ArticleThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry2026
Presurgical Sleep-Wake Disturbance and Postoperative Delirium: A Prospective Cohort Study.
Article in The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesPrior studies on the relationship between presurgical sleep-wake disturbance and postoperative delirium have been restricted to subjective or indirect sleep measures. This study evaluated whether objective measures of presurgical sleep-wake disturbance are associated with postoperative delirium.
designProspective study.
settingSingle site, tertiary care medical center.
participantsAdults aged 40 years or older having surgical aortic valve replacement. MEASUREMENTS: Before surgery, we assessed sleep using self-report, ambulatory polysomnography, and actigraphy. Other measures include sociodemographics, medical-surgical characteristics, and neuropsychological battery. After surgery, we assessed delirium and delirium severity.
resultsThe 100 participants had a mean age of 66.9 years (64% male). Twenty-seven subjects developed delirium. After adjusting for age, sex, comorbidity, and surgery duration, we found that each 10% decrease in presurgical sleep efficiency was associated with more than double the odds of delirium (OR 2.16, 95% CI [1.10, 3.71]), as was each 10% decrease in presurgical relative amplitude of rest-activity rhythms (2.59 [1.34, 5.23]). Lower sleep efficiency and relative amplitude were also associated with greater delirium severity (standardized |β| = 0.39 and 0.42, respectively). Apnea-hypopnea index ≥15 events/h was associated with higher odds of delirium (OR 3.4 [1.01, 11.7]) but not delirium severity. Mild cognitive impairment and lower global cognitive function were also associated with higher odds of delirium and greater delirium severity.
conclusionsLower presurgical sleep efficiency, apnea-hypopnea index ≥15 events/h, and weaker rest-activity rhythms were associated with a higher odd of postoperative delirium suggesting a potential role for targeting these sleep-wake disturbances to mitigate delirium.
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