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The purpose of this study is to examine the mechanisms of brain injury contributing to postoperative neurocognitive disorders (PNCD) in an at-risk population (obstructive sleep apnea (OSA)) undergoing surgery. The investigators will enroll 50 OSA patients scheduled for surgery. All patients will have a brain scan (fMRI) within five days before surgery and two days and six months after surgery. During this visit cognitive function will be assessed using the Wide Range Assessment of Memory and Learning (WRAML2) and Montreal Cognitive Assessment (MoCA) tests. Patients will also be asked to participate in a blood draw during the first 2 visits for fMRI (within five days of surgery and two days after surgery). The Confusion Assessment Method (CAM-S) test, will be used to examine postoperative delirium.
The investigators will examine the potential mechanisms of brain injury contributing to postoperative neurocognitive disorders (PNCD) in an at-risk population (obstructive sleep apnea (OSA)). This study proposes that neuro-inflammation is associated with measurable tissue changes that can be examined with MD measures and blood biomarkers.
On the day of surgery, standard of care procedures will take place. Hemodynamic vitals will be continuously monitored. As per the latest guidelines and recommendations from the American Society of Anesthesiologists (ASA), mean arterial pressure (MAP) will be targeted to > 60 mmHg or within 20% of baseline values, and processed EEG-guided anesthesia will be monitored to maintain a patient state index between 20-50. Electronic medical records and intraoperative integrated physiologic waveform will be collected.
In summary, the investigators will examine the potential mechanisms of brain injury contributing to postoperative delirium (POD) and acute and long-lasting neurocognitive deficits in an at-risk population (OSA).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study Group | brain scans, cognitive tests, blood biomarkers |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Brain Imaging | Diagnostic Test | Magnetic resonance imaging (MRI) using diffusion tensor imaging (DTI)-based mean diffusivity (MD) measures. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Preoperative cognitive function | Montreal Cognitive Assessment (MoCA) test | pre-surgery (within five days before) |
| Postoperative cognitive dysfunction - delayed cognitive recovery | Montreal Cognitive Assessment (MoCA) test | Post-surgery (within two days post surgery). |
| Postoperative cognitive dysfunction - neurocognitive disorder | Montreal Cognitive Assessment (MoCA) test | Post-surgery (6 months after surgery). |
| Preoperative cognitive function II | Wide Range Assessment of Memory and Learning (WRAML2) | pre-surgery (within five days before surgery) |
| Postoperative cognitive dysfunction - delayed cognitive recovery II | Wide Range Assessment of Memory and Learning (WRAML2) | Post-surgery (within two days post surgery). |
| Postoperative cognitive dysfunction - neurocognitive disorder II | Wide Range Assessment of Memory and Learning (WRAML2) | Post-surgery (6 months after surgery). |
| Postoperative Delirium | The Confusion Assessment Method (CAM-S) test | A two times per day for up to three days or discharge from the hospital. |
| Measure | Description | Time Frame |
|---|---|---|
| Blood Serum anti-inflammatory Biomarkers | Assess blood inflammatory biomarkers (IL6, TNFa and IL1B) using enzyme-linked immunosorbent assay | pre- (within five days before surgery) |
| Blood Serum anti-inflammatory Biomarkers II |
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Inclusion Criteria:
Subjects with a diagnosis of moderate-to-severe OSA (apnea hypopnea index [AHI]>15 events/hour confirmed by overnight polysomnography), scheduled for open or robotic surgery (abdominal, gynecologic, or urologic), and upper or lower extremity orthopedic procedures
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Subjects with a diagnosis of moderate-to-severe OSA (apnea hypopnea index [AHI]>15 events/hour confirmed by overnight polysomnography),
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| Name | Affiliation | Role |
|---|---|---|
| Rajesh Kumar, PhD | University of California, Los Angeles | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ronald Reagan UCLA Medical Center, Department of Anesthesiology & Perioperative Medicine | Los Angeles | California | 90095 | United States |
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| ID | Term |
|---|---|
| D020181 | Sleep Apnea, Obstructive |
| D019965 | Neurocognitive Disorders |
| ID | Term |
|---|---|
| D012891 | Sleep Apnea Syndromes |
| D001049 | Apnea |
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| D059906 | Neuroimaging |
| ID | Term |
|---|---|
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D003943 | Diagnostic Techniques, Neurological |
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| Cognitive testing | Diagnostic Test | Wide Range Assessment of Memory and Learning (WRAML2), Montreal Cognitive Assessment (MoCA), and Confusion Assessment Method for the ICU -severity (CAM-ICU S) tests. |
|
| Blood Biomarkers | Diagnostic Test | Inflammatory markers |
|
Assess blood inflammatory biomarkers (IL6, TNFa and IL1B) using enzyme-linked immunosorbent assay
| post-surgery (within two days of surgery). |
| Brain changes | Using non-invasive magnetic resonance imaging based diffusion tensor imaging | pre- (within five days before) and post-surgery (within two days and 6 months). |
| Brain changes II | Using non-invasive magnetic resonance imaging based diffusion tensor imaging | Post-surgery (within two days post surgery). |
| Brain changes III | Using non-invasive magnetic resonance imaging based diffusion tensor imaging | Post-surgery (within six months post surgery). |
| D020919 |
| Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
| D001523 | Mental Disorders |
| D008919 | Investigative Techniques |