Wearable EEG Recordings Show Dysregulated Sleep-wake and Circadian Rhythms in Hospitalized Patients With Delirium (P10-2.014)

Objective To identify specific differences in sleep architecture and circadian rhythms between older hospitalized patients with and without delirium. Background Delirium is an acute and fluctuating state of confusion, often accompanied by disturbances in attention and cognitive function. Delirium affects over 20% of hospitalized older adults and is associated with poorer clinical outcomes, including increased mortality. More than 90% of patients with delirium experience disturbances in sleep-wake activity. However, the ways in which circadian rhythms are disrupted in delirium remain unclear. Design/Methods In this prospective cohort study, we collected and analyzed 513 single-channel electroencephalogram (EEG) recordings, each approximately 24 hours in duration, from 208 hospitalized patients aged 50 years and older (n = 208; 134 non-delirious, 74 delirious). We defined delirium using the 3-minute diagnostic interview for the Confusion Assessment Method (3D-CAM). Sleep-wake activity was assessed in 30-second epochs using multiple automated sleep staging models. Results Across both automated sleep staging models, patients with delirium exhibited significantly greater total sleep duration compared to patients without delirium (linear mixed effects model (LMEM); U-Sleep: t=6.58, p<0.001; Luna: t=6.04, p<0.001). Patients with delirium also spent significantly more time in N2 sleep (Estimated Marginal Means; U-Sleep: t=8.10, p<0.001; Luna: t=19.80, p<0.001 ), had more N2-to-REM transitions (LMEM U-Sleep: t = 6.03, p < 0.001; LMEM Luna: t = 4.76, p < 0.001), and had greater intervals of uninterrupted sleep (LMEM U-Sleep: t = 4.17, p < 0.001; LMEM Luna: t = 5.95, p < 0.001). Conclusions Delirium status is associated with changes in sleep quantity, quality, and structure. Ongoing work aims to examine specific circadian patterns to determine how the timing and distribution of sleep across the day may differ between delirious and non-delirious patients. Identifying specific circadian disruptions in sleep architecture may guide targeted interventions for improving sleep onset and quality, potentially improving outcomes in patients with delirium. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Ms. Zhao has nothing to disclose. Ms. Dhar has received personal compensation for serving as an employee of Northwestern University . Mr. Sherrington has nothing to disclose. Mr. Tesh has nothing to disclose. Mr. Coughlin has nothing to disclose. Dr. Lam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurona Therapeutics. Dr. Lam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acadia Pharmaceuticals. The institution of Dr. Lam has received research support from Neurona Therapeutics. The institution of Dr. Lam has received research support from NIH. The institution of Dr. Lam has received research support from Alzheimer's Association. Dr. Cash has received stock or an ownership interest from Beacon Biosignals. Dr. Westover has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Beacon Biosignals. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. The institution of Dr. Kimchi has received research support from NIH. The institution of an immediate family member of Dr. Kimchi has received research support from NIH.