [32], the mean number of awakenings as recorded by actigraphy and the mean percent time spent awake after falling asleep (WASO) on 1 and 2 days before surgery were significantly higher in patients with postoperative 7 delirium (n = 7) than in patients with no delirium (n = 43). These results suggested that sleep disruption just before surgery might indicate preoperative anxiety resulting in postoperative delirium, and perioperative intervention might be effective to minimize the risk of postoperative delirium.…”