Sleep Loss the night before surgery and incidence of postoperative delirium in adults 65–95 years of age

Abstract

Study objectivesTo describe the association between preoperative sleep disruption and postoperative delirium. MethodsProspective cohort study with six time points (3 nights pre-hospitalization and 3 nights post-surgery). The sample included 180 English-speaking patients ≥65 years old scheduled for major non-cardiac surgery and anticipated minimum hospital stay of 3 days. Six days of wrist actigraphy recorded continuous movement to estimate wake and sleep minutes during the night from 22:00 to 05:59. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 32) and without (n = 148) postoperative delirium were compared using multivariate logistic regression. ResultsParticipants had a mean age of 72 ± 5 years (range 65–95 years). The incidence of postoperative delirium during any of the three postoperative days was 17.8%. Postoperative delirium was significantly associated with surgery duration (OR = 1.49, 95% CI 1.24–1.83) and sleep loss >15% on the night before surgery (OR = 2.64, 95% CI 1.10–6.62). Preoperative symptoms of pain, anxiety and depression were unrelated to preoperative sleep loss. ConclusionsIn this study of adults ≥65 years of age, short sleep duration was more severe preoperatively in the patients who experienced postoperative delirium as evidenced by sleep loss >15% of their normal night's sleep. However, we were unable to identify potential reasons for this sleep loss. Further investigation should include additional factors that may be associated with preoperative sleep loss to inform potential intervention strategies to mitigate preoperative sleep loss and reduce risk of postoperative delirium.