Yang Shuting, Zhang Qian, Xu Yifan, Chen Futeng, Shen Fangming, Zhang Qin, Liu He, Zhang Yueying
Xuzhou Medical University, Xuzhou City, Jiangsu Province, People's Republic of China.
Department of Anesthesiology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; Huzhou Central Hospital, Huzhou City, Zhejiang Province, People's Republic of China.
Nat Sci Sleep. 2021 Aug 24;13:1473-1483. doi: 10.2147/NSS.S319339. eCollection 2021.
To develop a risk prediction nomogram of postoperative sleep disturbance (PSD) in patients undergoing non-cardiac surgery.
Data on 881 consecutive patients who underwent non-cardiac surgery at the Affiliated Hospital of Xuzhou Medical University between June 2020 and April 2021 were prospectively collected. Of these, we randomly divided 881 non-cardiac patients into two groups, training cohort (n = 617) and validation cohort (n = 264) at the ratio of 7:3. Characteristic variables were selected based on the data of training cohort through least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was used to identify the independent risk factors associated with PSD that then were incorporated into the nomogram. The predictive performance of the nomogram was measured by concordance index (C index), receiver operating characteristic (ROC) curve, and calibration with 1000 bootstrap samples to decrease the over-fit bias.
PSD was found in 443 of 617 patients (71.8%) and 190 of 264 patients (72.0%) in the training and validation cohorts, respectively. The perioperative risk factors associated with PSD were female sex, anxiety, dissatisfaction of ward environment, absence of combined regional nerve block, postoperative nausea and vomiting (PONV), the longer duration stayed in post anesthesia care unit (PACU), the higher dose of midazolam and sufentanil, the higher postoperative numeric rating score for pain (NRS) score. Incorporating these 9 factors, the nomogram achieved good concordance indexes of 0.82 (95% confidence interval [CI], 0.78-0.85) and 0.80 (95% CI, 0.74-0.85) in predicting PSD in the training and validation cohorts, respectively, and obtained well-fitted calibration curves. The sensitivity and specificity (95% CIs) of the nomogram were calculated, resulting in sensitivity of 74.0% (70.0-78.2%) and 75.3% (68.4-81.7%) and specificity of 79.3% (72.5-85.2%) and 70.3% (58.4-80.7%) for the training and validation cohorts, respectively. Patients who had a nomogram score of less than 262 or 262 or greater were considered to have low or high risks of PSD presence, respectively.
The proposed nomogram achieved an optimal prediction of PSD in patients undergoing non-cardiac surgery. The risks for an individual patient to harbor PSD can be determined by this model, which can lead to a reasonable preventive and treatment measures.
建立非心脏手术患者术后睡眠障碍（PSD）的风险预测列线图。
前瞻性收集了2020年6月至2021年4月在徐州医科大学附属医院连续接受非心脏手术的881例患者的数据。其中，我们将881例非心脏手术患者按照7:3的比例随机分为两组，即训练队列（n = 617）和验证队列（n = 264）。通过最小绝对收缩和选择算子（LASSO）回归，根据训练队列的数据选择特征变量。采用多因素逻辑回归分析确定与PSD相关的独立危险因素，然后将其纳入列线图。通过一致性指数（C指数）、受试者工作特征（ROC）曲线以及对1000个自助抽样样本进行校准来测量列线图的预测性能，以减少过度拟合偏差。
训练队列中617例患者中有443例（71.8%）发生PSD，验证队列中264例患者中有190例（72.0%）发生PSD。与PSD相关的围手术期危险因素包括女性、焦虑、对病房环境不满意、未联合区域神经阻滞、术后恶心呕吐（PONV）、在麻醉后护理单元（PACU）停留时间较长、咪达唑仑和舒芬太尼剂量较高、术后疼痛数字评分量表（NRS）评分较高。纳入这9个因素后，列线图在训练队列和验证队列中预测PSD的一致性指数分别为0.82（95%置信区间[CI]，0.78 - 0.85）和0.80（95%CI，0.74 - 0.85），并获得了拟合良好的校准曲线。计算了列线图的敏感性和特异性（95%CI），训练队列的敏感性分别为74.0%（70.0 - 78.2%）和75.3%（68.4 - 81.7%），特异性分别为79.3%（72.5 - 85.2%）和70.3%（58.4 - 80.7%）。列线图得分小于262或大于等于262的患者分别被认为PSD发生风险低或高。
所提出的列线图对非心脏手术患者的PSD实现了最佳预测。该模型可以确定个体患者发生PSD的风险，从而制定合理的预防和治疗措施。
