背景:衰老和术前睡眠障碍是影响术后认知结果的主要危险因素。然而,手术后神经认知恢复延迟的发病机制仍然不明确,在术前睡眠障碍的老年成年患者中,仍缺乏神经认知恢复延迟的潜在生物标志物.本研究旨在探讨术前睡眠障碍的老年患者术后早期黑色素浓缩激素(MCH)与神经认知恢复延迟的关系。
方法:在这项单中心前瞻性观察研究中,在内蒙古的学术医学中心纳入了156名接受选择性全髋关节置换术(THA)或全膝关节置换术(TKA)的术前睡眠障碍的老年患者(65岁或以上),中国,从2021年10月到2022年11月,所有患者都接受了脊髓麻醉。匹兹堡睡眠质量指数(PSQI)用于评估所有患者的术前睡眠质量。术前睡眠障碍定义为PSQI评分>5。我们测量了所有患者的脑脊液(CSF)MCH和血浆MCH水平。主要结果是术后早期神经认知恢复延迟。所有患者在手术前1天和术后7天(术后第7天[POD7])通过蒙特利尔认知评估(MoCA)进行认知功能评估。延迟神经认知恢复定义为POD7MoCA<26。在单变量逻辑分析中,潜在的混杂因素包括P<.2的变量,以及文献报道的神经认知恢复延迟的重要危险因素。基于Enter方法的多变量logistic回归模型评估了MCH与术前睡眠障碍老年患者神经认知恢复延迟的相关性。
结果:59名(37.8%)患有术前睡眠障碍的老年患者在POD7时出现神经认知恢复延迟。CSFMCH水平增加(增加1pg/mL的比值比[OR]=1.16,95%置信区间[CI],1.09-1.23,P<.001)和血浆MCH水平的降低(OR为1pg/mL=0.92,95%CI,0.86-0.98,P=.003)与延迟的神经认知恢复有关,在调整了年龄之后,性别,教育,基线MoCA分数,美国麻醉医师协会(ASA)等级,冠心病(CHD)。
结论:术前睡眠障碍的老年患者,MCH与术后神经认知恢复延迟的发生有关。CSFMCH或血浆MCH的术前测试可能会增加识别患有术前睡眠障碍的老年成年患者神经认知恢复延迟的高危人群的可能性。
BACKGROUND: Aging and preoperative sleep disorders are the main risk factors affecting postoperative cognitive outcomes. However, the pathogenesis of delayed neurocognitive recovery after surgery remains ambiguous, and there is still a lack of potential biomarkers for delayed neurocognitive recovery in older adult patients with preoperative sleep disorders. Our study aimed to explore the relationship between melanin-concentrating hormone (MCH) and delayed neurocognitive recovery early after surgery in older adult patients with preoperative sleep disorders.
METHODS: In this monocentric prospective observational study, 156 older adult patients (aged 65 years or older) with preoperative sleep disorders undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) were included at an academic medical center in Inner Mongolia,
China, from October 2021 to November 2022, and all patients underwent spinal anesthesia. The Pittsburgh Sleep Quality Index (PSQI) was applied to assess the preoperative sleep quality of all patients, and preoperative sleep disorders were defined as a score of PSQI >5. We measured the levels of cerebrospinal fluid (CSF) MCH and plasma MCH of all patients. The primary outcome was delayed neurocognitive recovery early after surgery. All patients received cognitive function assessment through the Montreal Cognitive Assessment (MoCA) 1 day before and 7 days after surgery (postoperative day 7 [POD7]). Delayed neurocognitive recovery was defined as a score of POD7 MoCA <26. The potential confounders included variables with P < .2 in the univariate logistic analysis, as well as the important risk factors of delayed neurocognitive recovery reported in the literature. Multivariable logistic regression model based on the Enter method assessed the association of MCH and delayed neurocognitive recovery in older adult patients with preoperative sleep disorders.
RESULTS: Fifty-nine (37.8%) older adult patients with preoperative sleep disorders experienced delayed neurocognitive recovery at POD7. Increase in CSF MCH levels (odds ratio [OR] for an increase of 1 pg/mL = 1.16, 95% confidence interval [CI], 1.09-1.23, P < .001) and decrease in plasma MCH levels (OR for an increase of 1 pg/mL = 0.92, 95% CI, 0.86-0.98, P = .003) were associated with delayed neurocognitive recovery, after adjusting for age, sex, education, baseline MoCA scores, American Society of Anesthesiologists (ASA) grade, and coronary heart disease (CHD).
CONCLUSIONS: In older adult patients with preoperative sleep disorders, MCH is associated with the occurrence of delayed neurocognitive recovery after surgery. Preoperative testing of CSF MCH or plasma MCH may increase the likelihood of identifying the high-risk population for delayed neurocognitive recovery in older adult patients with preoperative sleep disorders.