Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Preoperative sleep variability and risk of Anesthesia-related delirium in geriatric surgical patients: The mediating role of intraoperative hemodynamic instability in a single-center study.
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Lei Xiaowen, Wang Rong, Wen Xu, Liu Jinjiang
Аннотация
BACKGROUND: Older adults undergoing elective surgery are at high risk of anaesthesia-related delirium. Recent evidence points to the coefficient of variation of total sleep time (CV_TST), rather than mean sleep duration alone, as a decisive predictor. We examined whether pre-operative CV_TST is associated with post-anaesthetic delirium and whether intra-operative haemodynamic instability mediates that association.
METHODS: In this prospective cohort (n = 122, ≥65 y), wrist actigraphy (ActiGraph wGT3X-BT, ActiGraph LLC, USA) recorded seven nights of sleep before surgery. CV_TST of total sleep time (TST) defined sleep variability and was categorised into quartiles (Q1-Q4). Continuous arterial pressure and heart rate were captured, and haemodynamic instability was defined as SBP < 90 mmHg or ≥20 % below baseline for ≥5 min, MAP < 65 mmHg for ≥5 min, HR < 50 or >110 min-1 for ≥ 5 min, or ≥10 min cumulative hypotension/tachycardia. Delirium within 72 h was assessed by 3D-CAM/CAM-ICU. Multivariable logistic regression produced odds ratios (ORs); mediation analysis used non-parametric bootstrapping.
RESULTS: Delirium occurred in 18/122 (14.8 %). Compared with Q1, Q4 showed an OR = 1.73 (95 % CI 1.46-2.05) for delirium after full adjustment. The relationship between CV_TST and delirium was approximately linear (P < 0.001). Haemodynamic instability partially mediated this effect, accounting for 25.4 % of the total association (indirect OR = 1.18, P = 0.004). Both short (<6 h) and long (>9 h) mean TST were linked to higher delirium risk (OR = 1.61 and 1.38, respectively) relative to 6-9 h.
CONCLUSION: Large day-to-day fluctuations in pre-operative sleep independently increase the odds of anaesthesia-related delirium in older adults, and about one-quarter of this effect operates through intra-operative haemodynamic instability. Optimising sleep regularity and tightening haemodynamic control might jointly mitigate delirium.
METHODS: In this prospective cohort (n = 122, ≥65 y), wrist actigraphy (ActiGraph wGT3X-BT, ActiGraph LLC, USA) recorded seven nights of sleep before surgery. CV_TST of total sleep time (TST) defined sleep variability and was categorised into quartiles (Q1-Q4). Continuous arterial pressure and heart rate were captured, and haemodynamic instability was defined as SBP < 90 mmHg or ≥20 % below baseline for ≥5 min, MAP < 65 mmHg for ≥5 min, HR < 50 or >110 min-1 for ≥ 5 min, or ≥10 min cumulative hypotension/tachycardia. Delirium within 72 h was assessed by 3D-CAM/CAM-ICU. Multivariable logistic regression produced odds ratios (ORs); mediation analysis used non-parametric bootstrapping.
RESULTS: Delirium occurred in 18/122 (14.8 %). Compared with Q1, Q4 showed an OR = 1.73 (95 % CI 1.46-2.05) for delirium after full adjustment. The relationship between CV_TST and delirium was approximately linear (P < 0.001). Haemodynamic instability partially mediated this effect, accounting for 25.4 % of the total association (indirect OR = 1.18, P = 0.004). Both short (<6 h) and long (>9 h) mean TST were linked to higher delirium risk (OR = 1.61 and 1.38, respectively) relative to 6-9 h.
CONCLUSION: Large day-to-day fluctuations in pre-operative sleep independently increase the odds of anaesthesia-related delirium in older adults, and about one-quarter of this effect operates through intra-operative haemodynamic instability. Optimising sleep regularity and tightening haemodynamic control might jointly mitigate delirium.