A Single-Center, Prospective, Pilot Cohort Study of Preoperative Abnormal Sleep Patterns and Postoperative Delirium in Older Hispanic/Latino Patients Undergoing Cardiac Surgery.

Abstract

Abstract Background Delirium occurs in 20–50% of older patients after cardiac surgery and is associated with prolonged intensive care and hospital length of stay, postoperative cognitive decline, and dementia. Preoperative abnormal sleep patterns are potentially modifiable risk factors that have been associated with an increased incidence of postoperative delirium. Hispanic/Latinos may be a particularly vulnerable population given their higher prevalence of risk factors for delirium including cognitive impairment, lower level of education, and sleep disturbances, as compared to non-Hispanic White adults. A largescale cohort study is needed to determine if altered sleep patterns increase the risk of delirium in older, Hispanic/Latino patients after cardiac surgery. The primary aims of this pilot study were to determine the feasibility of recruitment, retention, preoperative sleep actigraphy measurements, preoperative sleep questionnaire and cognitive batteries, and postoperative delirium testing. Methods We conducted a single-center, prospective, pilot cohort study of older Hispanic/Latino patients undergoing cardiac surgery with and without preoperative sleep disturbances and postoperative delirium from February 2020 to December 2021 at UHealth of the University of Miami, an academic tertiary center in Miami, FL. Patients underwent preoperative cognitive and sleep questionnaire testing and wore an actigraphy wristwatch with a sleep diary for 5 to 7 days prior to surgery. Postoperatively patients were tested for delirium for up to 7 days or hospital discharge. Feasibility of the study protocol was the primary objective of this pilot study. Results 155 patients were screened, 40 met full inclusion criteria, and 14 patients were recruited. The mean age was 67.2 years old. Spanish was the preferred language in 21.4% of patients. Poor sleep quality was present in 78.5% of subjects. 57.1% of subjects experienced either delirium or subsyndromal delirium. Despite being conducted during the height of the COVID-19 pandemic, our pilot trial met our a priori thresholds for specific feasibility criteria. Conclusions The protocol was feasible and a future, definitive prospective cohort study of older Hispanic/Latino patients undergoing cardiac surgery with and without preoperative altered sleep patterns and an outcome of postoperative delirium will be planned. Trial registration: The study was registered at ClinicalTrials.gov on March 8, 2021 (NCT04786899)