The Effects Of Perioperative Sleep Disorders On Postoperative Delirium In Elderly Patients Following Lower Limbs Orthopedic Surgery

Objective: Perioperative sleep problems and postoperative delirium(POD)in the elderly have become practical problems with the increasing number of surgical operations for the elderly.However,there are still many indeterminacies in this field in current.The relationship between perioperative sleep and postoperative delirium is not clear,and the interventions to improving sleep and postoperative delirium do not work well.In this trial,we look forward to exploring the association between perioperative sleep disorders(PSD)and the postoperative delirium(POD)by comparing the incidence of POD among elderly patients with acute preoperative sleep disorders after admission with the incidence of POD among elderly patients who did not have preoperative sleep disorders.Thus,we can provide a reference for further intervention to improve sleep quality and reduce POD.Methods: 294 elderly patients aged ≥65 years undergoing major orthopedic lower extremity surgery(including any of the following three: hip replacement,knee replacement,and closed reduction of hip fracture)were prospectively analyzed.On 3 days prior to surgery,patients’ consciousness were assessed by the Montreal Cognitive Assessment(Mo CA)and sleep quality were assessed by Pittsburgh sleep quality index(PSQI),so that those who had a MOCA score < 26 or a PSQI score > 5 were excluded.In the perioperative period,the sleep quality of the patients was assessed by the Chinese version of the Richards Campbell sleep scale(RCSQ).After surgery,postoperative delirium was diagnosed according to the 3-minute diagnostic interview for the fusion assessment method(3DCAM).Risk factors for POD were determined by univariate analysis and multivariate logistic regression analysis.Results: Among 294 patients,34(11.56%)patients were diagnosed as POD.According to preoperative RCSQ scores,124 patients were included in the preoperative PSD group and170 patients were included in the preoperative non-PSD group,and there was no significant difference in POD incidence between the two groups.According to RCSQ scores on the surgery night,the day after 1 day and the day after 2 days,149 patients with postoperative PSD were found among postoperative patients,and the occurrence rate of POD between the postoperative PSD group and the postoperative non-PSD group had significant statistical differences.Subgroup analysis of preoperative PSD found significant statistical differences between the two groups;univariate and multivariate risk analysis of POD risk factors,including VAS>3 points(OR: 3.67,95%CI(1.38-9.78),P = 0.009),preoperative 1-day serious PSD(OR: 3.62,95%CI(1.19-10.92),P = 0.02),postoperative PSD(OR: 2.76,95%CI(1.19-6.38),P = 0.02),severe PSD within 3 days after surgery(OR: 2.91,95%CI(1.33-6.37),P = 0.02).A single and multiple factor risk analysis was performed for each daily POD.In the POD one day after operation,preoperative RCSQ <25(OR: 5.67,95%CI(1.87-17.24),P = 0.002),postoperative PSD positive(OR:4.33,95%CI(1.63-11.52),P =0.003),postoperative RCSQ <25(OR:3.65,95%CI(1.48-8.97),P = 0.005).In the POD two days after operation,preoperative ASA grade >3rd grade(OR:5.23,95%CI(1.33-20.59),P= 0.02),preoperative serious PSD(RCSQ score < 25 points)(OR:6.43,95%CI(1.71-24.26),P = 0.006),postoperative PSD(post-PSD day2)(OR:6.08,95%CI(1.79-20.62),P= 0.004),and postoperative serious PSD(post-day 2 RCSQ score <25 points)(OR:8.53,95%CI(2.64-27.56),P < 0.0001).In the POD three days after operation,postoperative serious PSD(post-day 3 RCSQ score < 25 points)(OR: 10.40,95%CI(1.63-66.51),P =0.01).For patients with postoperative PSD,it was found that 51.7% of the patients had preoperative PSD.Conclusions:Firstly,acute PSD before surgery was not associated with POD,but acute severe PSD on the night before surgery was an independent risk factor for POD.Secondly,postoperative PSD was significantly correlated to POD and was an independent risk factor for its occurrence,while severe postoperative PSD further increased this risk.Thirdly,postoperative PSD,especially severe postoperative PSD,may be related to POD occurred on the next day.Fourthly,there is a correlation between preoperative PSD and postoperative PSD.