Effects of Intranasal Insulin Pretreatment on Preoperative Sleep Quality and Postoperative Delirium in Patients Undergoing Valve Replacement for Rheumatic Heart Disease

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Nature and Science of Sleep Pub Date : 2024-05-29 DOI:10.2147/nss.s439703

Qingqing Huang, Xiao Wu, Ni Lei, Xin Chen, Sixun Yu, Xuemei Dai, Qin Shi, Gu Gong, Hai-Feng Shu

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引用次数: 0

Abstract

Background: Postoperative delirium (POD) is a common neurological complication associated with valve replacement. Preoperative sleep disturbance is a risk factor for POD development, and nasal insulin modulates the sleep-wake cycle. This study investigated the beneficial effects of intranasal insulin pretreatment on preoperative sleep quality and reducing POD in patients undergoing valve replacement for rheumatic heart disease.
Patients and Methods: This prospective, single-center, randomized controlled trial (RCT) included 76 adult patients aged 18– 65 years undergoing valve surgery with cardiopulmonary bypass who were randomly allocated to receive intranasal insulin or normal saline interventions two days before surgery. POD incidence was on postoperative days 1 (T3), 2 (T4), and 3 (T5). Before the first intervention (T0), 1 d before surgery (T1), and before anesthesia on the day of surgery (T2), sleep quality was assessed and serum cortisol concentrations were measured. At T1 and T2, sleep quality related indicators monitored by sleep monitoring watches from the previous night were recorded.
Results: Compared with the normal saline group, 3 days after surgery, the insulin group showed a significantly reduced incidence of POD; significantly increased deep sleep, REM sleep, deep sleep continuity, and total sleep quality scores at T1 and T2; and significantly reduced serum cortisol concentration, PSQI scale, light sleep ratio, and wakefulness at T1 and T2.
Conclusion: The administration of 20 U of intranasal insulin twice daily, from 2 days preoperatively until 10 minutes preanesthesia on the day of surgery, can improved preoperative sleep quality significantly and reduced POD incidence in patients with rheumatic heart disease undergoing valve replacement.
Clinical Trial Registration: This study was registered with the Chinese Clinical Trial Registry (www.chictr.org.cn, with the unique identifier ChiCTR2100048515; July 9, 2021).

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鼻内胰岛素预处理对风湿性心脏病瓣膜置换术患者术前睡眠质量和术后谵妄的影响

背景：术后谵妄（POD）是瓣膜置换术后常见的神经系统并发症。术前睡眠障碍是 POD 发生的一个危险因素，而鼻腔胰岛素可调节睡眠-觉醒周期。本研究探讨了鼻腔内胰岛素预处理对风湿性心脏病瓣膜置换术患者术前睡眠质量和减少 POD 的有益影响：这项前瞻性、单中心、随机对照试验（RCT）纳入了76名年龄在18-65岁之间、接受心肺旁路瓣膜手术的成年患者，他们在术前两天被随机分配接受鼻内胰岛素或生理盐水干预。POD 发生率分别为术后第 1 天（T3）、第 2 天（T4）和第 3 天（T5）。在首次干预前（T0）、手术前 1 天（T1）和手术当天麻醉前（T2），对睡眠质量进行评估，并测量血清皮质醇浓度。在T1和T2，记录前一晚睡眠监测手表监测到的睡眠质量相关指标：与正常生理盐水组相比，胰岛素组术后 3 天 POD 发生率显著降低；T1 和 T2 深度睡眠、快速动眼期睡眠、深度睡眠连续性和总睡眠质量评分显著增加；T1 和 T2 血清皮质醇浓度、PSQI 量表、浅睡比和觉醒显著降低：结论：从术前2天开始至手术当天麻醉前10分钟，每天两次鼻内注射20 U胰岛素，可明显改善风湿性心脏病瓣膜置换术患者的术前睡眠质量，降低POD发生率：本研究已在中国临床试验注册中心（www.chictr.org.cn，唯一标识符为ChiCTR2100048515；2021年7月9日）注册。

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.