Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

Jens Roggenbach, Marvin Klamann, Rebecca von Haken, Thomas Bruckner, Matthias Karck, Stefan Hofer, Jens Roggenbach, Marvin Klamann, Rebecca von Haken, Thomas Bruckner, Matthias Karck, Stefan Hofer

Abstract

Introduction: Delirium is a frequent complication after cardiac surgery. Although various risk factors for postoperative delirium have been identified, the relationship between nocturnal breathing disorders and delirium has not yet been elucidated. This study evaluated the relationship between sleep-disordered breathing (SDB) and postoperative delirium in cardiac surgery patients without a previous diagnosis of obstructive sleep apnea.

Methods: In this prospective cohort study, 92 patients undergoing elective cardiac surgery with extracorporeal circulation were evaluated for both SDB and postoperative delirium. Polygraphic recordings were used to calculate the apnea-hypopnea index (AHI; mean number of apneas and hypopneas per hour recorded) of all patients preoperatively. Delirium was assessed during the first four postoperative days using the Confusion Assessment Method. Clinical differences between individuals with and without postoperative delirium were determined with univariate analysis. The relationship between postoperative delirium and those covariates that were associated with delirium in univariate analysis was determined by a multivariate logistic regression model.

Results: The median overall preoperative AHI was 18.3 (interquartile range, 8.7 to 32.8). Delirium was diagnosed in 44 patients. The median AHI differed significantly between patients with and without postoperative delirium (28 versus 13; P = 0.001). A preoperative AHI of 19 or higher was associated with an almost sixfold increased risk of postoperative delirium (odds ratio, 6.4; 95% confidence interval, 2.6 to 15.4; P <0.001). Multivariate logistic regression analysis showed that preoperative AHI, age, smoking, and blood transfusion were independently associated with postoperative delirium.

Conclusions: Preoperative SDB (for example, undiagnosed obstructive sleep apnea) were strongly associated with postoperative delirium, and may be a risk factor for postoperative delirium.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curve of the apnea-hypopnea index of predictability for postoperative delirium. The area under the curve (AUC) was 0.712 (confidence interval: 0.604 to 0.82) with a cutoff value of 19 (sensitivity 71%, specificity 73%).
Figure 2
Figure 2
Bar chart indicating the number of cases of individuals with postoperative delirium, divided into groups with preoperative apnea-hypopnea index (AHI) values higher or lower than 19.

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