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Obstructive sleep apnea and delirium: exploring possible mechanisms

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Abstract

Introduction

Obstructive sleep apnea (OSA) is a medical disorder strongly associated with multiple comorbidities and postoperative complications. Current evidence suggests that OSA disturbs fundamental biochemical processes, leading to low-grade systemic inflammation and oxidative stress. Animal models have shown that OSA may lead to apoptosis of central neurons. In clinical studies, oxygen desaturation index and sleep fragmentation have been shown to be independently associated with cognitive dysfunction. Moreover, in several studies, patients with OSA were shown to have decreased brain activation in multiple brain areas.

OSA and delirium

The possibility of an association between OSA and delirium has been highlighted in several case reports. The first prospective study of the possible link between apnea and delirium showed that the presence of OSA was independently associated with the occurrence of delirium after knee replacement surgery.

Conclusions

Therefore, we suggest that OSA should be considered as a risk factor for delirium, and clinicians should assess patients for OSA and related risk factors prior to surgery. However, further research is required to shed light on the mechanisms connecting these disorders and on whether the treatment of OSA affects the incidence of delirium.

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Acknowledgments

Supported by NIH/NIA grant # R01AG019766 to Madan M. Kwatra.

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Authors and Affiliations

  1. Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL, USA

    Aibek E. Mirrakhimov

  2. Department of Anesthesiology, Medical University of South Carolina, Charleston, SC, USA

    Carey L. Brewbaker

  3. Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA

    Andrew D. Krystal

  4. Department of Anesthesiology, Duke University Medical Center, P.O. Box 3094, Durham, NC, 27710, USA

    Madan M. Kwatra

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  1. Aibek E. Mirrakhimov
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Correspondence to Madan M. Kwatra.

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Mirrakhimov, A.E., Brewbaker, C.L., Krystal, A.D. et al. Obstructive sleep apnea and delirium: exploring possible mechanisms. Sleep Breath 18, 19–29 (2014). https://doi.org/10.1007/s11325-013-0846-z

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