Supplementary file 1_Dynamic changes in peripheral inflammation as a risk factor for perioperative sleep disturbances in elderly patients undergoing laparoscopic hepatobiliary surgery.docx

BackgroundElderly surgical patients are at high risk of perioperative sleep disturbances (PSD), and the underlying pathogenic mechanisms remain unclear. The relationship between peripheral inflammatory status and PSD pathogenesis currently lacks substantial clinical evidence.
ObjectiveThis study aims to evaluate the association between peripheral inflammation indicators and PSD in elderly patients undergoing laparoscopic hepatobiliary surgery, and to analyze the dynamic changes in peripheral inflammation in PSD patients throughout the perioperative period.
Method and materialsUsing retrospective data, this study compares peripheral inflammatory markers (NLR, MLR, PLR, SII, IL-6, and IL-10) in patients with PSD vs. those with normal sleep patterns before and after surgery. Receiver operating characteristic (ROC) curves were employed to evaluate the discriminative power of these indicators for PSD. Logistic regression models were employed to assess risk associations between inflammatory markers and PSD. Dynamic changes in peripheral inflammation were compared before surgery, on the day the surgery ended, and 1 day post-surgery between patients with PSD and those with normal sleep, exploring potential correlations with PSD pathogenesis.
ResultThe study ultimately included clinical data from 156 patients. Findings indicated that elevated NLR and SII levels before and after surgery, alongside decreased plasma IL-10 levels post-surgery, are associated with a higher incidence of PSD. Peripheral inflammatory markers on the day of surgery were not significantly predictive of post-PSD. Multivariable logistic regression analyses identified NLR, SII, IL-6, and IL-10 as independent predictors of pre-PSD, while NLR, SII, and IL-10 remained independently associated with post-PSD.
ConclusionDynamic changes in peripheral inflammation during the perioperative period are associated with PSD in elderly patients undergoing laparoscopic hepatobiliary surgery. These findings may support the early identification and screening of high-risk PSD patients, providing new insights into the underlying mechanisms of PSD pathogenesis.

背景：老年手术患者是围手术期睡眠障碍（perioperative sleep disturbances, PSD）的高发人群，其潜在发病机制目前尚未明确。当前关于外周炎症状态与PSD发病机制之间的关联，尚缺乏足够的临床证据支持。
目的：本研究旨在评估接受腹腔镜肝胆手术的老年患者外周炎症指标与PSD之间的关联，并分析PSD患者围手术期外周炎症的动态变化特征。
方法与材料：本研究采用回顾性数据，对比了围手术期术前及术后合并PSD与睡眠正常的老年患者的外周炎症标志物，包括中性粒细胞-淋巴细胞比值（NLR）、单核细胞-淋巴细胞比值（MLR）、血小板-淋巴细胞比值（PLR）、系统性免疫炎症指数（SII）、白细胞介素-6（IL-6）及白细胞介素-10（IL-10）。采用受试者工作特征（Receiver Operating Characteristic, ROC）曲线评估上述指标对PSD的鉴别效能；通过logistic回归模型分析炎症标志物与PSD之间的风险关联。此外，本研究对比了术前、手术当日及术后1天时，PSD患者与睡眠正常患者的外周炎症动态变化情况，以探索其与PSD发病机制的潜在关联。
结果：本研究最终纳入156例患者的临床数据。研究结果显示，术前及术后升高的NLR与SII水平，以及术后血浆IL-10水平降低，均与PSD的高发生率显著相关。手术当日的外周炎症标志物对术后PSD无显著预测价值。多因素logistic回归分析表明，NLR、SII、IL-6及IL-10是术前PSD的独立预测因子；而NLR、SII及IL-10仍与术后PSD存在独立关联。
结论：围手术期外周炎症的动态变化与接受腹腔镜肝胆手术的老年患者PSD发生显著相关。本研究结果可为PSD高危患者的早期识别与筛查提供依据，同时为阐明PSD的潜在发病机制提供新的研究视角。