睡眠障碍与术后认知功能障碍的关系

Relationship between Sleep Disorders and Postoperative Cognitive Dysfunction

摘要: 术后认知功能障碍(POCD)是外科手术，特别是老年患者术后常见的严重并发症，与住院时间延长、医疗费用增加、长期认知能力下降甚至死亡率升高密切相关。近年来，睡眠作为一种重要的可调节生理过程，在POCD发生发展中的作用日益受到关注。本综述系统阐述了睡眠障碍与POCD的流行病学关联、潜在的病理生理学机制(包括神经炎症、氧化应激、类淋巴系统功能障碍等)，并重点讨论了围术期睡眠障碍与POCD不同亚型(如术后谵妄、神经认知恢复延迟)的具体关系。此外，本文还总结了针对睡眠的干预措施(如非药物干预、右美托咪定、褪黑素等)在预防和管理POCD中的研究进展与潜在价值。最后，对未来研究方向进行了展望，强调通过改善围术期睡眠质量可能成为防治POCD的新策略。

Abstract: Postoperative Cognitive Dysfunction (POCD) is a common and serious complication following surgical procedures, particularly among elderly patients. It is closely associated with prolonged hospital stays, increased healthcare costs, long-term cognitive decline, and even elevated mortality rates. In recent years, sleep, as an important modifiable physiological process, has gained increasing attention for its role in the development of POCD. This review systematically elaborates on the epidemiological associations between sleep disorders and POCD, along with potential pathophysiological mechanisms (including neuroinflammation, oxidative stress, and dysfunction of the glymphatic system). It further highlights the specific relationships between perioperative sleep disorders and different subtypes of POCD, such as postoperative delirium and delayed neurocognitive recovery. Additionally, this article summarizes recent advances and the potential value of sleep-targeted interventions (e.g., non-pharmacological approaches, dexmedetomidine, melatonin) in preventing and managing POCD. Finally, future research directions are proposed, emphasizing that improving perioperative sleep quality may serve as a novel strategy for preventing and treating POCD.