Impact of Preoperative Sleep Disturbances on Postoperative Delirium in Patients with Intracranial Tumors: A Prospective, Observational, Cohort Study

Figures & data

Figure 1 Working principle of sleep device.

Table 1 Univariate Analysis According to Sleep Disturbances

	All patients (n=130)	Sleep Disturbances (n=63)	No Sleep Disturbances (n=67)	Statistics	P value
Age, yr, n (%)				9.430	0.002*
45–60	89 (68.5)	35 (55.6)	54 (80.6)
>60	41 (31.5)	28 (44.4)	13 (19.4)
Gender, M/F	62/68	30/33	32/35	0.000	0.987*
Body mass index, kg/m^2	23.9 (22.3, 26.0)	23.4 (21.2, 25.6)	24.5 (22.6, 26.3)	−1.652	0.099^‡
Years of education, years	9.0 (6.0, 12.0)	9.0 (6.0, 12.0)	9.0 (6.0, 12.0)	−0.300	0.764^‡
Alcohol consumption, n (%)	19 (14.6)	12 (19.0)	7 (10.4)	1.924	0.165*
Smoking, n (%)	28 (21.5)	16 (25.4)	12 (17.9)	1.077	0.299*
Hypertension, n (%)	36 (27.7)	17 (27.0)	19 (28.4)	0.031	0.861*
Diabetes, n (%)	9 (6.9)	4 (6.3)	6 (7.5)	0.000	1.000*
PSQI score	5.0 (3.0, 9.0)	9.0 (7.0, 12.0)	3.0 (2.0, 4.0)	−9.888	0.000^‡
Tumor classification, n (%)				1.112	0.774*
Meningioma	47 (36.2)	25 (39.7)	22 (32.8)
Glioma	47 (36.2)	20 (31.7)	27 (40.3)
Acoustic neuroma	16 (12.3)	8 (12.7)	8 (11.9)
Other	20 (15.4)	10 (15.9)	10 (14.9)
Tumor location, n (%)				0.647	0.421*
Supratentorial	91 (70.0)	42 (66.7)	49 (73.1)
Infratentorial	39 (30.0)	21 (33.3)	18 (26.9)
Malignant, n (%)	64 (49.2)	26 (41.3)	38 (56.7)	3.100	0.078*
Tumor size, cm^3	36.0 (16.9, 80.2)	36.0 (16.3, 90.0)	36.0 (17.1, 77.1)	−0.165	0.869^‡
Postoperative delirium, n (%)	28 (21.5)	20 (31.7)	8 (11.9)	7.537	0.006*
Time of onset of POD, day	3.0 (2.0, 4.0)	3.0 (2.3, 4.8)	3.0 (2.0, 3.8)	−0.686	0.493^‡
Duration of POD, days	2.0 (2.0, 3.0)	2.0 (2.0, 3.0)	2.0 (2.0, 2.8)	−0.489	0.625^‡

Notes: Data are presented as n (%), mean ± standard deviation, or median (Interquartile range). These analyses were performed using *Chi‑square test, and ^‡Mann–Whitney U-test.

Abbreviation: POD, Postoperative Delirium.

Figure 2 Flow chart of included population.

Table 2 Baseline Characteristics Associated with Postoperative Delirium

	All patients (n=130)	No postoperative delirium (n=102)	Postoperative delirium (n=28)	Statistics	P value
Age, yr, n (%)				10.835	0.001*
45–60	89 (68.5)	77 (75.5)	12 (42.9)
>60	41 (31.5)	25 (24.5)	16 (57.1)
Gender, M/F	62/68	48/54	14/14	0.076	0.783*
Body mass index, kg/m^2	23.9 (22.3, 26.0)	24.1 (22.5, 26.1)	23.3 (21.2, 25.3)	−1.005	0.315^‡
Years of education, years	9.0 (6.0, 12.0)	9.0 (6.8, 12.0)	8.5 (6.0, 12.0)	−1.255	0.209^‡
Alcohol consumption, n (%)	19 (14.6)	17 (16.7)	2 (7.1)	0.925	0.336*
Smoking, n (%)	28 (21.5)	25 (24.5)	3 (10.7)	2.474	0.116*
Hypertension, n (%)	36 (27.7)	32 (31.4)	4 (14.3)	3.203	0.073*
Diabetes, n (%)	9 (6.9)	7 (6.0)	2 (7.1)	0.000	1.000*
Sleep disturbances, n (%)	63 (48.5)	43 (42.2)	20 (71.4)	7.537	0.006*
Tumor classification, n (%)				2.521	0.509*
Meningioma	47 (36.2)	37 (36.3)	10 (35.7)
Glioma	47 (36.2)	34 (33.3)	13 (46.4)
Acoustic neuroma	16 (12.3)	13 (12.7)	3 (10.7)
Other	20 (15.4)	18 (17.6)	2 (7.1)
Tumor location, n (%)				2.506	0.113*
Supratentorial	91 (70.0)	68 (66.7)	23 (82.1)
Infratentorial	39 (30.0)	34 (33.3)	5 (17.9)
Malignant, n (%)	64 (49.2)	49 (48.0)	15 (53.6)	0.269	0.604*
Tumor size, cm^3	36.0 (16.9, 80.2)	34.0 (14.5, 77.0)	69.0 (30.0, 119.7)	−1.883	0.060^‡
PSQI score	5.0 (3.0, 9.0)	4.0 (3.0, 8.3)	7.5 (4.3, 12.0)	−2.660	0.008^‡
MMSE score	27.0 (25.0, 30.0)	27.0 (25.8, 30.0)	27.0 (25.0, 28.8)	−1.252	0.211^‡
HADS-Anxiety score	2.0 (0, 4.0)	2.0 (0, 4.0)	3.0 (0, 8.0)	−1.695	0.090^‡
HADS-Depression score	2.0 (0, 4.0)	2.0 (0, 4.0)	2.5 (0, 7.5)	−1.329	0.184^‡
Hemoglobin, g/L	135.1±14.01	134.9±14.33	136.0±13.00	−0.383	0.703^†
Albumin, g/L	39.3 (37.8, 40.8)	39.2 (37.8, 40.5)	40.4 (37.5, 42.2)	−1.575	0.115^‡
Glucose, mmol/L	5.2 (4.8, 5.8)	5.8 (5.2, 6.7)	5.6 (5.4, 5.9)	−0.464	0.642^‡
Neutrophil-to-lymphocyte ratio	2.2 (1.6, 3.1)	2.1 (1.6, 2.9)	3.0 (1.7, 3.6)	−2.240	0.025^‡
Monocyte-to-lymphocyte ratio	0.2 (0.2, 0.3)	0.2 (0.2, 0.3)	0.2 (0.2, 0.3)	−0.289	0.772^‡

Notes: Data are presented as n (%), mean ± standard deviation, or median (Interquartile range). These analyses were performed using *Chi‑square test, ^†independent Student’s t‑test, and ^‡Mann–Whitney U-test.

Abbreviations: MMSE, Mini‑Mental State Examination; HADS, Hospital Anxiety and Depression Scale.

Table 3 Surgical Characteristics Associated with Postoperative Delirium

	All Patients (n=130)	No Postoperative Delirium (n=102)	Postoperative Delirium (n=28)	Statistics	P value
Intraoperative characteristics
Midazolam administration, n (%)	113 (86.9)	88 (86.3)	25 (89.3)	0.010	0.919*
Propofol administration, n (%)	120 (92.3)	94 (92.2)	26 (92.9)	0.000	1.000*
Blood loss during surgery, mL	300.0 (200.0, 462.5)	300.0 (200.0, 400.0)	400.0 (200.0, 500.0)	−1.016	0.310^‡
Urine volume, mL	1600.0 (1100.0, 2300.0)	1600.0 (1100.0, 2425.0)	2275.0 (1500.0, 2550.0)	−0.318	0.750^‡
Crystalloid solution volume, mL	2700.0 (2200.0, 3425.0)	2700.0 (2200.0, 3625.0)	2700.0 (2075.0, 3200.0)	−0.790	0.429^‡
Colloidal solution volume, mL	1000.0 (1000.0, 1000.0)	1000.0 (1000.0, 1000.0)	1000.0 (1000.0, 1000.0)	−0.525	0.599^‡
Mannitol infusion volume, mL	250.0 (100.0, 250.0)	250.0 (100.0, 250.0)	250.0 (250.0, 250.0)	−0.819	0.413^‡
Autologous blood volume, mL	0 (0, 125.0)	0 (0, 125.0)	0 (0, 125.0)	−0.085	0.933^‡
Duration of surgery, mins	281.5 (225.0, 350.0)	280.0 (221.5, 347.0)	305.0 (243.5, 362.5)	−1.119	0.263^‡
Postoperative characteristics
Postoperative opioid analgesics, n (%)				2.903	0.408*
None	28 (21.5)	21 (20.6)	7 (25.0)
Dezocine	61 (46.9)	51 (50.0)	10 (35.7)
Sufentanil	11 (8.5)	7 (6.9)	4 (14.3)
Sufentanil and Dezocine	30 (23.1)	23 (22.5)	7 (25.0)
NRS score	0.5 (0, 4.0)	0 (0, 4.0)	2.5 (0, 4.0)	−0.510	0.610^‡
Postoperative intubation time, hours	3.0 (2.0, 4.0)	3.0 (2.0, 4.0)	4.0 (3.0, 5.0)	−1.969	0.049^‡
Length of stay in the ICU, hours	7.0 (5.5, 13.5)	6.5 (5.0, 12.5)	11.5 (6.6, 15.5)	−2.560	0.010^‡
Duration of urinary catheterization, days	2.0 (2.0, 3.0)	2.0 (2.0, 3.0)	3.0 (2.0, 5.0)	−3.367	0.001^‡
Duration of drainage tube retention, days	2.0 (0, 4.0)	2.0 (0, 4.0)	3.0 (0, 5.0)	−0.794	0.427^‡

Notes: Data are presented as n (%) or median (Interquartile range). These analyses were performed using *Chi‑square test and ^‡Mann–Whitney U-test.

Abbreviations: NRS, Numerical Rating Scale; ICU, Intensive Care Unit.

Table 4 Variables Associated with Postoperative Delirium on Multivariable Analysis

	Regression Coefficient	S.E.	Wald	P	OR	95% CI for OR
Sleep disturbances	0.997	0.498	4.002	0.045	2.709	1.020–7.192
Age (> 60)	1.111	0.476	5.452	0.020	3.038	1.195–7.719
Duration of urinary catheterization	0.220	0.099	4.891	0.027	1.246	1.025–1.513

Notes: These analyses were performed using multivariate logistic regression analysis.

Abbreviations: S.E, Standard error; OR, Odds ratio; CI, Confidence interval.

Figure 3 Different parameters of perioperative sleep patterns in patients with and without POD ((A): Sleep latency; (B) Deep sleep duration; (C) Frequency of awakenings; (D) Apnea-hypopnea index; (E) Sleep efficiency).

Notes: These analyses were performed using analysis of generalized estimating equations (*P <0.05). Patients with POD: n=22; Patients without POD: n=65. Estimated mean and 95% CI are plotted for each group for each day.

Abbreviation: POD, Postoperative delirium.

Table 5 Clinical Outcomes Associated with Postoperative Delirium

	No Postoperative Delirium	Postoperative Delirium	Statistics	P value
DVT, n (%)	13 (12.7)	6 (21.4)	0.723	0.395*
Nausea and vomiting, n (%)	51 (50.0)	14 (50.0)	0.000	1.000*
Pneumonia, n (%)	13 (12.7)	5 (17.9)	0.148	0.700*
LOS, days	16.0 (14.0, 20.0)	17.0 (16.0, 21.8)	−1.843	0.065^‡
Postoperative LOS, days	11.0 (9.0, 14.0)	12.5 (10.3, 14.8)	−1.913	0.056^‡
Hospitalization costs, RMB	96,987.0 (89,874.0, 106,597.0)	103,261.0 (97,105.0, 118,064.0)	−2.696	0.007^‡
Barthel index	90.0 (83.8, 100.0)	80.0 (70.0, 90.0)	−3.857	<0.001^‡
EORTC QLQ-C30^§
Global health status	75.0 (66.7, 83.3)	75.0 (66.7, 83.3)	−1.157	0.247^‡
Physical functioning	60.0 (53.3, 73.3)	60.0 (46.7, 80.0)	−0.882	0.378^‡
Role functioning	66.7 (50.0, 83.3)	66.7 (50.0, 83.3)	−1.287	0.198^‡
Emotional functioning	75.0 (58.3, 83.3)	75.0 (58.3, 83.3)	−0.169	0.866^‡
Cognitive functioning	66.7 (33.3, 83.3)	50.0 (33.3, 66.7)	−0.835	0.403^‡
Social functioning	66.7 (50.0, 83.3)	66.7 (50.0, 83.3)	−0.320	0.749^‡
Fatigue	33.3 (33.3, 55.6)	44.4 (33.3, 44.4)	−0.668	0.504^‡
Nausea and vomiting	8.3 (0, 33.3)	16.7 (0, 33.3)	−1.094	0.274^‡
Pain	0 (0, 33.3)	0 (0, 16.7)	−0.420	0.675^‡
Dyspnoea	0 (0, 33.3)	0 (0, 0)	−1.029	0.303^‡
Insomnia	33.3 (0, 41.7)	0 (0, 33.3)	−0.455	0.649^‡
Appetite loss	0 (0, 33.3)	0 (0, 33.3)	−0.060	0.952^‡
Constipation	33.3 (0, 66.7)	33.3 (0, 66.7)	−0.559	0.576^‡
Diarrhea	0 (0, 33.3)	0 (0, 33.3)	−0.222	0.825^‡
Financial difficulties	33.3 (0, 66.7)	33.3 (0, 33.3)	−0.390	0.697^‡

Notes: Data are presented as n (%) or median (Interquartile range). These analyses were performed using *Chi‑square test and ^‡Mann–Whitney U-test. ^§113 patients completed follow-up, including 23 patients with POD and 90 patients without POD.

Abbreviations: DVT, Deep vein thrombosis; LOS, Length of stay; EORTC QLQ-C30, The European Organization for Research and Treatment of Cancer, quality of life questionnaire-core 30.

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author (Baoguo Wang) upon request.