Obstructive sleep apnea and postoperative delirium

http://www.ncbi.nlm.nih.gov/pubmed/22337162

Anesthesiology. 2012 Feb 14. [Epub ahead of print]
Obstructive Sleep Apnea and Incidence of Postoperative Delirium after Elective Knee Replacement in the Nondemented Elderly.
Flink BJ, Rivelli SK, Cox EA, White WD, Falcone G, Vail TP, Young CC, Bolognesi MP, Krystal AD, Trzepacz PT, Moon RE, Kwatra MM.
Source
* Student, School of Medicine, † Assistant Professor, Department of Psychiatry and Behavioral Sciences, and Assistant Professor, Department of Medicine, ‡ Resident, § Biostatistician, ** Associate Professor, Department of Anesthesiology, # Nurse Practitioner, ‡‡ Professor, Department of Psychiatry and Behavioral Sciences, †† Assistant Professor, Department of Surgery, ## Professor, Department of Anesthesiology, and Professor, Department of Medicine, Duke University Medical Center, Durham, North Carolina. ‖ Professor, Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California. §§ Lilly Research Laboratories, Indianapolis, Indiana.

Abstract
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.