He Ertao, Dong Ying, Jia Haitao, Yu Lixin
Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China.
Department of Anesthesiology, Dingzhou People's Hospital, Dingzhou, China.
Gland Surg. 2022 Jul;11(7):1192-1203. doi: 10.21037/gs-22-312.
Studies have investigated the relationship between sleep disturbance and postoperative delirium (PD) but have controversial results. A systematic review and meta-analysis have a high level of evidence to comprehensively evaluate the effect of sleep disturbance on PD. Our study aims to provide available evidence regarding the effect of sleep disturbance on PD.
PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies from database inception to April 28, 2021. The eligible studies were identified according to the "PICOS" principles. Odds ratio (OR) was used to indicate the effect index, and 95% confidence interval (CI) was applied to express the effect size. The heterogeneity was tested. Subgroup analyses, meta-regression, and sensitivity analysis were also applied. Begg's test was used to test potential publication bias. The modified Newcastle-Ottawa Scale (NOS) was used to evaluate the literature quality.
Totally, 18 articles including 2,714 patients were enrolled, with most of the included literature being of moderate to high quality. The results of systematic and meta-analysis suggested that sleep disturbance was associated with an increased risk of PD (OR: 3.731; 95% CI: 2.338 to 5.956). Subgroup analysis results demonstrated that sleep disturbance in patients aged <65 years (OR: 6.072; 95% CI: 3.054 to 12.071), aged ≥65 years (OR: 2.904; 95% CI: 1.487 to 5.671), and undergoing cardiac (OR: 3.390; 95% CI: 1.359 to 8.453), orthopedic (OR: 3.943; 95% CI: 2.219 to 7.008), or other surgeries (OR: 4.963; 95% CI: 2.156 to 11.420) increased the risk of PD (all P<0.005). Moreover, increased risk of PD was found for both preoperative (OR: 2.804; 95% CI: 1.517 to 5.184) and postoperative (OR: 6.302; 95% CI: 3.794 to 10.467) sleep disturbance (all P<0.005). No associations between obstructive sleep apnea (OSA; OR: 2.008; 95% CI: 0.753 to 5.354; P=0.164), insomnia (OR: 4.005; 95% CI: 0.636 to 25.203; P=0.139) and risk of PD were observed.
Our study indicated the relationship between sleep disturbance and the risk of PD. Patients undergoing surgical treatments should pay attention to their sleep quality. However, more research is needed to confirm its relationship.
已有研究探讨了睡眠障碍与术后谵妄（PD）之间的关系，但结果存在争议。系统评价和荟萃分析具有较高的证据水平，可全面评估睡眠障碍对PD的影响。本研究旨在提供关于睡眠障碍对PD影响的可用证据。
检索PubMed、Embase、Cochrane图书馆和Web of Science数据库，查找从数据库建立至2021年4月28日的相关研究。根据“PICOS”原则确定符合条件的研究。采用比值比（OR）表示效应指标，应用95%置信区间（CI）表示效应大小。对异质性进行检验。还进行了亚组分析、荟萃回归和敏感性分析。采用Begg检验检测潜在的发表偏倚。使用改良的纽卡斯尔-渥太华量表（NOS）评估文献质量。
共纳入18篇文章，涉及2714例患者，纳入的文献大多为中高质量。系统评价和荟萃分析结果表明，睡眠障碍与PD风险增加相关（OR：3.731；95%CI：2.338至5.956）。亚组分析结果显示，年龄<65岁（OR：6.072；95%CI：3.054至12.071）、年龄≥65岁（OR：2.904；95%CI：1.487至5.671）以及接受心脏手术（OR：3.390；95%CI：1.359至8.453）、骨科手术（OR：3.943；95%CI：2.219至7.008）或其他手术（OR：4.963；95%CI：2.156至11.420）的患者睡眠障碍会增加PD风险（均P<0.005）。此外，术前（OR：2.804；95%CI：1.517至5.184）和术后（OR：6.302；95%CI：3.794至10.467）睡眠障碍均与PD风险增加相关（均P<0.005）。未观察到阻塞性睡眠呼吸暂停（OSA；OR：2.008；95%CI：0.753至5.354；P=0.164）、失眠（OR：4.005；95%CI：0.636至25.203；P=0.139）与PD风险之间存在关联。
我们的研究表明了睡眠障碍与PD风险之间的关系。接受手术治疗的患者应注意其睡眠质量。然而，需要更多研究来证实这种关系。
