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ORIGINAL RESEARCH article

Front. Anesthesiol.
Sec. Cardiothoracic Anesthesiology
Volume 3 - 2024 | doi: 10.3389/fanes.2024.1483837

Longitudinal Impact of Cross-Clamp Duration on Postoperative Sleep Disturbance and Quality of Life in Elderly Cardiac Surgery Patients: A Secondary Analysis of the MINDDS

Provisionally accepted
Grace E Namirembe Grace E Namirembe Jamie Sparling Jamie Sparling Alexis Novak Alexis Novak Ariel Mueller Ariel Mueller Julia Bertsch Julia Bertsch Kwame Wiredu Kwame Wiredu Jason Z Qu Jason Z Qu M Brandon Westover M Brandon Westover Timothy T Houle Timothy T Houle Oluwaseun Akeju Oluwaseun Akeju *
  • Massachusetts General Hospital, Harvard Medical School, Boston, United States

The final, formatted version of the article will be published soon.

    Objectives: This study aimed to assess the enduring impact of cross-clamp duration on postoperative sleep disturbance and functional outcomes (up to 180 days) in cardiac surgery patients.Design: This is a secondary analysis of data from a randomized, double-blind trial comparing dexmedetomidine to placebo for delirium prevention (Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep).Setting: Data from patients recruited at a tertiary medical center in Boston, Massachusetts, between March 2017 and February 2022 were analyzed in January 2024.The study included 394 patients aged ≥60 who underwent cardiac surgery with cardiopulmonary bypass.The primary exposure was cross-clamp time, while secondary exposures included surgical type (isolated coronary artery bypass graft [CABG] or not) and dexmedetomidine randomization.The primary outcome was sleep quality, assessed using the PROMIS Sleep Disturbance questionnaire at 30, 90, and 180 days postoperatively. Secondary outcomes encompassed cognitive function and health-related quality of life in various domains.Sleep quality, measured by PROMIS scores, showed improvement over time, and did not differ based on cross-clamp duration (MD 0.74 points, 95% CI: -0.57, 2.07), procedure type (MD 2.14 points, 95% CI: 0.29, 3.99), or dexmedetomidine (MD 0.9 points, 95% CI: -1.33, 1.5). However, isolated CABG patients reported sleep disturbance at all time points. Notably, extended crossclamp time (>90 minutes) significantly worsened the trajectories of mental health (90-day: MD -2.37 points, 95% CI: -4.35, -0.39; 180-day: MD -2.68 points, 95% CI: -4.62, -0.73) and applied cognition (180-day: MD: -2.59 points, 95% CI: -4.49, -0.68).Regardless of the duration of the cross-clamp, sleep quality tends to improve over time following cardiac surgery. However, cross-clamp times that last longer than 90 minutes have been identified as a risk factor for self-reported declines in mental health and applied cognition.

    Keywords: cardiac surgery, Cross-clamp time, Dexmedetomidine, PROMIS, postoperative delirium, Sleep, Valvular surgery

    Received: 20 Aug 2024; Accepted: 16 Dec 2024.

    Copyright: © 2024 Namirembe, Sparling, Novak, Mueller, Bertsch, Wiredu, Qu, Brandon Westover, Houle and Akeju. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Oluwaseun Akeju, Massachusetts General Hospital, Harvard Medical School, Boston, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.