The potential link between obstructive sleep apnea and postoperative neurocognitive disorders: current knowledge and possible mechanisms.

Journal Article (Journal Article;Review)

PURPOSE: This narrative review examines the current evidence on whether obstructive sleep apnea (OSA) is associated with postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The mechanisms that could predispose OSA patients to these disorders are also explored. SOURCE: Relevant literature was identified by searching for pertinent terms in Medline®, Pubmed, ScopusTM, and Google scholar databases. Case reports, abstracts, review articles, original research articles, and meta-analyses were reviewed. The bibliographies of retrieved sources were also searched to identify relevant papers. PRINCIPAL FINDINGS: Seven studies have investigated the association between OSA and POD, with mixed results. No studies have examined the potential link between OSA and POCD. If these relationships exist, they could be mediated by several mechanisms, including increased neuroinflammation, blood-brain barrier breakdown, cerebrovascular disease, Alzheimer's disease neuropathology, disrupted cerebral autoregulation, sleep disruption, sympathovagal imbalance, and/or disrupted brain bioenergetics. CONCLUSION: There is very limited evidence that OSA plays a role in postoperative neurocognitive disorders because few studies have been conducted in the perioperative setting. Additional perioperative prospective observational cohort studies and randomized controlled trials of sleep apnea treatment are needed. These investigations should also assess potential underlying mechanisms that could predispose patients with OSA to postoperative neurocognitive disorders. This review highlights the need for more research to improve postoperative neurocognitive outcomes for patients with OSA.

Full Text

Duke Authors

Cited Authors

  • Devinney, MJ; VanDusen, KW; Kfouri, JM; Avasarala, P; Spector, AR; Mathew, JP; Berger, M

Published Date

  • October 2022

Published In

Volume / Issue

  • 69 / 10

Start / End Page

  • 1272 - 1287

PubMed ID

  • 35982354

Pubmed Central ID

  • PMC9924301

Electronic International Standard Serial Number (EISSN)

  • 1496-8975

Digital Object Identifier (DOI)

  • 10.1007/s12630-022-02302-4


  • eng

Conference Location

  • United States