Background Delirium is a distressing neurocognitive disorder recently linked to sleep disturbances. However, the longitudinal relationship between sleep and delirium remains unclear. This study assessed the associations of poor sleep burden, and its trajectory, with delirium risk during hospitalization. Methods About 321 818 participants from the UK Biobank (mean age 58 ± 8 years [SD]; range 37–74 years) reported (2006–2010) sleep traits (sleep duration, excessive daytime sleepiness, insomnia-type complaints, napping, and chronotype—a closely related circadian measure for sleep timing), aggregated into a sleep burden score (0–9). New-onset delirium (n = 4 775) was obtained from hospitalization records during a 12-year median follow-up. About 42 291 (mean age 64 ± 8 years; range 44–83 years) had repeat sleep assessment on average 8 years after their first. Results In the baseline cohort, Cox proportional hazards models showed that moderate (aggregate scores = 4–5) and severe (scores = 6–9) poor sleep burden groups were 18% (hazard ratio = 1.18 [95% confidence interval: 1.08–1.28], p < .001) and 57% (1.57 [1.38–1.80], p < .001), more likely to develop delirium, respectively. The latter risk magnitude is equivalent to 2 additional cardiovascular risks. These findings appeared robust when restricted to postoperative delirium and after exclusion of underlying dementia. Higher sleep burden was also associated with delirium in the follow-up cohort. Worsening sleep burden (score increase ≥2 vs no change) further increased the risk for delirium (1.79 [1.23–2.62], p = .002) independent of their baseline sleep score and time lag. The risk was highest in those younger than 65 years at baseline (p for interaction <.001). Conclusion Poor sleep burden and worsening trajectory were associated with increased risk for delirium; promotion of sleep health may be important for those at higher risk.

中文翻译：

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中老年人睡眠负担不佳与住院期间谵妄风险的关系


背景 谵妄是一种令人痛苦的神经认知障碍，最近与睡眠障碍有关。然而，睡眠与谵妄之间的纵向关系仍不清楚。这项研究评估了不良睡眠负担及其轨迹与住院期间谵妄风险的关系。方法 来自英国生物银行的约 321 818 名参与者（平均年龄 58 ± 8 岁 [SD]；范围 37-74 岁）报告了（2006-2010 年）睡眠特征（睡眠持续时间、白天过度嗜睡、失眠型主诉、午睡和睡眠时间类型（与睡眠时间密切相关的昼夜节律测量），汇总为睡眠负担评分 (0-9)。新发谵妄 (n = 4 775) 是从 12 年中位随访期间的住院记录中获得的。大约 42 291 人（平均年龄 64 ± 8 岁；范围 44-83 岁）在第一次睡眠评估后平均 8 年进行了重复睡眠评估。结果 在基线队列中，Cox 比例风险模型显示，中度（总分 = 4-5）和重度（分数 = 6-9）睡眠负担不佳组的比例为 18%（风险比 = 1.18 [95% 置信区间：1.08- 1.28]，p < .001) 和 57% (1.57 [1.38–1.80]，p < .001)，更有可能出现谵妄。后者的风险程度相当于 2 个额外的心血管风险。当仅限于术后谵妄并排除潜在的痴呆后，这些发现显得很可靠。在随访队列中，较高的睡眠负担也与谵妄有关。睡眠负担恶化（分数增加 ≥2 与无变化）进一步增加谵妄的风险 (1.79 [1.23–2.62], p = .002)，与基线睡眠分数和时间滞后无关。基线时年龄小于 65 岁的人群的风险最高（交互作用 p <.001）。 结论 睡眠负担不佳和轨迹恶化与谵妄风险增加相关；促进睡眠健康对于高风险人群可能很重要。