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A Systematic Review and Meta-Analysis Examining the Impact of Sleep Disturbance on Postoperative Delirium

Fadayomi, Ayòtúndé B., MBBS, MPH1; Ibala, Reine, BS2; Bilotta, Federico, MD, PhD3; Westover, Michael B., MD, PhD4; Akeju, Oluwaseun, MD, MMSc2

doi: 10.1097/CCM.0000000000003400
Online Review Articles

Objectives: Basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for postoperative delirium. We aimed to assess the association between preoperative sleep disturbance and postoperative delirium.

Data Sources: We searched PubMed, Embase, CINAHL, Web of Science, and Cochrane from inception until May 31, 2017.

Study Selection: We performed a systematic search of the literature for all studies that reported on sleep disruption and postoperative delirium excluding cross-sectional studies, case reports, and studies not reported in English language.

Data Extraction: Two authors independently performed study selection and data extraction. We calculated pooled effects estimates with a random-effects model constructed in Stata and evaluated the risk of bias by formal testing (Stata Corp V.14, College Station, TX),

Data Synthesis: We included 12 studies, from 1,238 citations that met our inclusion criteria. The pooled odds ratio for the association between sleep disturbance and postoperative delirium was 5.24 (95% CI, 3.61–7.60; p < 0.001 and I2 = 0.0%; p = 0.76). The pooled risk ratio for the association between sleep disturbance and postoperative delirium in prospective studies (n = 6) was 2.90 (95% CI, 2.28–3.69; p < 0.001 and I2 = 0.0%; p = 0.89). The odds ratio associated with obstructive sleep apnea and unspecified types of sleep disorder were 4.75 (95% CI, 2.65–8.54; p < 0.001 and I2 = 0.0%; p = 0.85) and 5.60 (95% CI, 3.46–9.07; p < 0.001 and I2 = 0.0%; p = 0.41), respectively. We performed Begg’s and Egger’s tests for publication bias and confirmed a null result for publication bias (p = 0.371 and 0.103, respectively).

Conclusions: Preexisting sleep disturbances are likely associated with postoperative delirium. Whether system-level initiatives targeting patients with preoperative sleep disturbance may help reduce the prevalence, morbidity, and healthcare costs associated with postoperative delirium remains to be determined.

1Division of Epidemiology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

2Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

3Department of Anesthesia and Critical Care Medicine, Sapienza University, Rome, Italy.

4Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

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Supported, in part, by grants National Institutes of Health National Institute of Aging R01 R01AG053582.

Drs. Fadayomi, Westover, and Akeju received support for article research from the National Institutes of Health (NIH). Dr. Akeju received funding from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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