Correlation Analysis Of Atypical Sleep And Postoperative Delirium In Patients With Cardiac Surgery Under Cardiopulmonary Bypass

Objective:Firstly,the aim of this study was to evaluate sleep stages,and to analysis sleep characteristics in patients after cardiac surgery with cardiopulmonary bypass(CPB).Secondly,this study was designed to investigate the risk factors for delirium in patients with cardiac surgery under CPB within a week after the operation,and to determine the effect of atypical sleep on postoperative delirium.Methods:A observational study design,based on inclusion/exclusion criteria,was used to enroll patients after cardiac surgery under CPB admitted to the intensive care unit(ICU)between January 2020 and November 2020 at a Fujian provincial Grade 3A hospital.Sleep of patients in postoperative night 1 were monitored and recorded using polysomnography,and the analysis of sleep characteristics was perform using the Polypro S1 software.The delirium status of participants was assess using the Confusion Assessment Method-ICU.The general information and clinical data were collected using self-made data survey scales.All data statistical analysis was performed using R software,including the statistical describe,Student t test,Chi-square test,Mann-Whitney U test,Fisher exact test,univariate and multivariate logistic regression analyses.Results:A total of 98 cases were included in the first part of this study.The result shows the sleep characteristics in postoperative night 1 of patients with cardiac surgery under CPB.The mean of total sleep time and sleep efficiency were 241.82 min and 48.43%.The occurrence of atypical sleep was high,31.6%.In patients after cardiac surgery with CPB,sleep was characterized by sleep fragmentation,an increased proportion of N1 stage,a decreased proportion of N2 stage,and with significantly inhibited of N3 stage and rapid eye movement sleep.And a total of 111 cases were included in the second part of this study,including the delirium group(55 cases)and non-delirium group(56 cases).Univariate logistic regression analysis indicated that,there were statistically significant differences between two groups in age,hypertension,total blood transfusion>1000 ml,used of morphine,the Sequential Organ Failure Assessment(SOFA)score,the duration of mechanical ventilation,the length of ICU stay,the proportion of rapid eye movement(REM)sleep,the absence of REM sleep,and atypical sleep(P<0.05).None of the other comparisons were statistically significant(P>0.05).The result of multivariate logistic regression analyses indicated that age(OR=1.052,95%CI: 1.001-1.105,P=0.045),used of morphine(OR=6.392,95%CI: 1.890-21.615,P=0.003),SOFA score(OR=1.522,95%CI: 1.005-2.198,P=0.025),the absence of REM sleep(OR=6.531,95%CI: 1.388-30.727,P=0.018),and atypical sleep(OR=5.933,95%CI: 1.494-23.566,P=0.011)were independent risk factors for postoperative delirium in patients after cardiac surgery with CPB.Conclusion:The sleep quality and sleep efficiency were poor in patients after cardiac surgery with CPB,and the occurrence of atypical sleep was 31.6%.And postoperative delirium is affected by variety of factors.Age,used of morphine,the SOFA score,the absence of REM sleep,and atypical sleep were independent risk factors for postoperative delirium in patients after cardiac surgery with CPB.