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Early Postoperative Actigraphy Poorly Predicts Hypoactive Delirium.

Hannah R Maybrier¹, C Rya King¹, Amanda E Crawford¹

¹Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri.

Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine

|January 10, 2019

Summary

Wrist actigraphy shows limited ability to predict hypoactive delirium in elderly surgical patients. Altered sleep-wake patterns detected by actigraphy were not reliable sole predictors of postoperative delirium.

Keywords:

actigraphy anesthesia arousal postoperative delirium sleep surgery

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Area of Science:

Geriatric Medicine
Surgical Complications
Sleep Science

Background:

Delirium is a common postoperative complication in elderly patients, characterized by cognitive and attention disturbances.
Wrist actigraphy is proposed to monitor inactivity and sleep patterns, potentially identifying delirium markers.

Purpose of the Study:

To investigate if altered motor activity and immobility patterns, indicative of sleep-wake disturbances, can predict hypoactive postoperative delirium in elderly surgical patients.

Main Methods:

Eighty-four elderly surgical patients were categorized based on delirium occurrence (no delirium, delirium POD 0-1, delirium POD 2-5).
Wrist actigraphy measured motor activity and immobility on the first postoperative day and night.
Statistical analyses, including Wilcoxon rank-sum tests and C-statistics, were used to assess predictive capacity.

Main Results:

Actigraphy metrics exhibited significant interpatient variability.
Patients without delirium showed distinct day-night activity patterns compared to delirious groups, though discrimination was poor.
While immobility measures improved with signal inclusion, actigraphy alone had limited predictive power for delirium incidence, even after adjusting for covariates.

Conclusions:

Early postoperative wrist actigraphy metrics, reflecting sleep-wake patterns, have limited capacity as standalone predictors of hypoactive delirium.
Further research may be needed to integrate actigraphy with other clinical data for improved delirium prediction.