POSTOPERATIVE DELIRIUM AND ELECTROENCEPHALOGRAPHIC MEASURES OF SLEEP AND WAKEFULNESS

摘要 术后妄想是心脏手术后最常见的并发症之一，其发生率 高达50%。精神错乱除了对患者和照顾者造成心理和身体上的损失外，还会干扰 康复。它将受损的个人置于自我伤害和摔倒的风险中。鉴于精神错乱与 对于随后的长期认知损害，急性诱发因素的阐明可能有助于洞察 阿尔茨海默病和相关痴呆的慢性病理过程。生物标志物是 迫切需要推进旨在确定术后精神错乱的易感性、发病和 恢复。这些生物标志物的开发也将是朝着澄清 病理生理机制。用于定义睡眠结构的脑电(EEG)特征 有可能填补这些空白。它们在术后期间的特征也是必不可少的 评估围手术期睡眠障碍是导致和预测精神错乱的因素。我们的建议，术后 精神错乱和脑电睡眠和觉醒的测量，旨在探测颞叶 精神错乱与预测认知功能障碍的特征良好的脑电信号之间的关系。 未来对妄想症易感性的术前分层可以让患者及其家人了解 选择性手术后潜在认知轨迹的可能性。对于医疗从业者来说，识别 对易感患者进行术前重点诊断和优化。拟议的工作还可以 促进新的药理学和非药理学干预。这类疗法的目标是 潜在的丘脑皮质环路和特定脑电模式的表达影响认知恢复。 总体而言，我们希望这项工作能够产生廉价、非侵入性和易于翻译的生物标记物，从而 改善围手术期医学内外的神经学结果。

Abstract Postoperative delirium is one of the most common complications following cardiac surgery, with an incidence of up to 50%. Apart from its psychological and physical toll on patients and caregivers, delirium interferes with rehabilitation. It places compromised individuals at risk for self-injury and falls. Given that delirium is associated with subsequent long-term cognitive impairment, elucidation of acute precipitating factors may lend insight into the chronic pathological processes underlying Alzheimer's disease and related dementias. Biomarkers are urgently needed to advance efforts aimed at characterizing postoperative delirium susceptibility, onset, and recovery. Development of these biomarkers would also serve as a major step toward clarifying pathophysiologic mechanisms. Electroencephalographic (EEG) signatures used in defining sleep architecture have potential to address these voids. Their characterization in the postoperative period is also essential for evaluating perioperative sleep disruption as a contributor and predictor of delirium. Our proposal, Postoperative Delirium and Electroencephalographic Measures of Sleep and Wakefulness, is designed to probe temporal relationships between delirium and well-characterized EEG signatures that predict cognitive dysfunction. Future preoperative stratification for delirium vulnerability could inform patients and their families regarding the likelihood of potential cognitive trajectories after elective procedures. For health care practitioners, identification of susceptible patients before surgery could focus diagnostics and optimization. The proposed work may also contribute to novel pharmacologic and non-pharmacologic interventions. Such therapies would target underlying thalamocortical circuits and the expression of specific EEG motifs to impact cognitive recovery. Overall, we expect this work to yield inexpensive, noninvasive, and readily translatable biomarkers, thereby improving neurological outcomes within and beyond perioperative medicine.