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Background <p>Delirium is a frequent complication among hospitalized older adults and is associated with prolonged recovery, increased mortality, and long-term cognitive decline. However, traditional risk models rely largely on baseline clinical characteristics and often fail to capture dynamic physiologic vulnerability during hospitalization. We therefore aimed to develop a multidomain physiologic index integrating sleep, circadian, autonomic, and environmental disturbances to improve delirium risk prediction.</p> Methods <p>In this prospective cohort study, 600 hospitalized adults aged ≥ 60&#xa0;years admitted to surgical wards or intensive care units in a tertiary hospital were enrolled. Participants underwent multimodal monitoring including actigraphy, heart rate variability, and bedside noise–light sensors; 96 also completed overnight EEG. Eighteen physiologic and environmental variables were standardised and reduced using principal component analysis. The first component, reflecting sleep fragmentation, circadian instability, autonomic imbalance, and environmental load, was prespecified as the Sleep–Brain Vulnerability Index (SBVI). Delirium was assessed daily, and cognition at baseline, 3&#xa0;months, and 12&#xa0;months. Associations between SBVI and outcomes were examined using multivariable logistic, Cox, and linear mixed-effects models.</p> Results <p>Delirium occurred in 148 participants (24.7%). Higher SBVI was independently associated with delirium (adjusted OR per SD 1.94; 95% CI 1.48–2.56) and showed graded risk across tertiles (12.3%, 23.7%, 39.8%). Adding SBVI to a clinical model improved discrimination (AUC 0.72 to 0.81). SBVI predicted slower discharge (HR 0.86; 95% CI 0.80–0.93) and greater 12-month cognitive decline (β − 0.47 MoCA points per SD; 95% CI − 0.70 to − 0.25). EEG analyses showed reduced slow-wave activity among individuals with higher SBVI.</p> Conclusions <p>SBVI provides a multidomain physiologic measure that predicts delirium, recovery, and long-term cognitive decline in hospitalized older adults. Because its components can be obtained using feasible bedside monitoring, SBVI may enable early identification of vulnerable patients and support targeted geriatric interventions.</p>

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A multidomain sleep–brain vulnerability index predicts delirium and long-term cognitive decline in hospitalized older adults

  • 期刊论文

  • 发表日期：

    2026年4月18日

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  • Shengjie Pan,
  • Gang Wang

摘要

Background

Delirium is a frequent complication among hospitalized older adults and is associated with prolonged recovery, increased mortality, and long-term cognitive decline. However, traditional risk models rely largely on baseline clinical characteristics and often fail to capture dynamic physiologic vulnerability during hospitalization. We therefore aimed to develop a multidomain physiologic index integrating sleep, circadian, autonomic, and environmental disturbances to improve delirium risk prediction.

Methods

In this prospective cohort study, 600 hospitalized adults aged ≥ 60 years admitted to surgical wards or intensive care units in a tertiary hospital were enrolled. Participants underwent multimodal monitoring including actigraphy, heart rate variability, and bedside noise–light sensors; 96 also completed overnight EEG. Eighteen physiologic and environmental variables were standardised and reduced using principal component analysis. The first component, reflecting sleep fragmentation, circadian instability, autonomic imbalance, and environmental load, was prespecified as the Sleep–Brain Vulnerability Index (SBVI). Delirium was assessed daily, and cognition at baseline, 3 months, and 12 months. Associations between SBVI and outcomes were examined using multivariable logistic, Cox, and linear mixed-effects models.

Results

Delirium occurred in 148 participants (24.7%). Higher SBVI was independently associated with delirium (adjusted OR per SD 1.94; 95% CI 1.48–2.56) and showed graded risk across tertiles (12.3%, 23.7%, 39.8%). Adding SBVI to a clinical model improved discrimination (AUC 0.72 to 0.81). SBVI predicted slower discharge (HR 0.86; 95% CI 0.80–0.93) and greater 12-month cognitive decline (β − 0.47 MoCA points per SD; 95% CI − 0.70 to − 0.25). EEG analyses showed reduced slow-wave activity among individuals with higher SBVI.

Conclusions

SBVI provides a multidomain physiologic measure that predicts delirium, recovery, and long-term cognitive decline in hospitalized older adults. Because its components can be obtained using feasible bedside monitoring, SBVI may enable early identification of vulnerable patients and support targeted geriatric interventions.