Department of anesthesiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
Department of anesthesiology, Ningbo No.2 Hospital, Ningbo, 315000, Zhejiang, China.
BMC Anesthesiol. 2023 Sep 11;23(1):306. doi: 10.1186/s12871-023-02267-x.
Postoperative delirium (POD) is an acute form of brain dysfunction that can result in serious adverse consequences. There has been a link between cognitive dysfunction and poor sleep. The present study aimed to determine the association and prediction of subjective sleep quality and postoperative delirium during major non-cardiac surgery.
One hundred and thirty-four patients, aged 60 years or older, were scheduled for elective laparotomy or orthopaedic procedures. The Pittsburgh Sleep Quality Index (PSQI) and sleep log were used to assess perioperative subjective sleep quality in participants. Nursing Delirium Screening Checklist (NU-DESC) was used for screening, and the Confusion Assessment Method (CAM) was used to diagnose POD during the first seven days following surgery. The association between subjective sleep quality and POD was assessed using a multivariate logistic regression model. Thereafter, the prediction performance of subjective sleep quality was evaluated using a receiver operating characteristic (ROC) curve.
All assessments were completed on 119 patients who had an average PSQI score of 7.0 ± 2.4 before surgery. 23 patients (19.3%) suffered from POD. The multivariate logistic regression analysis showed that the occurrence of POD was closely related to age, BMI, PSQI and operation time. After adjusting for related factors, there was a statistically significant association between PSQI and POD occurrence (OR = 1.422, 95%CI 1.079-1.873, per 1-point increase in PSQI). The ROC curve analysis showed that the optimal PSQI cutoff value was 8.0 for predicting POD, and the area under the ROC (AUROC) value of PSQI was 0.741 (95%CI 0.635 to 0.817). The AUROC of the model developed by the multivariate logistic regression analysis was 0.870 (95%CI 0.797 to 0.925).
The study found that preoperative subjective sleep quality was strongly associated with POD during major non-cardiac surgery. Additionally, PSQI combined with age, BMI, and operation time improved POD prediction.
术后谵妄（POD）是一种急性脑功能障碍，可导致严重的不良后果。认知功能障碍与睡眠质量差之间存在关联。本研究旨在确定主要非心脏手术后主观睡眠质量与术后谵妄之间的关联和预测。
选择 134 名年龄在 60 岁及以上的患者，计划接受剖腹手术或矫形手术。匹兹堡睡眠质量指数（PSQI）和睡眠日志用于评估参与者围手术期的主观睡眠质量。使用护理谵妄筛查检查表（NU-DESC）进行筛查，使用意识混乱评估方法（CAM）在术后 7 天内诊断 POD。使用多变量逻辑回归模型评估主观睡眠质量与 POD 之间的关联。此后，使用受试者工作特征（ROC）曲线评估主观睡眠质量的预测性能。
所有评估均在 119 名患者中完成，这些患者在手术前的平均 PSQI 评分为 7.0±2.4。23 名患者（19.3%）患有 POD。多变量逻辑回归分析表明，POD 的发生与年龄、BMI、PSQI 和手术时间密切相关。在调整相关因素后，PSQI 与 POD 发生之间存在统计学显著关联（OR=1.422，95%CI 1.079-1.873，PSQI 每增加 1 分）。ROC 曲线分析表明，PSQI 的最佳截断值为 8.0 用于预测 POD，PSQI 的 ROC 曲线下面积（AUROC）值为 0.741（95%CI 0.635-0.817）。多变量逻辑回归分析建立的模型的 AUROC 为 0.870（95%CI 0.797-0.925）。
研究发现，主要非心脏手术后术前主观睡眠质量与 POD 密切相关。此外，PSQI 结合年龄、BMI 和手术时间可提高 POD 预测。
