Acute preoperative sleep disruption and postoperative delirium

摘要 精神错乱和睡眠障碍在住院的老年患者中都很常见。精神错乱是一种状态 急性精神错乱，尤其是住院的老年人，有可能 对患者的预后有不利影响。在住院患者中，精神错乱的发生率最高之一发生在 大手术。术后精神错乱的发展与较长的住院时间有关， 显著增加功能衰退、丧失独立生活能力和增加死亡率的风险。上一首 研究的重点是描述术后精神错乱的临床表现和结果；然而， 睡眠障碍是否与精神错乱的发展有关，还没有得到严格的调查。 睡眠中断，包括睡眠模式和结构的改变，以及睡眠质量下降 通常在年长的受试者中观察到。在医院，环境因素和医疗保健做法进一步 导致术后老年患者睡眠障碍。在从更老的人那里获得的初步数据中 对手术患者进行持续腕部活动监测，我们观察到睡眠中断 以总觉醒时间衡量，显著更长，唤醒次数甚至显著更高 在手术前。在计划中的手术前观察到的睡眠中断模式与 术后神志不清的发生率增加。与之前关于睡眠和睡眠的小型研究不同 认知结果，我们提出了一项全面的、探索性的前瞻性队列研究来检验这一假设。 术前睡眠障碍是调整后术后精神错乱的独立预测因子 术后精神错乱的已知风险。此外，与以往只关注这一时期的研究不同 手术后，我们建议检验这一假设，即睡眠障碍在老年患者中普遍存在 手术并与可改变的患者相关风险因素有关。年龄在65岁或以上的患者 在进行非心脏手术时，我们将使用腕部连续测量手术前后的睡眠 动作记录仪。术后将以有效可靠的方法每天测量一次幻觉。我们的总目标是 目的是确定手术前后睡眠中断之间的关系，以便确定 干预的最佳时间段。此外，我们还将测量与睡眠相关的风险因素 家庭和手术后的干扰，使改善睡眠和尽量减少睡眠的策略得以发展 精神错乱。我们的研究结果将对设计未来的随机临床试验至关重要，以同时针对患者- 导致睡眠中断的相关和医院相关因素，最终目的是改善睡眠 保持卫生，减少术后不良认知后果。

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.