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A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty.

Publication ,  Journal Article
Nadler, JW; Evans, JL; Fang, E; Preud'Homme, XA; Daughtry, RL; Chapman, JB; Bolognesi, MP; Attarian, DE; Wellman, SS; Krystal, AD
Published in: Anaesthesia
June 2017

Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the 'real world' peri-operative setting. In a single-blind randomised controlled trial, 135 elderly surgical patients at risk for obstructive sleep apnoea were randomly assigned to receive peri-operative continuous positive airway pressure (CPAP) or routine care. Of the 114 patients who completed the study, 21 (18.4%) experienced delirium. Delirium was equally common in both groups: 21% (12 of 58 subjects) in the CPAP group and 16% (9 of 56 subjects) in the routine care group (OR = 1.36 [95%CI 0.52-3.54], p = 0.53). Delirious subjects were slightly older - mean (SD) age 68.9 (10.7) vs. 64.9 (8.2), p = 0.07 - but had nearly identical pre-operative STOP-Bang scores (4.19 (1.1) versus 4.27 (1.3), p = 0.79). Subjects in the CPAP group used their devices for a median (IQR [range]) of 3 (0.25-5 [0-12]) nights pre-operatively (2.9 (0.1-4.8 [0.0-12.7]) hours per night) and 1 (0-2 [0-2]) nights postoperatively (1.4 (0.0-5.1 [0.0-11.6]) hours per night). Among the CPAP subjects, the residual pre-operative apnoea-hypopnea index had a significant effect on delirium severity (p = 0.0002). Although we confirm that apnoea is associated with postoperative delirium, we did not find that providing a short-course of auto-titrating CPAP affected its likelihood or severity. Voluntary adherence to CPAP is particularly poor during the initiation of therapy.

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Published In

Anaesthesia

DOI

EISSN

1365-2044

Publication Date

June 2017

Volume

72

Issue

6

Start / End Page

729 / 736

Location

England

Related Subject Headings

  • Sleep Apnea, Obstructive
  • Single-Blind Method
  • Prospective Studies
  • Postoperative Complications
  • Perioperative Care
  • Patient Compliance
  • Middle Aged
  • Male
  • Humans
  • Female
 

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Nadler, J. W., Evans, J. L., Fang, E., Preud’Homme, X. A., Daughtry, R. L., Chapman, J. B., … Krystal, A. D. (2017). A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty. Anaesthesia, 72(6), 729–736. https://doi.org/10.1111/anae.13833
Nadler, J. W., J. L. Evans, E. Fang, X. A. Preud’Homme, R. L. Daughtry, J. B. Chapman, M. P. Bolognesi, D. E. Attarian, S. S. Wellman, and A. D. Krystal. “A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty.Anaesthesia 72, no. 6 (June 2017): 729–36. https://doi.org/10.1111/anae.13833.
Nadler JW, Evans JL, Fang E, Preud’Homme XA, Daughtry RL, Chapman JB, Bolognesi MP, Attarian DE, Wellman SS, Krystal AD. A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty. Anaesthesia. 2017 Jun;72(6):729–736.
Journal cover image

Published In

Anaesthesia

DOI

EISSN

1365-2044

Publication Date

June 2017

Volume

72

Issue

6

Start / End Page

729 / 736

Location

England

Related Subject Headings

  • Sleep Apnea, Obstructive
  • Single-Blind Method
  • Prospective Studies
  • Postoperative Complications
  • Perioperative Care
  • Patient Compliance
  • Middle Aged
  • Male
  • Humans
  • Female