Obstructive Sleep Apnea and Incidence of Postoperative Delirium after Elective Knee Replacement in the Nondemented Elderly
| Autor: | William D. White, Thomas P. Vail, Paula T. Trzepacz, Christopher C. Young, Sarah K. Rivelli, Madan M. Kwatra, Richard E. Moon, Benjamin J. Flink, Michael P. Bolognesi, Elizabeth A. Cox, Grace Falcone, Andrew D. Krystal |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_treatment Knee replacement behavioral disciplines and activities Postoperative Complications Surveys and Questionnaires Cognitive problems mental disorders medicine Humans Postoperative delirium Prospective Studies Arthroplasty Replacement Knee Prospective cohort study Aged Aged 80 and over Sleep Apnea Obstructive business.industry Incidence Incidence (epidemiology) Delirium Sleep apnea medicine.disease Arthroplasty nervous system diseases Obstructive sleep apnea Anesthesiology and Pain Medicine Elective Surgical Procedures Anesthesia Female medicine.symptom Complication business Elective Surgical Procedure |
| Zdroj: | Anesthesiology. 116:788-796 |
| ISSN: | 0003-3022 |
| DOI: | 10.1097/aln.0b013e31824b94fc |
| Popis: | Background Postoperative delirium, a common complication in the elderly, can occur following any type of surgery and is associated with increased morbidity and mortality; it may also be associated with subsequent cognitive problems. Effective therapy for postoperative delirium remains elusive because the causative factors of delirium are likely multiple and varied. Methods Patients 65 yr or older undergoing elective knee arthroplasty were prospectively evaluated for postoperative Diagnostic and Statistical Manual of Mental Disorders-IV delirium. Exclusion criteria included dementia, mini-mental state exam score less than 24, delirium, clinically significant central nervous system/neurologic disorder, current alcoholism, or any serious psychiatric disorder. Delirium was assessed on postoperative days 2 and 3 using standardized scales. Patients' preexisting medical conditions were obtained from medical charts. The occurrence of obstructive sleep apnea was confirmed by contacting patients to check their polysomnography records. Data were analyzed using Pearson chi-square or Wilcoxon rank sum tests and multiple logistic regressions adjusted for effects of covariates. Results Of 106 enrolled patients, 27 (25%) developed postoperative delirium. Of the 15 patients with obstructive sleep apnea, eight (53%) experienced postoperative delirium, compared with 19 (20%) of the patients without obstructive sleep apnea (P = 0.0123, odds ratio: 4.3). Obstructive sleep apnea was the only statistically significant predictor of postoperative delirium in multivariate analyses. Conclusions This is the first prospective study employing validated measures of delirium to identify an association between preexisting obstructive sleep apnea and postoperative delirium. |
| Databáze: | OpenAIRE |
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