Liu Yang, Zhang Xiaoyu, Jiang Mengyang, Zhang Yiqiang, Wang Chenhui, Sun Yongxing, Shi Zhonghua, Wang Baoguo
Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, People's Republic of China.
Department of Intensive Care Medicine, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, People's Republic of China.
Nat Sci Sleep. 2023 Dec 21;15:1093-1105. doi: 10.2147/NSS.S432829. eCollection 2023.
Postoperative delirium (POD) is prevalent in craniotomy patients and is associated with high mortality. Sleep disturbances are receiving increasing attention from clinicians as associated risk factors for postoperative complications. This study aimed to determine the impact of preoperative sleep disturbances on POD in craniotomy patients.
We recruited 130 patients undergoing elective craniotomy for intracranial tumors between May 1st and December 30th, 2022. Preoperative subjective sleep disturbances were assessed using the Pittsburgh Sleep Quality Index on the day of admission. We also measured objective perioperative sleep patterns using a dedicated sleep monitoring device 3 days before and 3 days after the surgery. POD was assessed twice daily using the Confusion Assessment Model for the Intensive Care Unit within the first week after craniotomy.
Preoperative sleep disturbances were diagnosed in 49% of the study patients, and POD was diagnosed in 22% of all the study patients. Sleep disturbances were an independent risk factor for POD (: 2.709, 95% : 1.020-7.192, = 0.045). Other risk factors for POD were age (: 3.038, 95% : 1.195-7.719, = 0.020) and the duration of urinary catheterization (: 1.246, 95% : 1.025-1.513, = 0.027). Perioperative sleep patterns (including sleep latency, deep sleep duration, frequency of awakenings, apnea-hypopnea index, and sleep efficiency) were significantly associated with POD.
This study demonstrated that preoperative sleep disturbances predispose patients undergoing craniotomy to POD, also inferred a correlation between perioperative sleep patterns and POD. The targeted screening and intervention specifically for sleep disturbances during the perioperative period are immensely required.
术后谵妄（POD）在开颅手术患者中很常见，且与高死亡率相关。睡眠障碍作为术后并发症的相关危险因素正受到临床医生越来越多的关注。本研究旨在确定术前睡眠障碍对开颅手术患者发生POD的影响。
我们招募了2022年5月1日至12月30日期间因颅内肿瘤接受择期开颅手术的130例患者。入院当天使用匹兹堡睡眠质量指数评估术前主观睡眠障碍。我们还在手术前3天和手术后3天使用专用睡眠监测设备测量围手术期客观睡眠模式。开颅手术后第一周内，每天使用重症监护病房意识模糊评估法对POD进行两次评估。
49%的研究患者被诊断为术前睡眠障碍，22%的所有研究患者被诊断为POD。睡眠障碍是POD的独立危险因素（比值比：2.709，95%置信区间：1.020 - 7.192，P = 0.045）。POD的其他危险因素包括年龄（比值比：3.038，95%置信区间：1.195 - 7.719，P = 0.020）和导尿持续时间（比值比：1.246，95%置信区间：1.025 - （此处原文似乎有误，推测应为1.513），P = 0.027）。围手术期睡眠模式（包括睡眠潜伏期、深度睡眠时间、觉醒频率、呼吸暂停低通气指数和睡眠效率）与POD显著相关。
本研究表明，术前睡眠障碍使开颅手术患者易发生POD，也推断出围手术期睡眠模式与POD之间存在相关性。迫切需要针对围手术期睡眠障碍进行有针对性的筛查和干预。
