The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort.
The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort.
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阻塞性睡眠呼吸暂停与术后谵妄和疼痛之间的关系：外科队列的观察性研究。
DOI：
10.1111/anae.14855
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发表时间：
2019
期刊：
影响因子：
10.7
通讯作者：
Avidan,MS
中科院分区：
文献类型：
--
作者：
Strutz,PK;Kronzer,V;Tzeng,W;Arrington,B;McKinnon,SL;BenAbdallah,A;Haroutounian,S;Avidan,MS
阻塞性睡眠呼吸暂停患者术后不良结局的风险增加，如心脏和呼吸系统并发症。据推测，阻塞性睡眠呼吸暂停也会增加术后谵妄和术后急性疼痛的风险。我们进行了一项回顾性、观察性研究，调查阻塞性睡眠呼吸暂停与术后谵妄和术后急性疼痛严重程度的关系。如果患者被诊断患有阻塞性睡眠呼吸暂停，或者如果他们使用“STOP‐BANG”筛查工具对四个以上的因素呈阳性，则将其归类为阻塞性睡眠呼吸暂停的高风险。采用校正logistic回归分析阻塞性睡眠呼吸暂停与术后谵妄的关系，采用多元线性回归分析阻塞性睡眠呼吸暂停与术后疼痛严重程度的关系。1441例患者中术后谵妄的发生率为307例（21.3%; 95%CI 19.2-23.5%）。在未校正的分析中，阻塞性睡眠呼吸暂停高风险与谵妄相关，比值比（95%CI）为1.77（1.22-2.57; p = 0.003）。调整预先规定的变量后，相关性无统计学显著性，比值比为1.34（0.80-2.23; p = 0.27）。在0-100 mm视觉模拟量表上，整个队列报告的平均（SD）最大疼痛（静息或激发）为63.8（27.9）mm。阻塞性睡眠呼吸暂停高风险与术后疼痛严重程度无关（β系数2.82; 95%CI，−2.34-7.97; p = 0.28）。这些结果表明，阻塞性睡眠呼吸暂停不太可能是术后谵妄或急性术后疼痛严重程度的一个强有力的危险因素。
Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity. Patients were classified as being at high risk for obstructive sleep apnoea if they had been diagnosed with this condition, or if they were positive for more than four factors using the ‘STOP‐BANG’ screening tool. Adjusted logistic regression was used to investigate the association between obstructive sleep apnoea and postoperative delirium, and multivariable linear regression to study the relationship between obstructive sleep apnoea and postoperative pain severity. The incidence of postoperative delirium was 307 in 1441 patients (21.3%; 95%CI 19.2–23.5%). In unadjusted analysis, high risk for obstructive sleep apnoea was associated with delirium, with an odds ratio (95%CI) of 1.77 (1.22–2.57; p = 0.003). After adjustment for pre‐specified variables, the association was not statistically significant with odds ratio 1.34 (0.80–2.23; p = 0.27). The mean (SD) maximum pain (resting or provoked) reported for the entire cohort was 63.8 (27.9) mm on a 0–100 mm visual analogue scale. High risk for obstructive sleep apnoea was not associated with postoperative pain severity (β‐coefficient 2.82; 95%CI, −2.34–7.97; p = 0.28). These findings suggest that obstructive sleep apnoea is unlikely to be a strong risk factor for postoperative delirium or acute postoperative pain severity.