Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study

Abstract

Background

Postoperative delirium (POD) is prevalent in craniotomy patients and is associated with high mortality. Sleep disturbances are receiving increasing attention from clinicians as associated risk factors for postoperative complications. This study aimed to determine the impact of preoperative sleep disturbances on POD in craniotomy patients.

Methods

We recruited 130 patients undergoing elective craniotomy for intracranial tumors between May 1st and December 30th, 2022. Preoperative subjective sleep disturbances were assessed using the Pittsburgh Sleep Quality Index on the day of admission. We also measured objective perioperative sleep patterns using a dedicated sleep monitoring device 3 days before and 3 days after the surgery. POD was assessed twice daily using the Confusion Assessment Model for the Intensive Care Unit within the first week after craniotomy.

Results

Preoperative sleep disturbances were diagnosed in 49% of the study patients, and POD was diagnosed in 22% of all the study patients. Sleep disturbances were an independent risk factor for POD (OR: 2.709, 95% CI: 1.020–7.192, P = 0.045). Other risk factors for POD were age (OR: 3.038, 95% CI: 1.195–7.719, P = 0.020) and the duration of urinary catheterization (OR: 1.246, 95% CI: 1.025–1.513, P = 0.027). Perioperative sleep patterns (including sleep latency, deep sleep duration, frequency of awakenings, apnea-hypopnea index, and sleep efficiency) were significantly associated with POD.

Conclusion

This study demonstrated that preoperative sleep disturbances predispose patients undergoing craniotomy to POD, also inferred a correlation between perioperative sleep patterns and POD. The targeted screening and intervention specifically for sleep disturbances during the perioperative period are immensely required.

Keywords:

• postoperative delirium
• preoperative sleep disturbances
• craniotomy
• sleep pattern
• confusion assessment model for the intensive care unit
• Pittsburgh Sleep Quality Index

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author (Baoguo Wang) upon request.

Ethics Statements

This study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Sanbo Brain Hospital of Capital Medical University (SBNK-YJ-2022-011-01). All patients had signed an informed consent form for inclusion.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was supported by the Application and Evaluation of Active Health Cloud Platform in China, National Key Research and Development Program of China (2018YFC2000704).