The purpose of this prospective observational study is to investigate the changes in sleep architecture after a hip surgery and its potential association with postoperative delirium and postoperative cognitive dysfunctions respectively.
Sleep research has confirmed the association of sleep (REM sleep and slow-wave sleep) with memory and cognitive function in general. There are changes in the quantity of REM sleep after certain forms of anesthesia, especially with barbiturate, as shown in mouse model. This study is designed to be the first explorative clinical studyl to measure changes in sleep architecture in surgical patients undergoing different types of anesthesia (general anesthesia and spinal anesthesia) and its potential associations with the development of postoperative delirium and postoperative cognitive dysfunction. Additionally, parameters will be collected, that from recent research are suspected to be reliable markers for systemic inflammation that might account for delirium and cognitive dysfunction after surgical interventions. Patients were stratified into two groups: age (≤ 65 years; \> 65 years) and benzodiazepine premedication (yes/no).
Study Type
OBSERVATIONAL
Department of Anesthesiology and Intensive Care Medicine Berlin
Berlin, Germany
Changes in prevalence of rapid eye movement sleep
Changes in prevalence of rapid eye movement (REM) sleep in the preoperative night compared to the night following the first postoperative day, including potentially compensatory sleep during daytime after surgery. Sleep architecture will be measured with the Somnoscreen device for mobile polysomnography for a total time duration of 36 h (beginning in the preoperative evening, to be finished the morning of the second postoperative day).
Time frame: Up to 36 hours
Insomnia Severity Index
The ISI will be assessed by self-assessment questionnaire
Time frame: Up to 90 days after the operation
Malnutrition
Malnutrition Screening Tools
Time frame: Up to 90 days after the operation
Epsworth Sleepiness Scale
The ESS will be assessed by self-assessment questionnaire
Time frame: Up to 90 days after the operation
Postoperative Cognitive Dysfunction
Postoperative Cognitive Dysfunction will be measured at hospital discharge and at the 90th postoperative day.
Time frame: Up to 90 days after the operation
Depth of anesthesia
Depth of anesthesia will be measured by processive Electroencephalography and Electromyography (EEG/EMG) -Data (SedLine®)
Time frame: At time of surgery
Opioid requirements
Postoperative pain will be measured by Numeric Rating Scale - Visualized (NRS-V), the Faces Pain Scale - Revised (FPS-R), the Behavioral Pain Scale (BPS) or the Behavioral Pain Scale for Non-Intubated (BPS-NI)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
Length of hospital stay
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
Pain
Postoperative pain will be measured by Numeric Rating Scale - Visualized (NRS-V), the Faces Pain Scale - Revised (FPS-R), the Behavioral Pain Scale (BPS) or the Behavioral Pain Scale for Non-Intubated (BPS-NI)
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
N-Methyl-D-aspartate (NMDA)-receptor autologous antibodies
Identification of NMDA-receptor autologous antibodies in blood serum and cerebrospinal fluid; the requested blood samples will be collected on the operation day, on the last day of hospitalisation and after 90 days. The requested liquor samples will be collected on the operation day (only in patients with spinal anesthesia).
Time frame: Up to 90 days after the operation
Inflammation parameters
Assessment of inflammation parameters by means of extended differential blood count (Sysmex) ; the requested blood samples will be collected on the preoperative day, on the day of the intervention, on the following day and on the last day of the hospitalisation
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
Hemodynamic parameters
Hemodynamic variables are assessed by the anesthesia monitor and esophageal Doppler Monitor
Time frame: At time of surgery
Changes in prevalence of rapid eye movement sleep
REM-Sleep at operation day/night in comparison to preoperative night. Sleep architecture will be measured with the Somnoscreen device for mobile polysomnography for a total time duration of 24 h.
Time frame: Up to 24 hours
Changes in prevalence of slow-wave sleep (Stadium 3 of non rapid eye movement-sleep)
Slow wave sleep at operation day/night in comparison to preoperative night. Sleep architecture will be measured with the Somnoscreen device for mobile polysomnography for a total time duration of 24 h.
Time frame: Up to 24 hours
Changes in prevalence of slow-wave sleep (Stadium 3 of non rapid eye movement-sleep)
Changes in prevalence of slow-wave sleep in the preoperative night compared to the night following the first postoperative day, including potentially compensatory sleep during daytime after surgery. Sleep architecture will be measured with the Somnoscreen device for mobile polysomnography for a total time duration of 36 h (beginning in the preoperative evening, to be finished the morning of the second postoperative day).
Time frame: Up to 36 hours
Postoperative complications
Including Severity of Delirium
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
Transfusion requirements
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
Catecholamine administration intra- und postoperative
Time frame: Participants will be followed up for hospital stay an expected average of 7 days
Severity of postoperative Delirium
Delirium screening will be conducted preoperatively, one hour postoperative, the evening of operation day, and the following morning with the scoring devices of confusion assessment method (CAM), by confusion assessment method in the intensive care unit (CAM-ICU) or by Nursing Delirium Screening Scale (Nu-DESC)
Time frame: Up to 36 hours