Wang Hongbai, Zhang Liang, Zhang Zhe, Li Yinan, Luo Qipeng, Yuan Su, Yan Fuxia
Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.
Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
Front Psychiatry. 2020 Oct 14;11:570362. doi: 10.3389/fpsyt.2020.570362. eCollection 2020.
The aim of this systematic review and meta-analysis of clinical trials was to investigate the effects of perioperative sleep disturbances on postoperative delirium (POD). Authors searched for studies (until May 12, 2020) reporting POD in patients with sleep disturbances following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 29 relevant trials including 55,907 patients. We divided these trials into three groups according to study design: Seven retrospective observational trials, 12 prospective observational trials, and 10 randomized controlled trials. The results demonstrated that perioperative sleep disturbances were significantly associated with POD occurrence in observational groups [retrospective: OR = 0.56, 95% CI: [0.33, 0.93], = 91%, for effect = 0.03; prospective: OR = 0.27, 95% CI: [0.20, 0.36], = 25%, for effect < 0.001], but not in the randomized controlled trial group [OR = 0.58, 95% CI: [0.34, 1.01], = 68%, for effect = 0.05]. Publication bias was assessed using Egger's test. We used a one-by-one literature exclusion method to address high heterogeneity. Perioperative sleep disturbances were potential risk factors for POD in observational trials, but not in randomized controlled trials.
本系统评价和临床试验荟萃分析的目的是研究围手术期睡眠障碍对术后谵妄（POD）的影响。作者按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索了（截至2020年5月12日）报告睡眠障碍患者术后谵妄的研究。我们纳入了29项相关试验，涉及55907例患者。根据研究设计，我们将这些试验分为三组：七项回顾性观察性试验、十二项前瞻性观察性试验和十项随机对照试验。结果表明，在观察组中，围手术期睡眠障碍与术后谵妄的发生显著相关[回顾性研究：OR = 0.56，95%CI：[0.33, 0.93]，I² = 91%，效应P值 = 0.03；前瞻性研究：OR = 0.27，95%CI：[0.20, 0.36]，I² = 25%，效应P值<0.001]，但在随机对照试验组中无显著相关性[OR = 0.58，95%CI：[0.34, 1.01]，I² = 68%，效应P值 = 0.05]。采用Egger检验评估发表偏倚。我们采用逐一文献排除法处理高异质性问题。在观察性试验中，围手术期睡眠障碍是术后谵妄的潜在危险因素，但在随机对照试验中并非如此。
