Clinical Study Of Postoperative Sleep Disorder In Adult Patients With Infective Endocarditis

ObjectiveTo analyze the clinical characteristics and risk factors of preoperative and postoperative sleep disturbance in patients with infective endocarditis(IE)with combined subjective and objective sleep evaluation methods.Zolpidem was used to treat IE patients with sleep disturbance to explore its efficiency and provide clinical basis.MethodsIE patients who were admitted to Guangdong Provincial People’s Hospital from October 2016 to September 2018 and had undergone surgery,had passed the critical period after surgery,and were currently in recovery period were selected as the research subjects.Detailed medical history was collected.Pittsburgh Sleep Quality Index(PSQI)was used to assess subjective sleep quality after surgery,Epworth Sleep Scale(ESS)was used to assess daytime sleepiness,and body motion recorder was used to monitor objective sleep quality after surgery.Meanwhile,preoperative and postoperative data of demographic information,inflammatory response biomarkers(leukocytes,C-reactive protein,procalcitonin and interleukin-6)),embolic complications,other laboratory test results,and ultrasound findings were collected for risk-related analysis.Patients with postoperative sleep disorders from October 2017 to September 2019 were selected and zolpidem was used to evaluate the efficacy on sleep in 6 months after surgery and analyse its potential risk factors.Results1.Analysis of postoperative sleep characteristics and related factors in patients with IE139 patients completed the questionnaire,and 116 patients finished stereometer monitoring.During hospitalization,86 patients(61.9%)had PSQI≥8 points;44 patients(31.7%)had ESS≥9 points,suggesting that postoperative sleep disorders are common in IE patients.The PSQI score was≥8 in 46 patients(33.1%)and ESS was≥9 in 20 patients(14.4%)at 6 months after surgery,suggesting that the PSQI and ESS scores were significantly increased at 6 months after surgery.Objective sleep quality was monitored during hospitalization in 116 patients,with a sleep duration of 409.5±63.5 min and a sleep efficiency<85.0%in 60.3%of cases.Multiple logistic regression analysis indicated that age(OR=1.125,95%CI:1.068-1.186)and PSQI score of the second day being ransferred to the Cardiac Rehabilitation Unite(OR=1.759,95%CI:1.436-2.155)were potential risk factors for sleep disorders.2.Postoperative sleep quality assessment for 14 consecutive days by actigraph in IE patientsAmong 80 patients who wore the actigraphs continuously for 14 days,the actigraph results showed that the median sleep efficiency in the second week was significantly higher than that in the first week(86.8%vs.85.3%,P<0.001),and the median frequency of awakenings in the second week was significantly lower than that in the first week(19.3 vs.20.0 times,P=0.017).3.Relationship between postoperative sleep and inflammatory cytokines in IE patientsThis study revealed the influence of inflammatory factors on sleep disturbance in patients with infective endocarditis.In this study,we found that sleep efficiency and sleep duration showed a negative correlation with CRP and IL-6 levels,and the lower the sleep efficiency,the less the sleep duration.4.The efficiency of zolpidem treatment on the postoperative sleep quality of IE patients and risk factors analysis32 patients in the zolpidem group and 42 patients in the control group were included in the study.PSQI and ESS scores at 6 months after surgery were significantly lower than those at baseline for two groups(P=0.036).Multivariate analysis identified age(OR=1.257,95%CI:1.115-1.417),PSQI score(OR=2.662,95%CI:1.552-4.654),and no zolpidem use(OR=45.582,95%CI:3.006～691.234)as independent factors for poor sleep quality.ConclusionThe incidence of postoperative sleep disturbance in patients with infective endocarditis is relatively common,but the situation improves over time.Sleep disturbance severity was correlated with postoperative inflammatory factor levels,including IL-6 and CRP levels.In addition,age,PSQI score of the second day being transferred to the Cardiac Rehabilitation Unite,and no zolpidem treatment were independently associated with poor sleep quality.Therefore,zolpidem has the potential to be an effective treatment for sleep disturbance after surgical treatment of IE.