Table_4_Perioperative Sleep Disturbances and Postoperative Delirium in Adult Patients: A Systematic Review and Meta-Analysis of Clinical Trials.DOC

Background: The aim of this systematic review and meta-analysis of clinical trials was to investigate the effects of perioperative sleep disturbances on postoperative delirium (POD). Methods: Authors searched for studies (until May 12, 2020) reporting POD in patients with sleep disturbances following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: We identified 29 relevant trials including 55,907 patients. We divided these trials into three groups according to study design: Seven retrospective observational trials, 12 prospective observational trials, and 10 randomized controlled trials. The results demonstrated that perioperative sleep disturbances were significantly associated with POD occurrence in observational groups [retrospective: OR = 0.56, 95% CI: [0.33, 0.93], I2 = 91%, p for effect = 0.03; prospective: OR = 0.27, 95% CI: [0.20, 0.36], I2 = 25%, p for effect < 0.001], but not in the randomized controlled trial group [OR = 0.58, 95% CI: [0.34, 1.01], I2 = 68%, p for effect = 0.05]. Publication bias was assessed using Egger's test. We used a one-by-one literature exclusion method to address high heterogeneity. Conclusions: Perioperative sleep disturbances were potential risk factors for POD in observational trials, but not in randomized controlled trials.背景：本项针对临床试验的系统评价与荟萃分析旨在探讨围手术期睡眠障碍对术后谵妄（postoperative delirium, POD）的影响。 方法：研究者按照系统评价与荟萃分析优先报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南，检索截至2020年5月12日发表的、报道睡眠障碍患者术后谵妄情况的相关研究。 结果：本研究共纳入29项符合标准的临床试验，涉及55907例患者。根据研究设计将其分为三组：7项回顾性观察性试验、12项前瞻性观察性试验以及10项随机对照试验。结果显示，在观察性研究组中，围手术期睡眠障碍与术后谵妄的发生显著相关[回顾性研究：比值比（Odds Ratio, OR）=0.56，95%置信区间（95% Confidence Interval, 95% CI）=[0.33, 0.93]，异质性指数I²=91%，效应检验p=0.03；前瞻性研究：OR=0.27，95%CI=[0.20, 0.36]，I²=25%，效应检验p<0.001]，但在随机对照试验组中未发现此类关联[OR=0.58，95%CI=[0.34, 1.01]，I²=68%，效应检验p=0.05]。本研究采用Egger检验评估发表偏倚，并通过逐一排除文献的方法处理高异质性问题。 结论：在观察性试验中，围手术期睡眠障碍是术后谵妄的潜在危险因素，但在随机对照试验中未发现该关联。