Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, US.
Neurology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, US.
BMJ Open. 2019 Aug 26;9(8):e026649. doi: 10.1136/bmjopen-2018-026649.
Obstructive sleep apnoea (OSA) is common among older surgical patients, and delirium is a frequent and serious postoperative complication. Emerging evidence suggests that OSA increases the risk for postoperative delirium. We hypothesise that OSA is an independent risk factor for postoperative delirium, and that in patients with OSA, perioperative adherence to positive airway pressure (PAP) therapy decreases the incidence of postoperative delirium and its sequelae. The proposed retrospective cohort analysis study will use existing datasets to: (i) describe and compare the incidence of postoperative delirium in surgical patients based on OSA diagnosis and treatment with PAP; (ii) assess whether preoperatively untreated OSA is independently associated with postoperative delirium; and (iii) explore whether preoperatively untreated OSA is independently associated with worse postoperative quality of life (QoL). The findings of this study will inform on the potential utility and approach of an interventional trial aimed at preventing postoperative delirium in patients with diagnosed and undiagnosed OSA.
Observational data from existing electronic databases will be used, including over 100 000 surgical patients and ~10 000 intensive care unit (ICU) admissions. We will obtain the incidence of postoperative delirium in adults admitted postoperatively to the ICU who underwent structured preoperative assessment, including OSA diagnosis and screening. We will use doubly robust propensity score methods to assess whether untreated OSA independently predicts postoperative delirium. Using similar methodology, we will assess if untreated OSA independently predicts worse postoperative QoL.
This study has been approved by the Human Research Protection Office at Washington University School of Medicine. We will publish the results in a peer-reviewed venue. Because the data are secondary and high risk for reidentification, we will not publicly share the data. Data will be destroyed after 1 year of completion of active Institutional Review Board (IRB) approved projects.
阻塞性睡眠呼吸暂停（OSA）在老年手术患者中较为常见，谵妄是一种常见且严重的术后并发症。新出现的证据表明，OSA 增加了术后谵妄的风险。我们假设 OSA 是术后谵妄的独立危险因素，并且在 OSA 患者中，围手术期坚持使用正压通气（PAP）治疗可降低术后谵妄及其后遗症的发生率。本拟进行的回顾性队列分析研究将利用现有数据集：（i）根据 OSA 诊断和 PAP 治疗情况，描述和比较手术患者术后谵妄的发生率；（ii）评估术前未经治疗的 OSA 是否与术后谵妄独立相关；（iii）探讨术前未经治疗的 OSA 是否与术后生活质量（QoL）较差独立相关。本研究的结果将为旨在预防确诊和未确诊 OSA 患者术后谵妄的干预试验提供潜在的效用和方法。
将使用现有电子数据库中的观察性数据，包括超过 100000 例手术患者和~10000 例 ICU 住院患者。我们将获得术后入住 ICU 并接受结构化术前评估（包括 OSA 诊断和筛查）的成年患者术后谵妄的发生率。我们将使用双重稳健倾向评分方法来评估未经治疗的 OSA 是否独立预测术后谵妄。使用类似的方法，我们将评估未经治疗的 OSA 是否独立预测术后 QoL 较差。
本研究已获得华盛顿大学医学院人类研究保护办公室的批准。我们将在同行评审的期刊上发表研究结果。由于数据是二次数据且存在重新识别的高风险，我们将不会公开共享数据。在完成机构审查委员会（IRB）批准的项目后 1 年内，数据将被销毁。
