. METHODS: In this single-center prospective cohort study, older noncardiac surgery patients aged 60 years and above underwent preoperative home sleep apnea testing, and pre- and postoperative delirium assessments and cognitive testing. Sleep apnea severity was determined using the measured respiratory event index (REI). Global cognitive change from before to 6 weeks (and 1 year) after surgery was used to measure postoperative neurocognitive disorder severity. Postoperative changes in individual cognitive domain performance along with subjective cognitive complaints and/or deficits in instrumental activities of daily living were used to measure postoperative neurocognitive disorder incidence. RESULTS: Of 96 subjects who completed home sleep apnea testing, 58 tested positive for sleep apnea. In univariable analyses, sleep apnea severity was not associated with increased postoperative neurocognitive disorder severity at 6 weeks (global cognitive change ; [95% confidence interval [CI], −0.02 to 0.03]; P = .79) or 1-year after surgery (; [95% CI, −0.02 to 0.03]; P = .70). Adjusting for age, sex, baseline cognition, and surgery duration, sleep apnea severity remained not associated with increased postoperative neurocognitive disorder severity at 6 weeks (; [95% CI, −0.02 to 0.04]; P = .40) or 1-year after surgery (; [95% CI, −0.02 to 0.04]; P = .55). In a multivariable analysis, sleep apnea severity was not associated with postoperative neurocognitive disorder (either mild or major) incidence at 6 weeks (odds ratio [OR] = 0.89, [95% CI, 0.59–1.14]; P = .45) or 1-year postoperatively (OR = 1.01, [95% CI, 0.81–1.24]; P = .90). Sleep apnea severity was also not associated with postoperative delirium in univariable analyses (delirium incidence OR = 0.88, [95% CI, 0.59–1.10]; P = .37; delirium severity ; [95% CI, −0.02 to 0.03]; P = .79) or in multivariable analyses (delirium incidence OR = 1.07, [95% CI, 0.81–1.38]; P = .74; delirium severity OR = 0.95, [95% CI, 0.81–1.10]; P = .48). CONCLUSIONS: In this older noncardiac surgery cohort, untreated sleep apnea was not associated with increased incidence or severity of postoperative neurocognitive disorder or delirium....

中文翻译：

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睡眠呼吸暂停在老年非心脏手术患者术后神经认知障碍中的作用：一项前瞻性队列研究


.方法： 在这项单中心前瞻性队列研究中，60 岁及以上的老年非心脏手术患者接受了术前家庭睡眠呼吸暂停测试，以及术前和术后谵妄评估和认知测试。使用测量的呼吸事件指数 （REI） 确定睡眠呼吸暂停的严重程度。从手术前到手术后 6 周 （和 1 年） 的整体认知变化用于测量术后神经认知障碍的严重程度。个体认知领域表现的术后变化以及主观认知抱怨和/或日常生活工具性活动的缺陷用于测量术后神经认知障碍的发生率。结果： 在完成家庭睡眠呼吸暂停测试的 96 名受试者中，58 名睡眠呼吸暂停检测呈阳性。在单变量分析中，睡眠呼吸暂停的严重程度与 6 周时术后神经认知障碍严重程度的增加无关 （整体认知变化;[95% 置信区间 [CI]，-0.02 至 0.03];P = .79） 或手术后 1 年 （;[95% CI，-0.02 至 0.03];P = .70）。调整年龄、性别、基线认知和手术持续时间，睡眠呼吸暂停的严重程度与 6 周时术后神经认知障碍严重程度的增加无关 （;[95% CI，-0.02 至 0.04];P = .40） 或手术后 1 年 （;[95% CI，-0.02 至 0.04];P = .55）。在多变量分析中，睡眠呼吸暂停的严重程度与 6 周时术后神经认知障碍（轻度或重度）发生率无关（比值比 [OR] = 0.89，[95% CI，0.59-1.14];P = .45）或术后 1 年 （OR = 1.01，[95% CI，0.81-1.24];P = .90）。在单变量分析中，睡眠呼吸暂停的严重程度也与术后谵妄无关（谵妄发生率 OR = 0.88，[95% CI，0.59-1。10];P = .37;谵妄严重程度 ;[95% CI，-0.02 至 0.03];P = .79） 或多变量分析 （谵妄发生率 OR = 1.07， [95% CI， 0.81–1.38];P = .74;谵妄严重程度 OR = 0.95，[95% CI，0.81–1.10];P = .48）。结论： 在这个年龄较大的非心脏手术队列中，未经治疗的睡眠呼吸暂停与术后神经认知障碍或谵妄的发生率或严重程度增加无关。