The prevention of delirium in elderly surgical patients with obstructive sleep apnea (PODESA): a randomized controlled trial View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-09-14

AUTHORS

Jean Wong, Helen R. Doherty, Mandeep Singh, Stephen Choi, Naveed Siddiqui, David Lam, Nishanthi Liyanage, George Tomlinson, Frances Chung

ABSTRACT

BackgroundObstructive sleep apnea (OSA) is associated with neurocognitive impairment – a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty.MethodsWe conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were ≥6\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\ge 6$$\end{document}0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea–hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery.ResultsOf 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups.ConclusionsWe had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty.Trial registrationThis trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016. More... »

PAGES

290

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12871-022-01831-1

DOI

http://dx.doi.org/10.1186/s12871-022-01831-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1150987765

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/36104664


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34 Research Ethics Board approval
35 STOP-Bang score
36 Secondary outcome measures
37 academic hospital
38 adults
39 age
40 airway pressure
41 analysis
42 apnea
43 apnea test
44 apnea-hypopnea index
45 approval
46 arthroplasty
47 assessment methods
48 auto-titrating positive airway pressure
49 board approval
50 care
51 care group
52 chart review
53 complications
54 consent
55 criteria
56 days
57 delirium
58 differences
59 discharge
60 elderly surgical patients
61 elective hip
62 elective knee
63 ethics board approval
64 factors
65 group
66 hip
67 hip arthroplasty
68 home sleep apnea test
69 hospital
70 impairment
71 inclusion criteria
72 increase
73 index
74 informed consent
75 knee
76 knee replacement
77 length
78 length of stay
79 lower rates
80 mean age
81 mean length
82 measures
83 method
84 neurocognitive impairment
85 night
86 night 1
87 night 2
88 night 3
89 objective
90 obstructive sleep apnea
91 older adults
92 outcome measures
93 outcomes
94 participants
95 patients
96 perioperative complications
97 positive airway pressure
98 postoperative complications
99 postoperative delirium
100 postoperative night 1
101 pressure
102 prevention
103 prevention of delirium
104 primary outcome
105 rate
106 replacement
107 review
108 risk
109 risk factors
110 routine care
111 routine care group
112 scores
113 sites
114 sleep apnea
115 sleep apnea test
116 stay
117 study
118 surgery
119 surgical patients
120 test
121 total
122 treatment
123 treatment groups
124 trials
125 years
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