Effect of CPAP on Postoperative Delirium

Duke University135 enrolled

Overview

Patients with a medical condition known as obstructive sleep apnea may be at increased risk of delirium following surgery. This study loans autotitrating CPAP machines to randomly-selected patients who are at high-risk for obstructive sleep apnea with the goal of preventing post-operative delirium.

Patients undergoing elective knee and hip replacements will be prospectively enrolled. These surgical procedures all have an expected length of stay \> 3 days. Immediately following enrollment, patients will be randomized to receive CPAP or routine peri-operative care. Patients in the CPAP group will be instructed to wear an autotitrating positive airway pressure (APAP) device any time they sleep prior to surgery and on postoperative days 0, 1, and 2.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

135

Conditions

Sleep Apnea, Obstructive Delirium

Interventions

CPAPDEVICE

Eligibility

Sex: ALLMin age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 50 and above * Scheduled for an elective knee or hip replacement * Ability to speak English and give informed consent * At risk for obstructive sleep apnea as defined by a STOP-BANG score \> 2 Exclusion Criteria: * History of psychiatric or neurologic illness that would confound delirium assessment * Severe tracheal or lung disease * Contraindications to face-mask CPAP * Treated OSA

Locations (1)

Duke University

Durham, North Carolina, United States

Outcomes

Primary Outcomes

Presence of Postoperative Delirium

Assessments for delirium were made on postoperative day 2 using the Delirium Rating Scale-Revised-98 (DRS-R-98) diagnostic and assessment tool. The DRS-R-98 is a 16-item clinician-rated scale that consists of a severity score (maximum score 39, minimum 0) made up of items that can be used for repeated serial measurements and a total scale score (maximum score 46, minimum 0) that includes the severity score plus three diagnostic items (7 additional possible points) used for initial ratings. Items represent symptoms that are rated on a scale of 0 to 3 points, with text descriptions for each point. Higher scores on the scale represents a larger number of delirium symptoms or increased severity of those symptoms.

Time frame: Postoperative day 2

Presence of Postoperative Delirium

Assessments for delirium were made on postoperative day 2 using the Confusion Assessment Method (CAM) Diagnostic Algorithm. This binary tool identifies the presence or absence of delirium

Time frame: Postoperative day 2

Data from ClinicalTrials.gov

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