Georgian Med News. 2026 Jun;(375):6-15.
ABSTRACT
INTRODUCTION: Cardiac surgery involving cardiopulmonary bypass (CPB) is frequently associated with a spectrum of postoperative neurological complications, ranging from transient neurocognitive decline to permanent cerebrovascular damage. These events are often accompanied by significant disruptions in sleep architecture, which may further impede the brain's recovery process. Despite the prevalence of these issues, the correlation between postoperative sleep parameters and neurocognitive outcomes remains insufficiently explored.
OBJECTIVE: The primary goal of this prospective study was to evaluate the relationship between postoperative cerebrovascular and cognitive dysfunctions and alterations in polysomnographic (PSG) parameters in patients undergoing cardiac surgery.
METHODS: A total of 507 patients scheduled for cardiac surgery were screened, of whom 104 patients met the strict inclusion criteria and underwent comprehensive neurological and polysomnographic assessment. Patients were divided into two groups: Group I (n=52) received Citicoline as part of their perioperative management, while Group II (n=52) served as the control group. Cognitive function was assessed using the MMSE and MoCA scales. PSG parameters, including sleep latency, REM latency, and arousal index, were recorded preoperatively and postoperatively (at Day 10 and 1 month), while acute neurological evaluations were performed at Day 3.
RESULTS: Pre-operative screening revealed internal carotid artery stenosis or occlusion in 28.8% (n=30) of the enrolled cohort. Acute postoperative neurological complications were documented in 35.6% (n=37) of the patients on Day 3. PSG data revealed profound alterations in sleep architecture, characterized by increased sleep latency and an elevated arousal index on Day 10, closely correlating with cognitive impairment. Notably, within the subgroup analysis of patients with POCD, Group I (Citicoline) demonstrated a significant recovery in MoCA scores and faster structural stabilization of sleep parameters compared to the control group by Day 30 (p=0.0016).
CONCLUSION: The study demonstrates that polysomnography is a sensitive tool for detecting early neurocognitive dysfunction following cardiac surgery. The inclusion of Citicoline in the perioperative protocol significantly mitigates neurocognitive decline and facilitates the stabilization of sleep-wake cycles. PSG parameters may serve as reliable objective markers for predicting long-term neurological outcomes in cardiac surgery patients.
PMID:42603311