title: Sleep Disruption at Home As an Independent Risk Factor for Postoperative Delirium.
abstract: OBJECTIVE
  To determine whether sleep disruption at home or in hospital is an independent risk factor for postoperative delirium in older adults undergoing elective surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  German teaching hospital.
  
  
  METHODS
  Individuals aged 65 and older undergoing elective arthroplasty (N = 101).
  
  
  METHODS
  Preoperative questionnaires were used to assess sleep disruption at home (Pittsburgh Sleep Quality Index). Actigraphy was used to objectively measure sleep disruption in the hospital before and after surgery. Delirium was assessed daily after surgery using the Confusion Assessment Method and, if there was uncertainty, validated according to International Classification of Diseases, Tenth Revision (ICD-10), criteria.
  
  
  RESULTS
  Twenty-seven participants developed postoperative delirium. Those with sleep disruption at home were 3.26 times as likely to develop postoperative delirium as those without (95% confidence interval (CI) = 1.34-7.92, P = .009). Participants with sleep disruption in hospital were 1.21 times as likely to develop postoperative delirium as those without (95% CI = 1.03-1.41, P = .02). When adjusting for other variables, risk remained significant for sleep disruption at home (risk ratio (RR) = 3.90, 95% CI = 2.14-7.11, P < .001) but not in the hospital (RR = 1.19, 95% CI = 0.69-2.07). Jointly modeling sleep disruption at home and in the hospital, adjusted for covariates, resulted in significant contributions of both (home: RR = 3.10, 95% CI = 1.34-7.17, P = .008; hospital: RR = 1.38 95% CI = 1.13-1.68, P = .002).
  
  
  CONCLUSIONS
  Older people with sleep disruption at home are at significantly higher risk of developing postoperative delirium than those without. Sleep disruption in the hospital may further heighten this risk.
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.|Department of Psychiatry and Psychotherapy Bethel, Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bielefeld, Germany.
authors.forename: Oliver M
authors.identifier: http://orcid.org/0000-0001-7212-8095
authors.initials: OM
authors.lastname: Todd
authors.affiliation: Department of Psychiatry and Psychotherapy Bethel, Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bielefeld, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gelrich
authors.affiliation: Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Alasdair M
authors.initials: AM
authors.lastname: MacLullich
authors.affiliation: Department of Psychiatry and Psychotherapy Bethel, Evangelisches Klinikum Bethel, Bielefeld, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Driessen
authors.affiliation: Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Psychiatry and Psychotherapy Bethel, Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bielefeld, Germany.
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Kreisel
mesh_terms: D056044:Actigraphy; D000368:Aged; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D003693:Delirium / Q000209:etiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications*; D011795:Surveys and Questionnaires
keywords: delirium; insomnia; postoperative cognitive dysfunction; sleep