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

Figures & data

Table 1 Patient Demographics and Clinical Data

Characteristics	NS group (n=35)	INS group (n=36)	P-value
Age (years)	55 (10)	53 (12)	0.791^$
Sex (male)	14 (40%)	12 (33.3%)	0.560^#
Body mass index (kg/m²)	22.34 ± 2.91	23.25 ± 2.51	0.164^&
MMSE score	26.71 ± 2.78	26.89 ± 1.95	0.723^&
ASA classification			0.350^#
II	9 (25.7%)	6 (16.7%)
III	26 (74.3%)	30 (83.3%)
NYHA grade			0.386^#
II	9 (25.7%)	8 (22.2%)
III	14 (40%)	20 (55.6%)
IV	12 (34.3%)	8 (22.2%)
Operation time (min)	254.46 ± 47.68	256.61 ± 42.15	0.841^&
Bypass duration (min)	114.57 ± 32.26	109.64 ± 31.20	0.515^&
Intraoperative blood transfusion volume (mL)	700 (200)	700 (275)	0.977^$
Total amount of crystalloids provided during surgery (mL)	350 (100)	400 (200)	0.062^$
Intraoperative blood loss (mL)	600 (300)	600 (275)	0.884^$
Urine output (mL)	801.43 ± 274.80	812.50 ± 215.93	0.851^&
NRS score
T3	4 (1)	3.5 (1)	0.490^$
T4	3 (2)	3 (1)	0.990^$
T5	2 (2)	2 (1)	0.701^$

Notes: Data are presented as mean ± SD, median (interquartile range), or percentage (proportion). ^$Mann–Whitney U-test; ^&Independent t-test; ^#Pearson chi-square test.

Abbreviations: T3, postoperative day 1; T4, postoperative day 2; T5, postoperative day 3; MMSE, Mini-Mental State Examination; ASA, American Society of Anesthesiologists; NYHA, New York Heart Association; NRS, numerical rating scale.

Figure 1 Study flow diagram.

Table 2 Incidence of POD and CAM-CR Scores During the First Three Postoperative Day

Variable	Postoperative Days	NS group (n=35)	INS group (n=36)	cOR (95% CI)	P-value
POD	1AM	17 (48.6%)	8 (22.2%)	3.31 (1.18–9.24)	0.020^a#
	1 PM	16 (45.7%)	6 (16.7%)	4.21 (1.40–12.65)	0.008^a#
	2 AM	14 (40%)	5 (13.9%)	4.13 (1.29–13.21)	0.013^a#
	2 PM	10 (28.6%)	3 (8.3%)	4.40 (1.10–17.68)	0.027^a#
	3 AM	4 (11.4%)	1 (2.8%)	4.52 (1.18–42.59)	0.199*
	3 PM	2 (5.7%)	0 (0%)	-	0.239*
	Within 3 days of surgery	18 (51.4%)	8 (22.2%)	3.71 (1.33–10.36)	0.011^a#
CAM-CR	1 AM	17 (12)	15 (3)		0.000^a$
	1 PM	17 (13)	15 (3)		0.000^a$
	2 AM	16 (11)	14 (2)		0.000^a$
	2 PM	15 (10)	14 (2)		0.000^a$
	3 AM	14 (2)	14 (1)		0.178^$
	3 PM	14 (1)	14 (1)		0.344^$

Notes: Data are presented as percentage (proportion) or median (interquartile range). ^aP < 0.05 for comparison between two groups. ^$Mann–Whitney U-test; ^#Pearson chi-square test; *Fisher’s exact test.

Abbreviations: CAM-CR, Delirium Scale Analysis System; POD, postoperative delirium.

Table 3 PSQI Scores and Sleep Monitoring-Related Indicators Before Surgery

Variable	Time Point	NS group (n=35)	INS group (n=36)	P-value
PSQI	T0	8 (3)	8 (2)	0.739
	T1	10 (9)	6 (2)	0.000^a
	T2	9 (9)	6 (1)	0.000^a
Deep sleep ratio (%)	T1	36 (10)	39 (2)	0.000^a
	T2	36 (9)	39 (1)	0.000^a
Light sleep ratio (%)	T1	44 (16)	37 (4)	0.000^a
	T2	43 (16)	37 (3)	0.000^a
REM sleep ratio (%)	T1	20 (6)	24 (2)	0.000^a
	T2	21 (6)	24 (1)	0.000^a
Number of awakenings	T1	2 (1)	0 (1)	0.000^a
	T2	1 (1)	0 (1)	0.000^a
Deep sleep continuity score	T1	75 (19)	81 (4)	0.001^a
	T2	75 (20)	81 (3)	0.001^a
Total sleep quality score	T1	83 (21)	85.5 (7)	0.005^a
	T2	77 (18)	86 (5)	0.000^a

Notes: Data are presented as median (interquartile range). Comparisons between two groups were performed using the Mann–Whitney U-test. ^aP < 0.05 for comparison between two groups.

Abbreviations: PSQI, Pittsburgh Sleep Quality Index; NS, normal saline; INS, insulin; REM, random eye movement; T0, before the first intervention; T1, one day before surgery; T2, before anesthesia on the day of the surgery.

Table 4 Serum Cortisol Concentrations at Different Time Points (Mmol/L)

Time Point	NS group (n=35)	INS group (n=36)	F(group)/ P-value	F(time)/ P-value	F(group*time)/ P-value
T0	192.61 ± 12.80	195.35 ± 12.98	F=26.032 P<0.001	F=11.803 P<0.001	F=115.927 P<0.001
T1	212.00 ± 16.50 ^a	185.99 ± 13.92 ^ab
T2	210.50 ± 17.57 ^a	183.19 ± 15.28 ^ab

Notes: Data are expressed as mean ± SD. Comparisons between two groups were performed using the Dunnett-t test. Repeated measurements were compared using repeated measure ANOVA. ^aP <0.05 vs T0; ^bP <0.05 vs the NS group; * multiplication symbol.

Abbreviations: NS, normal saline; INS, insulin; T0, before the first intervention; T1, one day before surgery; T2, before anesthesia on the day of the surgery.

Table 5 Average Blood Glucose Values at Different Time Points (Mmol/L)

Time Point	NS group (n=35)	INS group (n=36)	P-value
T1	5.38+0.30	5.37+0.36	0.922
T2	5.27+0.42	5.35+0.14	0.355

Notes: are expressed as mean ± SD. Comparisons between two groups were performed using the independent t-test.

Abbreviations: NS, normal saline; INS, insulin; T1, one day before surgery; T2, before anesthesia on the day of the surgery.

Data Sharing Statement

The raw data for this study have been uploaded to www.medresman.org.cn and are also available from the corresponding author on reasonable request.