A Systematic Review and Meta-Analysis Examining the Impact of Sleep Disturbance on Postoperative Delirium.
A Systematic Review and Meta-Analysis Examining the Impact of Sleep Disturbance on Postoperative Delirium.
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DOI：
10.1097/ccm.0000000000003400
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发表时间：
2018-12
影响因子：
8.8
通讯作者：
Akeju O
中科院分区：
文献类型：
--
作者：
Fadayomi AB;Ibala R;Bilotta F;Westover MB;Akeju O
基础科学和临床研究表明，睡眠障碍可能是术后谵妄（POD）的一个可改变的危险因素。我们的目的是评估术前睡眠障碍和POD之间的关联。我们检索了PubMed、Embase、CINAHL、Web of Science和科克伦，从开始到2017年5月31日。我们对所有报告睡眠中断和POD的研究进行了系统性文献检索，排除了横断面研究、病例报告和未用英语报告的研究。两位作者独立进行研究选择和数据提取。我们使用Stata®中构建的随机效应模型计算汇总效应估计值，并通过正式检验（Stata® Corp V.14，Texas，USA）评估偏倚风险。我们纳入了12项研究，来自1，238篇符合纳入标准的引文。睡眠障碍与POD之间关联的合并比值比为5.24（95% CI：3.61至7.60，p <0.001; I2= 0.0%，p=0.76）。前瞻性研究（n = 6）中睡眠障碍与POD之间关联的合并风险比为2.90（95%CI：2.28 - 3.69，p <0.001; I2= 0.0%，p=0.89）。与阻塞性睡眠呼吸暂停和未指明类型的睡眠障碍相关的比值比分别为4.75（95% CI：2.65 - 8.54，p <0.001; I2= 0.0%，p=0.85）和5.60（95% CI：3.46 - 9.07，p <0.001; I2= 0.0%，p=0.41）。我们对发表偏倚进行了Begg和Egger检验，并确认发表偏倚结果为零（分别为P = 0.371和0.103）。预先存在的睡眠障碍可能与POD有关。针对术前睡眠障碍患者的系统级举措是否有助于降低与POD相关的患病率、发病率和医疗成本仍有待确定。
Basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for post-operative delirium (POD). We aimed to assess the association between pre-operative sleep disturbance and POD. We searched PubMed, Embase, CINAHL, Web of Science, and Cochrane from inception until May 31st, 2017. We performed a systematic search of the literature for all studies that reported on sleep disruption and POD excluding cross-sectional studies, case reports and studies not reported in English language. Two authors independently performed study selection and data extraction. We calculated pooled effects estimates with a random-effects model constructed in Stata® and evaluated the risk of bias by formal testing (Stata® Corp V.14, Texas, USA), We included 12 studies, from 1,238 citations that met our inclusion criteria. The pooled odds ratio for the association between sleep disturbance and POD was 5.24 (95% CI: 3.61 to 7.60, p <0.001; I2=0.0%, p=0.76). The pooled risk ratio for the association between sleep disturbance and POD in prospective studies (n = 6) was 2.90 (95% CI: 2.28 to 3.69, p <0.001; I2=0.0%, p=0.89). The odds ratio associated with obstructive sleep apnea and unspecified types of sleep disorder were 4.75 (95% CI: 2.65 to 8.54, p <0.001; I2=0.0%, p=0.85), and 5.60 (95% CI: 3.46 to 9.07, p <0.001; I2=0.0%, p=0.41), respectively. We performed Begg’s and Egger tests for publication bias and confirmed a null result for publication bias (P = .371 and .103, respectively). Pre-existing sleep disturbances are likely associated with POD. Whether system-level initiatives targeting patients with pre-operative sleep disturbance may help reduce the prevalence, morbidity and healthcare costs associated with POD remains to be determined.