Background Studies have investigated the relationship between sleep disturbance and postoperative delirium (PD) but have controversial results. A systematic review and meta-analysis have a high level of evidence to comprehensively evaluate the effect of sleep disturbance on PD. Our study aims to provide available evidence regarding the effect of sleep disturbance on PD. Methods PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies from database inception to April 28, 2021. The eligible studies were identified according to the “PICOS” principles. Odds ratio (OR) was used to indicate the effect index, and 95% confidence interval (CI) was applied to express the effect size. The heterogeneity was tested. Subgroup analyses, meta-regression, and sensitivity analysis were also applied. Begg’s test was used to test potential publication bias. The modified Newcastle-Ottawa Scale (NOS) was used to evaluate the literature quality. Results Totally, 18 articles including 2,714 patients were enrolled, with most of the included literature being of moderate to high quality. The results of systematic and meta-analysis suggested that sleep disturbance was associated with an increased risk of PD (OR: 3.731; 95% CI: 2.338 to 5.956). Subgroup analysis results demonstrated that sleep disturbance in patients aged <65 years (OR: 6.072; 95% CI: 3.054 to 12.071), aged ≥65 years (OR: 2.904; 95% CI: 1.487 to 5.671), and undergoing cardiac (OR: 3.390; 95% CI: 1.359 to 8.453), orthopedic (OR: 3.943; 95% CI: 2.219 to 7.008), or other surgeries (OR: 4.963; 95% CI: 2.156 to 11.420) increased the risk of PD (all P<0.005). Moreover, increased risk of PD was found for both preoperative (OR: 2.804; 95% CI: 1.517 to 5.184) and postoperative (OR: 6.302; 95% CI: 3.794 to 10.467) sleep disturbance (all P<0.005). No associations between obstructive sleep apnea (OSA; OR: 2.008; 95% CI: 0.753 to 5.354; P=0.164), insomnia (OR: 4.005; 95% CI: 0.636 to 25.203; P=0.139) and risk of PD were observed. Conclusions Our study indicated the relationship between sleep disturbance and the risk of PD. Patients undergoing surgical treatments should pay attention to their sleep quality. However, more research is needed to confirm its relationship.

Relationship of sleep disturbance and postoperative delirium: a systematic review and meta-analysis

Delirium and sleep disturbances-A narrative review.

Postoperative delirium (POD) is a common neurological complication associated with valve replacement. Preoperative sleep disturbance is a risk factor for POD development, and nasal insulin modulates the sleep-wake cycle. This study investigated the beneficial effects of intranasal insulin pretreatment on preoperative sleep quality and reducing POD in patients undergoing valve replacement for rheumatic heart disease. 

Effects of Intranasal Insulin Pretreatment on Preoperative Sleep Quality and Postoperative Delirium in Patients Undergoing Valve Replacement for Rheumatic Heart Disease

Ein postoperatives Delir ist gerade bei älteren Patienten eine häufige Komplikation chirurgischer Eingriffe 1 2 . Es erhöht Morbidität und Mortalität 1 2 3 . Strategien zum erfolgreichen Management des postoperativen Delirs sind nicht pharmakologische Multikomponentenmaßnahmen zur Risikoreduktion sowie Maßnahmen zur Früherkennung und Delir-Therapie. Dieser Beitrag soll Impulse für die praxisnahe Umsetzung des perioperativen nicht pharmakologischen Delir-Managements vermitteln.

Nicht pharmakologisches Management des postoperativen Delirs

STUDY OBJECTIVES
The COVID-19 Pandemic has highlighted disparities in healthcare. Parents assist in sickle cell disease management in children. Understanding sleep in parents of children who are diagnosed with sickle cell disease is an important facet of disease management. Our objectives were to identify sleep characteristics of parents of children with sickle cell disease aged 18 years or younger during the COVID-19 pandemic, to investigate measures used by parents to achieve restful sleep, and to discuss how sleep may be improved in parents of children diagnosed with sickle cell disease.


METHODS
This study conducted 14 face-to-face semi-structured interviews with parents of children diagnosed with sickle cell disease. A majority of the interviews (93%) was conducted at a hematology clinic. Qualitative thematic analysis was used to analyze data.


RESULTS
All parents reported that their child experienced pain because of sickle cell disease. Most parents (86.7%) reported that their child was diagnosed with HbSS. Four themes were identified: difficulty obtaining restful sleep during their child's sickle cell crisis, sleep during the COVID-19 pandemic, factors affecting sleep, and effects of sleep disturbance and deprivation on parental performance.


CONCLUSIONS
This research has highlighted some of the difficulties experienced by parents of children who are diagnosed with sickle cell disease and allows for additional insight into the sleep experiences of parents as they attempt to manage their child's disease.

Sleep experiences of parents of children 18 years or younger with sickle cell disease during the COVID-19 pandemic: a qualitative study.

Intraoperative ingestion of blood, cerebrospinal fluid, and irrigation fluid can lead to an increase in gastric volume, resulting in the potential risk of aspiration in patients after endoscopic endonasal transsphenoidal surgery (EETS). In this prospective observational study, we aimed to assess the volume of gastric contents in patients undergoing this neurosurgical procedure using ultrasound, and to determine the factors associated with volume change. Eighty-two patients diagnosed with pituitary adenoma were recruited consecutively. Semi-quantitative (Perlas scores: 0, 1 and 2) and quantitative (cross-sectional area, CSA) ultrasound assessments of the gastric antrum were performed immediately before and after surgery in the semi-recumbent and semi-recumbent right-lateral positions. Seven (8.5%) patients had antrum scores from preoperative grade 0 to postoperative grade 2; nine (11%) patients had antrum scores from preoperative grade 0 to postoperative grade 1. The mean ± standard deviation (SD) of increased gastric volume was 71.0 ± 33.1 mL and 236.5 ± 32.4 mL in postoperative grade 1 and 2 groups, respectively. Subgroup analysis showed that 11 (13.4%) patients (4 in grade 1 and all in grade 2) had postoperative estimated gastric volume > 1.5 mL kg-1 (mean ± SD 3.08 ± 1.67, range 1.51-5.01 mL kg-1). Logistic regression analysis revealed that older age, diabetes mellitus, and long surgical duration were independent risk factors for significant volume change (all P < 0.05). Our results showed a significant increase in gastric volume in some patients who underwent EETS. Bedside ultrasound measurements of gastric volume can be used to assess the postoperative aspiration risk, particularly in older diabetic patients with a longer surgical duration. 

/pdf/ultrasound-assessment-of-gastric-contents-and-volume-in-2gai8grb.pdf

Ultrasound assessment of gastric contents and volume in patients undergoing endoscopic endonasal transsphenoidal surgery: a prospective observational study

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Relationship of sleep disturbance and postoperative delirium: a systematic review and meta-analysis

Ultrasound assessment of gastric contents and volume in patients undergoing endoscopic endonasal transsphenoidal surgery: a prospective observational study