Acute preoperative sleep disruption and postoperative delirium

急性术前睡眠中断和术后谵妄

• 批准号: 9314897
• 负责人: JACQUELINE M LEUNG
• 金额: $ 23.73万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2019-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9314897
• 关键词: Acute; Admission activity; Adopted; Affect; Age-Years; Anxiety; Applications Grants; Architecture; Arousal; Clinical; Cognitive; Confusion; Data; Delirium; Development; Elderly; Environmental Health; Environmental Risk Factor; Functional disorder; Future; Goals; Healthcare; Home environment; Hospitalization; Hospitals; Hygiene; Inadequate Sleep Hygiene; Independent Living; Intervention; Knowledge; Length of Stay; Light; Measures; Monitor; Operative Surgical Procedures; Outcome; Outcome Study; Pain; Pain management; Pathway interactions; Patient Care; Patient Schedules; Patient-Focused Outcomes; Patients; Pattern; Perioperative; Population Study; Postoperative Period; Precipitating Factors; Prospective cohort study; Randomized Clinical Trials; Recruitment Activity; Risk; Risk Factors; Role; Sleep; Sleep Apnea Syndromes; Symptoms; Testing; Time; Wrist; actigraphy; aged; anxiety states; design; experience; functional decline; high risk; improved; innovation; modifiable risk; mortality; novel; older patient; postoperative delirium; therapy development

Abstract Delirium and sleep disruption are both common in the older patients who are hospitalized. Delirium is a state of acute confusion, experienced especially by older adults admitted to the hospital, with the potential to adversely impact patients' outcome. Of hospitalized patients, one of the highest rates of delirium occurs after major surgery. Development of postoperative delirium is associated with longer hospital length of stay, significantly higher risk of functional decline, loss of independent living, and increased mortality. Previous studies have focused on describing the clinical manifestations and outcomes of postoperative delirium; yet, whether sleep disruption is associated with the development of delirium, has not been rigorously investigated. Sleep disruption, including changes in sleep patterns and architecture, and decreased quality of sleep are commonly observed in older subjects. In the hospital, environmental factors and health care practices further contribute to sleep disruption in the postoperative older patients. In preliminary data acquired from older surgical patients who were monitored with continuous wrist actigraphy, we observed that sleep disruption as measured by total wake time was significantly longer, and number of awakenings was significantly higher even before surgery. The pattern of sleep disruption observed before the planned surgery was associated with increased rates of postoperative delirium. In contrast to previous small studies investigating sleep and cognitive outcomes, we propose a comprehensive, exploratory prospective cohort study to test the hypothesis that preoperative sleep disruption is an independent predictor for postoperative delirium after adjusting for known risks for postoperative delirium. Also, in contrast to previous studies which focused only on the period after surgery, we propose to test the hypothesis that sleep disruption in older patients is prevalent before surgery and is associated with modifiable patient-related risk factors. In patients aged 65 years of age or older undergoing noncardiac surgery, we will measure sleep before and after surgery continuously using wrist actigraphy. Postoperative delirium will be measured daily with a valid and reliable measure. Our overall goal is to determine the relationship between sleep disruption before and after surgery in order to determine the optimal time period for intervention. In addition, we will also measure the risk factors associated with sleep disruption at home and after surgery to enable the development of strategies to improve sleep and minimize delirium. Our study results will be critical for designing future randomized clinical trials to target both patient- related and hospital-related factors that precipitate sleep disruption, with the ultimate goal to improve sleep hygiene and decreasing adverse postoperative cognitive outcomes.

摘要 谵妄和睡眠中断在住院的老年患者中很常见。精神错乱是一种 急性意识模糊，尤其是住院的老年人，有可能 对患者的预后有不良影响。在住院患者中，谵妄的最高发生率之一发生在 大手术术后谵妄的发生与住院时间的延长有关， 功能下降、丧失独立生活能力和死亡率增加的风险显著增加。先前 研究集中于描述术后谵妄的临床表现和结果;然而， 睡眠中断是否与谵妄的发展有关，还没有严格的研究。 睡眠中断，包括睡眠模式和结构的变化，以及睡眠质量下降， 常见于老年人。在医院里，环境因素和医疗实践进一步 导致老年患者术后睡眠中断。在从旧设备获取的初步数据中 我们观察了用连续腕动记录仪监测的手术患者， 以总清醒时间衡量， 在手术前。计划手术前观察到的睡眠中断模式与以下因素相关： 术后谵妄发生率增加。与以前的小型研究睡眠和 认知结果，我们提出了一个全面的，探索性的前瞻性队列研究，以检验这一假设 术前睡眠中断是术后谵妄的独立预测因素， 术后谵妄的已知风险此外，与以往的研究相比， 在手术后，我们建议测试老年患者睡眠中断在手术前普遍存在的假设。 手术，并与可修改的患者相关的风险因素。年龄≥ 65岁的患者 在非心脏手术中，我们将使用腕关节连续测量手术前后的睡眠， 活动记录仪术后谵妄将每天使用有效和可靠的测量方法进行测量。我们的总目标 是确定手术前后睡眠中断之间的关系，以确定 干预的最佳时间。此外，我们还将测量与睡眠相关的危险因素 在家里和手术后中断，使战略的发展，以改善睡眠和尽量减少 精神错乱我们的研究结果对于设计未来的随机临床试验将是至关重要的， 导致睡眠中断的相关和医院相关因素，最终目标是改善睡眠 卫生和减少不良术后认知结果。