The Effect Of Sleep Disturbance On Postoperative Delirium And The Mechanism Of Chronic Stress-related Postoperative Brain Injury

Part ?.Effect of Sleep Disturbance on Delirium in Post-Cardiac Surgery PatientsObjective:We aim to examine the effect of sleep disturbance(SPD)on delirium in post-cardiac surgery patients.Methods:We prospectively selected 186 patients undergoing selective cardiac valve surgery from May 22 to July 29,2019.Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index(PSQI)and the Montreal Cognitive Assessment,respectively.The Confusion Assessment Method for Intensive Care Unit was used to assess postoperstive delirium(POD)from the first to seventh day postoperatively.Patients were divided into two groups according to the POD diagnosis:(1)No POD(NPOD)group and(2)the POD group.Results:Of 186 eligible patients,29(15.6%)were diagnosed with POD.A univariate analysis showed that gender(P=0.040),age(P=0.009),SPD(P=0.008),intraoperative infusion volume(P=0.034),postoperative intubation time(P=0.001),and intensive care unit stay time(P=0.009)were associated with POD.A multivariate logistic regression analysis demonstrated that age(odds ratio(OR):1.106;P=0.001)and SPD(OR:3.223;P=0.047)were independently associated with POD.A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of POD(area under curve:0.706;95%confidence interval:0.595-0.816).A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and POD incidence(P=0.009).Conclusions:Preoperative SPD was significantly associated with POD and a main predictor of POD.Part ?.Perioperative Sleep Disturbance and Postoperative Delirium in Adult Patients:A Systematic Review and Meta-Analysis of Clinical TrialsObjectives:The aim of this systematic review and meta-analysis of clinical trials was to investigate the effects of perioperative sleep disturbance on postoperative delirium(POD).Methods:Authors searched for studies(until May 12,2020)reporting POD in patients with sleep disturbances following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.RevMan version 5.3 and Stata version 12.0 were used to perform statistical analyses.Publication bias was assessed using Begg's test.We conducted sensitivity analysis to address high heterogeneity(I2>40%)through the methods of subgroup analysis or one-by-one article removal.Results:We identified 29 relevant trials including 55,907 patients.We divided these trials into three groups according to study design:Seven retrospective observational trials,12 prospective observational trials,and 10 randomized controlled trials.The results demonstrated that perioperative sleep disturbances were significantly associated with POD occurrence in observational groups[retrospective:OR=0.56,95%CI:[0.33,0.93],I2=91%,P for effect=0.03;prospective:OR=0.27,95%CI:[0.20,0.36],I2=25%,P for effect<0.001],but not in the randomized controlled trial group[OR=0.58,95%CI:[0.34,1.01],I2=68%,P for effect=0.05].We did not find publication bias in all three groups by Egger's test:ROT(P=0.085),POT(P=0.764)and RCT(P=0.933).To solve the high heterogeneity of ROT and RCT groups by one-by-one literature exclusion.The pooled results were consistent with those before addressing high heterogeneity(ROT group:OR=0.65,95%CI:[0.47,0.91],I2-12%,P=0.01;RCT group:OR=0.82,95%CI:[0.52,1.29],I2=19%,P=0.39).Conclusions:Perioperative SPD was potential risk factors for POD in observational trials,but not in randomized controlled trials.Part ?.The Potential Mechanism of Postoperative Brain Injury following Cardiac Surgery in Chronic Stress Rats by Proteomics and MetabolomicsObjectives:To investigate the mechanism of brain injury following cardiac surgery under cardiopulmonary bypass(CPB)in chronic stress(CS)rats by the methods of proteomics and metabolomics.Methods:The adult SD rats were divided into normal group,CS group and CS+cardiac surgery group.CS model was established in rats of CS group and CS+cardiac surgery groups.The rats in CS+cardiac surgery underwent cardiac surgery under general anesthesia and CPB.Immediately after surgery,three groups of rats were decapitated and brains were removed.HE staining was performed to observe the damage of hippocampal neurons in rats of three groups.The significantly regulated proteins and metabolites were screened by the methods of data-independent scan pattern(DIA)proteomics and untargeted metabolomics.Lastly,Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were used to screen the signal pathway of brain injury affected by cardiac surgery under CPB cardiac surgery in CS rats.Results:HE staining found that compared with the rats in normal group,the hippocampal area demonstrated a small amount of apoptotic neurons in rats of CS group,while a large number of apoptotic neurons in rats of CS+cardiac surgery group.Proteomics:The total number of screened proteins with significant regulation was 230 in the normal group vs.CS group(up-regulated:134;down-regulated:96);474 proteins in the normal group vs.CS+cardiac surgery group(up-regulated:333;down-regulated:141);200 proteins were screened in CS group vs.CS+cardiac surgery group(up-regulated:136;down-regulated:64).Metabolomics:The total number of screened metabolites with significant regulation was 155 in normal group vs.CS group(up-regulated:90;down-regulated:65);265 metabolites in normal group vs.CS+cardiac surgery group(up-regulation:131;down-regulated:134);117 metabolites in CS group vs.CS+cardiac surgery(up-regulated:36;down-regulated:81).Proteomics found the KEGG enriched signaling pathways including the number of proteins screened in the top 20,and the biosynthesis pathways of glycan proteins were the most common.Metabolomics found the KEGG enriched signaling pathways including the number of metabolites screened in the top 20,and the metabolism pathways of amino acids were the most common.Conclusions:The signaling pathways of glycans protein synthesis and amino acids metabolism may be the important mechanisms of brain injury after cardiac surgery in CS rats.Riview.Study Progress on the Mechanism of Sleep Disturbance related Cognitive DysfunctionSleep disturbance(SPD)is common physiological disorders and seriously affect the physical and mental health.Long-term SPD significantly lead to memory loss,learning ability decline,spatial positioning ability disorders and other cognitive dysfunction.Large number of studies have shown that SPD is a potential risk factor for Alzheimer's disease.The occurrence of cognitive dysfunction not only increases the pain of patients and caregivers,but also increases medical expenses,which is not conducive to economic and social development.Hence,exploring the mechanism of SPD related cognitive dysfunction has important clinical and socio-economic significance.This paper reviewed the mechanism of SPD related cognitive dysfunction and provided a theoretical basis for the prevention and treatment of SPD related cognitive dysfunction in the future.