The effect of sleep quality on delirium after hip replacement in the elderly

doi:10.3877/cma.j.issn.2096-0263.2022.03.002

Abstract

Abstract:

Objective

To analyze the relationship between preoperative sleep quality and postoperative delirium in elderly patients undergoing hip replacement.

Methods

The study sample was collected from 90 elderly patients (46 males and 44 females, aged 60-78 years, mean 71.85±4.69 years old) who underwent hip arthroplasty in our hospital.The treatment time was from January 2018 to January 2019. Before operation, each patient was assessed by Pittsburgh Sleep Quality Index Scale. According to the sleep condition of patients, 43 patients were divided into normal sleep group (sleep index<5 points) and 47 patients with sleep disorder group (sleep index ≥ 5 points). Rocuronium, sufentanil and propofol were used to induce anesthesia in each group. The time of anesthesia, operation, observation and hospitalization were recorded in each group. The scores of NRS, QoR-40 and the occurrence of delirium were compared between 1 day and 5 days after operation. All 90 patients were fully followed up, with a follow-up rate of 100.00% and a follow-up time of 6-18 months, with an average of (12.3±1.2) months.

Results

The anesthesia time, operation time, observation time and postoperative hospitalization days of sleep disorder group were higher than those of normal sleep group (P<0.05); The NRS scores of sleep disorder group (3.4±1.1, 3.2±1.0, 2.7±0.8, 2.1±0.6, 1.8±0.5) at 1-5 days after operation in sleep disorder group were higher than those in normal sleep group (2.7±1.3, 2.5±1.0, 2.2±0.9, 1.8±0.7, 1.5±0.6) (P<0.05); QoR-40 scores of sleep disorder group (146.1±6.2, 149.5± 6.3, 154.2±6.7, 158.5±4.1, 162.1±5.2) were lower than those of normal sleep group (149.2±5.1, 152.3±5.1, 158.3±5.5, 161.2±5.2, 165.6±4.1) (P<0.05); The total incidence of delirium was 34.04% (16/47) in sleep disorder group and 13.95%(6/47) in normal sleep group (P<0.05).

Conclusion

Sleep disturbance before operation can increase the incidence of delirium after operation, and prolong the hospital stay after operation, which is not conducive to the recovery of patients after operation. We should pay attention to the sleep condition before operation.

Key words: Delirium, Hipreplacement, Aged, Sleepquality, Pittsburgh Sleep Quality Index

Junling Wang, Huayu Yang, Yingchun Mao, Shuwei Cheng, Yanhong Wan, lin Shi. The effect of sleep quality on delirium after hip replacement in the elderly[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2022, 08(03): 135-139.

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组别	例数	男/女（例）	年龄（岁，±s）	体质指数（kg/m²，±s）	髋关节置换部位（例，左侧/右侧）	MMSE得分（分，±s）
睡眠正常组	43	22/21	71.2±5.2	22.3±1.1	19/24	26.5±1.6
睡眠障碍组	47	24/23	72.1±4.5	22.4±1.3	22/25	26.6±1.7
统计值		χ²=0.041	t=0.880	t=0.392	χ²=0.062	t=0.287
P值		0.840	0.381	0.696	0.803	0.775

组别	例数	男/女（例）	年龄（岁，±s）	体质指数（kg/m²，±s）	髋关节置换部位（例，左侧/右侧）	MMSE得分（分，±s）
睡眠正常组	43	22/21	71.2±5.2	22.3±1.1	19/24	26.5±1.6
睡眠障碍组	47	24/23	72.1±4.5	22.4±1.3	22/25	26.6±1.7
统计值		χ²=0.041	t=0.880	t=0.392	χ²=0.062	t=0.287
P值		0.840	0.381	0.696	0.803	0.775

组别	例数	麻醉时间（min）	手术时间（min）	观察时间（h）	手术后住院天数（d）
睡眠正常组	43	266.1±66.8	232.9±62.1	135.2±24.5	11.8±3.1
睡眠障碍组	47	295.9±67.1	261.4±65.4	147.1±25.6	15.6±4.2
t值		2.109	2.115	2.248	4.846
P值		0.038	0.037	0.027	0.001

组别	例数	麻醉时间（min）	手术时间（min）	观察时间（h）	手术后住院天数（d）
睡眠正常组	43	266.1±66.8	232.9±62.1	135.2±24.5	11.8±3.1
睡眠障碍组	47	295.9±67.1	261.4±65.4	147.1±25.6	15.6±4.2
t值		2.109	2.115	2.248	4.846
P值		0.038	0.037	0.027	0.001

组别	例数	术后
组别	例数	1 d	2 d	3 d	4 d	5 d
睡眠正常组	43	2.7±1.3	2.5±1.0	2.2±0.9	1.8±0.7	1.5±0.6
睡眠障碍组	47	3.4±1.1	3.2±1.0	2.7±0.8	2.1±0.6	1.8±0.5
t值		2.765	3.317	2.790	2.188	2.585
P值		0.007	0.001	0.006	0.031	0.011

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