Short term cognitive function after sevoflurane anesthesia in patients suspect to obstructive sleep apnea syndrome: an observational study

Abstract

Background The obstructive sleep apnea syndrome (OSAS) is characterized by intermittent cerebral hypoxia which can cause cognitive alterations. Likewise, hypoxia induced neurocognitive deficits are detectable after general anesthesia using volatile anesthetics. The objective of this study was to evaluate the association between a moderate to high risk patients of OSAS and postoperative cognitive dysfunction after volatile anesthesia. Methods In this single center prospective, observational study between May 2013 and September 2013, 46 patients aged 55 to 80 years with an estimated hospital stay of at least 3 days undergoing surgery were enrolled. Patients were screened using the STOP-BANG test with score of 3 or higher indicating moderate to high risk of OSAS. The cognitive function was assessed using a neuropsychological assessment battery, including the DemTect test for cognitive impairment among other tests e.g. SKT memory, the day before surgery and within 2 days after extubation. Results Twenty-three of the 46 analyzed patients were identified with a moderate to high risk of OSAS. When comparing post- to preoperative phase a significant better performance for the SKT was found for both groups (p < 0.001). While the moderate to high risk group scores increased postoperative in the DemTect test, they decreased in the low risk group (p < 0.003). When comparing the changes between groups, the moderate to high risk patients showed significant better test result for DemTect testing after anaesthesia. This effect remained robust when adjusting for potential confounding variables using a two-factor ANOVA. Conclusion Compared to low risk, a moderate to high risk of OSAS based on the STOP-BANG score was associated with improved postoperative cognitive function measured by the DemTect test. Trial registration The study was approved by the local Ethics committee (Ethikkommission der Medizinischen Fakultät der Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany) (reference number: 87_12 B) on 19.04.2012.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study

“…Only three human studies and three animal experiments have explored the correlation between OSA and POCD. Two human studies showed that the incidence of POCD before discharge in OSA patients was lower than that of non-OSA patients ( Wagner et al, 2018 , 2021 ) and one human study showed that OSA patients had a higher risk of POCD in the early postoperative period than patients without OSA ( Wu et al, 2022 ). Three animal models also suggested that the incidence of POCD was higher in OSA mice than that in non-OSA mice ( Dong et al, 2018 ; Zhang et al, 2019 ; Mei et al, 2020 ).…”

Association of Obstructive Sleep Apnea With Postoperative Delirium in Procedures of Moderate-to-High Complexity: A Hospital-Registry Study

“…12,13 OSA is associated with sleep fragmentation 14 and has been linked to insomnia and nightmares, 15 which is associated with an increased risk of delirium. 3 However, other prospective studies have suggested that patients at a high risk of OSA experience less postoperative cognitive dysfunction after anesthesia with volatile 16 and intravenous anesthetics. 17 In this hospital-registry study of hospitalized patients ≥60 years of age undergoing procedures of moderate-to-high complexity, we hypothesized that OSA is associated with delirium within 7 days after surgery.…”

“…12,13 OSA is associated with sleep fragmentation 14 and has been linked to insomnia and nightmares, 15 which is associated with an increased risk of delirium. 3 However, other prospective studies have suggested that patients at a high risk of OSA experience less postoperative cognitive dysfunction after anesthesia with volatile 16 and intravenous anesthetics. 17…”

Cognitive function in older patients and their stress challenge using different anesthesia regimes: a single center observational study

“…In order to assess potential alterations in patients' cognitive function, a cognitive assessment was carried out at two different time points using a neuropsychological test assessment [12,13]. The baseline testing was recorded on the day before surgery and the second survey on the first postoperative day.…”

“…Finally, due to its nine-subtest structure, memory and attention deficits were by the SKT test [18]. Further details have been previously described [12,13]. Table 1 summarizes cognitive assessments and corresponding tested cognitive function and domain.…”