Todd Oliver M, Gelrich Lisa, MacLullich Alasdair M, Driessen Martin, Thomas Christine, Kreisel Stefan H
Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Department of Psychiatry and Psychotherapy Bethel, Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bielefeld, Germany.
J Am Geriatr Soc. 2017 May;65(5):949-957. doi: 10.1111/jgs.14685. Epub 2017 Mar 17.
To determine whether sleep disruption at home or in hospital is an independent risk factor for postoperative delirium in older adults undergoing elective surgery.
Prospective cohort study.
German teaching hospital.
Individuals aged 65 and older undergoing elective arthroplasty (N = 101).
Preoperative questionnaires were used to assess sleep disruption at home (Pittsburgh Sleep Quality Index). Actigraphy was used to objectively measure sleep disruption in the hospital before and after surgery. Delirium was assessed daily after surgery using the Confusion Assessment Method and, if there was uncertainty, validated according to International Classification of Diseases, Tenth Revision (ICD-10), criteria.
Twenty-seven participants developed postoperative delirium. Those with sleep disruption at home were 3.26 times as likely to develop postoperative delirium as those without (95% confidence interval (CI) = 1.34-7.92, P = .009). Participants with sleep disruption in hospital were 1.21 times as likely to develop postoperative delirium as those without (95% CI = 1.03-1.41, P = .02). When adjusting for other variables, risk remained significant for sleep disruption at home (risk ratio (RR) = 3.90, 95% CI = 2.14-7.11, P < .001) but not in the hospital (RR = 1.19, 95% CI = 0.69-2.07). Jointly modeling sleep disruption at home and in the hospital, adjusted for covariates, resulted in significant contributions of both (home: RR = 3.10, 95% CI = 1.34-7.17, P = .008; hospital: RR = 1.38 95% CI = 1.13-1.68, P = .002).
Older people with sleep disruption at home are at significantly higher risk of developing postoperative delirium than those without. Sleep disruption in the hospital may further heighten this risk.
确定在家或医院的睡眠中断是否是接受择期手术的老年人术后谵妄的独立危险因素。
前瞻性队列研究。
德国教学医院。
65岁及以上接受择期关节置换术的个体（N = 101）。
术前问卷用于评估在家中的睡眠中断情况（匹兹堡睡眠质量指数）。活动记录仪用于客观测量手术前后在医院的睡眠中断情况。术后每天使用谵妄评估方法评估谵妄，如有不确定性，则根据《国际疾病分类第十版》（ICD - 10）标准进行验证。
27名参与者发生了术后谵妄。在家中存在睡眠中断的参与者发生术后谵妄的可能性是没有睡眠中断者的3.26倍（95%置信区间（CI）= 1.34 - 7.92，P = 0.009）。在医院存在睡眠中断的参与者发生术后谵妄的可能性是没有睡眠中断者的1.21倍（95% CI = 1.03 - 1.41，P = 0.02）。在对其他变量进行调整后，在家中睡眠中断的风险仍然显著（风险比（RR）= 3.90，95% CI = 2.14 - 7.11，P < 0.001），但在医院中则不然（RR = 1.19，95% CI = 0.69 - 2.07）。对在家中和医院的睡眠中断情况进行联合建模，并对协变量进行调整，结果表明两者均有显著影响（在家中：RR = 3.10，95% CI = 1.34 - 7.17，P = 0.008；在医院：RR = 1.38，95% CI = 1.13 - 1.68，P = 0.002）。
在家中存在睡眠中断的老年人发生术后谵妄的风险显著高于没有睡眠中断的老年人。在医院的睡眠中断可能会进一步增加这种风险。
