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Preoperative Sleep Disruption and Postoperative Delirium
Jacqueline M Leung1, Laura P Sands2, Stacey Newman1
1Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.
Summary
Preoperative sleep disruption, specifically increased wake after sleep onset (WASO), was significantly higher in surgical patients who later developed postoperative delirium. Poor sleep before surgery may predict delirium in older adults.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Sleep Medicine
Background:
- Postoperative delirium is a common complication in older surgical patients.
- Sleep disruption is prevalent in the perioperative period.
- The relationship between preoperative sleep patterns and postoperative delirium requires further investigation.
Purpose of the Study:
- To describe preoperative and postoperative sleep disruption in older adults undergoing major surgery.
- To investigate the association between sleep disruption and the incidence of postoperative delirium.
Main Methods:
- Prospective cohort study involving 50 patients aged 40 and older undergoing major non-cardiac surgery.
- Sleep was monitored for 6 days (3 pre-hospitalization, 3 post-surgery) using wrist actigraphy.
- Postoperative delirium was assessed using the Confusion Assessment Method.
Main Results:
- 14% of patients developed postoperative delirium.
- Patients who developed delirium had significantly higher wake after sleep onset (WASO) percentage the night before surgery (44% vs. 21%, p=0.012).
- Sleep disruption worsened postoperatively, and patients with WASO < 10% did not experience delirium.
Conclusions:
- Preoperative sleep disruption, particularly elevated WASO, is associated with a higher risk of postoperative delirium in older surgical patients.
- This pilot study suggests poor sleep quality before surgery may be a predictor of delirium.
- Larger studies are needed to confirm these findings and identify specific sleep parameters that predict delirium.
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