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Boots R, Mead G, Rawashdeh O, Bellapart J, Townsend S, Paratz J, Garner N, Clement P, Oddy D. Circadian Hygiene in the ICU Environment (CHIE) study. CRIT CARE RESUSC 2020; 22:361-369. [PMID: 38046884 PMCID: PMC10692571 DOI: 10.51893/2020.4.oa9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the environment and care in the intensive care unit (ICU) and its relationship to patient circadian temperature disruption. Design: 30-day, prospective period prevalence study. Setting: 27-bed tertiary ICU. Participants: Patients expected to remain in the ICU for at least 24 hours. Main outcome measures: Temperature, relative humidity, light and sound intensity in the ICU; nursing interventions (using the Therapeutic Intervention Scoring System-28); and core body temperature of ICU patients. Results: Of 28 patients surveyed, 20 (71%) were mechanically ventilated. Median (interquartile range [IQR]) light intensity peaked at 07:00 at 165 (12-1218) lux with a trough at 23:00 of 15 (12-51) lux and was consistently < 100 lux between 21:00 and 06:00. Peak median (IQR) sound intensity was at 07:00 (62.55 [57.87-68.03] dB) while 58.84 (54.81-64.71) dB at 02:00. Ambient temperature and humidity varied with median (IQR) peaks of 23.11°C (22.74-23.31°C) at 16:00 and 44.07% (32.76-51.08%) at 11:00 and median troughs of 22.37°C (21.79-22.88°C) at 05:00 and 39.95% (31.53-47.95%) at 14:00, respectively. Disturbances to sleep during the night occurred due to care activities including linen changes (15 patients, 54%) and bathing (13, 46%). On the day before and the day of the study, 13 patients (47%) and 10 patients (36%), respectively, had a circadian rhythm on core body temperature without an association with illness severity, nursing intervention or environmental measures. Conclusions: The ICU has low light intensity with relative humidity and ambient temperature not aligned to normal human circadian timing. Noise levels are commonly equivalent to conversational speech while patient care procedures interrupt overnight sleep. The contribution of these factors to disrupted CBT rhythmicity is unclear.
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Affiliation(s)
- Rob Boots
- Thoracic Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Gabrielle Mead
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Oliver Rawashdeh
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Judith Bellapart
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Shane Townsend
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - Jenny Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
- School of Allied Health, Griffith University, Brisbane, QLD, Australia
| | - Nicholas Garner
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pierre Clement
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - David Oddy
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | - On behalf of the Circadian Investigators in Critical Illness
- Thoracic Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, QLD, Australia
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- School of Allied Health, Griffith University, Brisbane, QLD, Australia
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Sleep Deprivation from the Perspective of a Patient Hospitalized in the Intensive Care Unit-Qualitative Study. Healthcare (Basel) 2020; 8:healthcare8030351. [PMID: 32967235 PMCID: PMC7551405 DOI: 10.3390/healthcare8030351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
(1) Introduction: Sleep architecture of Intensive Care Unit (ICU) patients is altered, with over 60% of them reporting sleep disorders or even sleep deprivation during their stay. The aim of the study was to describe the experiences related to sleep and nighttime rest of patients hospitalized in the ICU. (2) Method: the study used a qualitative project based on phenomenology as a research method. A semi-structured interview was used as the method to achieve the goal. The patients’ answers were recorded and transcribed. The data were coded and cross-processed. (3) Results: twenty-three patients were surveyed, fifteen men and eight women. The average age was 49.7 years. The average time of hospitalization was 34.3 days. During the ICU stay, patients required mechanical ventilation through the tracheostomy tube. Five themes were identified from the interview as factors disturbing sleep: fear, noise, light, medical staff, and at home best. (4) Conclusions: chronic anxiety appears to contribute to sleep disturbances in the ICUs, psychological support, and individualized approach to the hospitalized patient seem necessary. By raising the awareness of the essence of sleep among medical staff, environmental factors can be reduced as disturbing sleep. Based on the participants’ comments, it is possible that repeated actions could also increase the patients’ sense of security.
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Daou M, Telias I, Younes M, Brochard L, Wilcox ME. Abnormal Sleep, Circadian Rhythm Disruption, and Delirium in the ICU: Are They Related? Front Neurol 2020; 11:549908. [PMID: 33071941 PMCID: PMC7530631 DOI: 10.3389/fneur.2020.549908] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
Delirium is a syndrome characterized by acute brain failure resulting in neurocognitive disturbances affecting attention, awareness, and cognition. It is highly prevalent among critically ill patients and is associated with increased morbidity and mortality. A core domain of delirium is represented by behavioral disturbances in sleep-wake cycle probably related to circadian rhythm disruption. The relationship between sleep, circadian rhythm and intensive care unit (ICU)-acquired delirium is complex and likely bidirectional. In this review, we explore the proposed pathophysiological mechanisms of sleep disruption and circadian dysrhythmia as possible contributing factors in transitioning to delirium in the ICU and highlight some of the most relevant caveats for understanding the relationship between these complex phenomena. Specifically, we will (1) review the physiological consequences of poor sleep quality and efficiency; (2) explore how the neural substrate underlying the circadian clock functions may be disrupted in delirium; (3) discuss the role of sedative drugs as contributors to delirium and chrono-disruption; and, (4) describe the association between abnormal sleep-pathological wakefulness, circadian dysrhythmia, delirium and critical illness. Opportunities to improve sleep and readjust circadian rhythmicity to realign the circadian clock may exist as therapeutic targets in both the prevention and treatment of delirium in the ICU. Further research is required to better define these conditions and understand the underlying physiologic relationship to develop effective prevention and therapeutic strategies.
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Affiliation(s)
- Marietou Daou
- Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Respirology), University Health Network, Toronto, ON, Canada
| | - Irene Telias
- Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Respirology), University Health Network, Toronto, ON, Canada.,Department of Medicine (Critical Care Medicine), St. Michael's Hospital, Toronto, ON, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | | | - Laurent Brochard
- Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Critical Care Medicine), St. Michael's Hospital, Toronto, ON, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - M Elizabeth Wilcox
- Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine (Respirology), University Health Network, Toronto, ON, Canada
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Duclos C, Dumont M, Paquet J, Blais H, Van der Maren S, Menon DK, Bernard F, Gosselin N. Sleep-wake disturbances in hospitalized patients with traumatic brain injury: association with brain trauma but not with an abnormal melatonin circadian rhythm. Sleep 2020; 43:5575663. [PMID: 31562742 DOI: 10.1093/sleep/zsz191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/08/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To test whether the sleep-wake cycle disruption in patients hospitalized with traumatic brain injury (TBI) (1) is also found in patients with traumatic injuries other than TBI (non-TBI) and (2) is associated with a weaker or abnormal circadian clock signal. METHODS Forty-two non-mechanically ventilated and non-sedated patients hospitalized for moderate-to-severe TBI were compared to 34 non-TBI patients. They wore wrist actigraphs for 9.4 ± 4.2 days, starting 19.3 ± 12.6 days post-injury. Of these, 17 TBI and 14 non-TBI patients had their urine collected every hour for 25 hours, starting 18.3 ± 12.3 days post-injury. We calculated urinary 6-sulfatoxymelatonin concentration to obtain total 24-hour excretion, excretion onset, offset, duration, amplitude, and acrophase. Using Student's t-tests, we compared groups on actigraphy (daytime activity ratio, nighttime total sleep time, and fragmentation index) and melatonin variables. We investigated associations between melatonin and actigraphy variables using Pearson's correlations. RESULTS TBI patients had poorer daytime activity ratio (TBI: 77.5 ± 9.4%; non-TBI: 84.6 ± 6.9%), shorter nighttime total sleep time (TBI: 353.5 ± 96.6 min; non-TBI: 421.2 ± 72.2 min), and higher fragmentation index (TBI: 72.2 ± 30.0; non-TBI: 53.5 ± 23.6) (all p-values < 0.01). A melatonin rhythm was present in both groups, and no group differences were found on melatonin variables. No associations were found between melatonin and actigraphy variables in TBI patients. CONCLUSION Moderate-to-severe TBI patients have more serious sleep-wake disturbances than non-TBI patients hospitalized in the same environment, suggesting that the brain injury itself alters the sleep-wake cycle. Despite their deregulated 24-hour sleep-wake cycle, TBI patients have a normal circadian clock signal.
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Affiliation(s)
- Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Marie Dumont
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Jean Paquet
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada
| | - Solenne Van der Maren
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - David K Menon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Francis Bernard
- Department of Intensive Care, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada.,Department of Medicine, Université de Montréal, Montréal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
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55
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Diallo AB, Coiffard B, Leone M, Mezouar S, Mege JL. For Whom the Clock Ticks: Clinical Chronobiology for Infectious Diseases. Front Immunol 2020; 11:1457. [PMID: 32733482 PMCID: PMC7363845 DOI: 10.3389/fimmu.2020.01457] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
The host defense against pathogens varies among individuals. Among the factors influencing host response, those associated with circadian disruptions are emerging. These latter depend on molecular clocks, which control the two partners of host defense: microbes and immune system. There is some evidence that infections are closely related to circadian rhythms in terms of susceptibility, clinical presentation and severity. In this review, we overview what is known about circadian rhythms in infectious diseases and update the knowledge about circadian rhythms in immune system, pathogens and vectors. This heuristic approach opens a new fascinating field of time-based personalized treatment of infected patients.
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Affiliation(s)
- Aïssatou Bailo Diallo
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Benjamin Coiffard
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Aix-Marseille Univ, AP-HM, Hôpital Nord, Médecine Intensive-Réanimation, Marseille, France
| | - Marc Leone
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Aix-Marseille Univ, AP-HM, CHU Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Soraya Mezouar
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Jean-Louis Mege
- Aix-Marseille Univ, MEPHI, IRD, AP-HM, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,AP-HM, UF Immunologie, Marseille, France
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56
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Hartman ME, Williams CN, Hall TA, Bosworth CC, Piantino JA. Post-Intensive-Care Syndrome for the Pediatric Neurologist. Pediatr Neurol 2020; 108:47-53. [PMID: 32299742 PMCID: PMC7306429 DOI: 10.1016/j.pediatrneurol.2020.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
Abstract
The number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-intensive-care morbidity. Critical illness in childhood affects a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the intensive care unit and continue after discharge has recently been termed post-intensive-care syndrome. A conceptual model of the post-intensive-care syndrome experienced by children who survive critical illness, their siblings, and parents has been coined post-intensive-care syndrome in pediatrics. Owing to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurological injury are among those at the highest risk for post-intensive-care syndrome in pediatrics. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization and remains involved after the patient leaves the hospital. Hence it is important for pediatric neurologists to become versed in the early recognition and management of post-intensive-care syndrome in pediatrics. In this review, we discuss the current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics, which have been successfully implemented at our institutions. Dissemination of this "road map" may assist others interested in establishing recovery programs, therefore mitigating the burden of post-intensive-care morbidity in children.
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Affiliation(s)
- Mary E. Hartman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Critical care, Oregon Health & Science University
| | - Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Christopher C. Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Juan A. Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University
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57
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Davidson S, Villarroel M, Harford M, Finnegan E, Jorge J, Young D, Watkinson P, Tarassenko L. Vital-sign circadian rhythms in patients prior to discharge from an ICU: a retrospective observational analysis of routinely recorded physiological data. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:181. [PMID: 32345354 PMCID: PMC7189546 DOI: 10.1186/s13054-020-02861-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/30/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Shaun Davidson
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Mauricio Villarroel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Mirae Harford
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.,Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Eoin Finnegan
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Joao Jorge
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Duncan Young
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Watkinson
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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58
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Abstract
PURPOSE OF REVIEW This review summarizes the results from long-term intensive care outcome research over the past 50 years. Key findings from early studies are reflected in citations of contemporary research. RECENT FINDINGS The postintensive care syndrome (PICS) is a multifaceted entity of residual disability and complications burdening survivors of critical illness. Some interventions applied early in the history of outcomes research have now been confirmed as effective in counteracting specific PICS components. SUMMARY Interest in patient-centred outcomes has been present since the beginning of modern intensive care. Findings from early long-term studies remain valid even in the face of contemporary large registries that facilitate follow-up of larger cohorts. A further understanding of the mechanisms leading to experienced physical and psychological impairment of PICS will be essential to the design of future intervention trials.
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Abstract
PURPOSE OF REVIEW The alteration of circadian rhythms in the postoperative period has been demonstrated to influence the outcomes. With this narrative review we would revise how anesthesia, surgery and intensive care can interfere with the circadian clock, how this could impact on the postsurgical period and how to limit the disruption of the internal clock. RECENT FINDINGS Anesthesia affects the clock in relation to the day-time administration and the type of anesthetics, N-methyl-D-aspartate receptor antagonists or gamma-aminobutyric acid receptors agonists. Surgery causes stress and trauma with consequent alteration in the circadian release of cortisol, cytokines and melatonin. ICU represents a further challenge for the patient internal clock because of sedation, immobility, mechanical ventilation and alarms noise. SUMMARY The synergic effect of anesthesia, surgery and postoperative intensive care on circadian rhythms require a careful approach to the patient considering a role for therapies and interventions aimed to re-establish the normal circadian rhythms. Over time, approach like the Awakening and Breathing Coordination, Delirium Monitoring and Management, Early Mobility and Family engagement and empowerment bundle can implement the clinical practice.
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60
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Yang PL, Ward TM, Burr RL, Kapur VK, McCurry SM, Vitiello MV, Hough CL, Parsons EC. Sleep and Circadian Rhythms in Survivors of Acute Respiratory Failure. Front Neurol 2020; 11:94. [PMID: 32117040 PMCID: PMC7033606 DOI: 10.3389/fneur.2020.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Little is known about sleep and circadian rhythms in survivors of acute respiratory failure (ARF) after hospital discharge. Objectives: To examine sleep and rest-activity circadian rhythms in ARF survivors 3 months after hospital discharge, and to compare them with a community-dwelling population. Methods: Sleep diary, actigraphy data, and insomnia symptoms were collected in a pilot study of 14 ARF survivors. Rest-activity circadian rhythms were assessed with wrist actigraphy and sleep diary for 9 days, and were analyzed by cosinor and non-parametric circadian rhythm analysis. Results: All participants had remarkable actigraphic sleep fragmentation, 71.5% had subclinical or clinical insomnia symptoms. Compared to community-dwelling adults, this cohort had less stable rest-activity circadian rhythms (p < 0.001), and weaker circadian strength (p < 0.001). Conclusion: Insomnia and circadian disruption were common in ARF survivors. Sleep improvement and circadian rhythm regularity may be a promising approach to improve quality of life and daytime function after ARF.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Teresa M. Ward
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Robert L. Burr
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Vishesh K. Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
| | - Susan M. McCurry
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Catherine L. Hough
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
| | - Elizabeth C. Parsons
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
- VA Puget Sound Health Care System, Seattle, WA, United States
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61
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Fares A, Zhong SH, Jiang J. EEG-based image classification via a region-level stacked bi-directional deep learning framework. BMC Med Inform Decis Mak 2019; 19:268. [PMID: 31856818 PMCID: PMC6921386 DOI: 10.1186/s12911-019-0967-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As a physiological signal, EEG data cannot be subjectively changed or hidden. Compared with other physiological signals, EEG signals are directly related to human cortical activities with excellent temporal resolution. After the rapid development of machine learning and artificial intelligence, the analysis and calculation of EEGs has made great progress, leading to a significant boost in performances for content understanding and pattern recognition of brain activities across the areas of both neural science and computer vision. While such an enormous advance has attracted wide range of interests among relevant research communities, EEG-based classification of brain activities evoked by images still demands efforts for further improvement with respect to its accuracy, generalization, and interpretation, yet some characters of human brains have been relatively unexplored. METHODS We propose a region-level stacked bi-directional deep learning framework for EEG-based image classification. Inspired by the hemispheric lateralization of human brains, we propose to extract additional information at regional level to strengthen and emphasize the differences between two hemispheres. The stacked bi-directional long short-term memories are used to capture the dynamic correlations hidden from both the past and the future to the current state in EEG sequences. RESULTS Extensive experiments are carried out and our results demonstrate the effectiveness of our proposed framework. Compared with the existing state-of-the-arts, our framework achieves outstanding performances in EEG-based classification of brain activities evoked by images. In addition, we find that the signals of Gamma band are not only useful for achieving good performances for EEG-based image classification, but also play a significant role in capturing relationships between the neural activations and the specific emotional states. CONCLUSIONS Our proposed framework provides an improved solution for the problem that, given an image used to stimulate brain activities, we should be able to identify which class the stimuli image comes from by analyzing the EEG signals. The region-level information is extracted to preserve and emphasize the hemispheric lateralization for neural functions or cognitive processes of human brains. Further, stacked bi-directional LSTMs are used to capture the dynamic correlations hidden in EEG data. Extensive experiments on standard EEG-based image classification dataset validate that our framework outperforms the existing state-of-the-arts under various contexts and experimental setups.
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Affiliation(s)
- Ahmed Fares
- The Research Institute for Future Media Computing, College of Computer Science & Software Engineering, Shenzhen University, Shenzhen, 518060 China
- Department of Electrical Engineering, Computer Engineering branch, Faculty of Engineering at Shoubra, Benha University, Shoubra, Egypt
| | - Sheng-hua Zhong
- The Research Institute for Future Media Computing, College of Computer Science & Software Engineering, Shenzhen University, Shenzhen, 518060 China
- National Engineering Laboratory for Big Data System Computing Technology, Shenzhen University, Shenzhen, Shenzhen, 518060 China
- Guangdong Key Laboratory of Intelligent Information Processing, Shenzhen University, Shenzhen, 518060 China
| | - Jianmin Jiang
- The Research Institute for Future Media Computing, College of Computer Science & Software Engineering, Shenzhen University, Shenzhen, 518060 China
- National Engineering Laboratory for Big Data System Computing Technology, Shenzhen University, Shenzhen, Shenzhen, 518060 China
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Telias I, Ferguson ND. Added Benefit of Noninvasive Ventilation to High-Flow Nasal Oxygen to Prevent Reintubation in Higher-Risk Patients. JAMA 2019; 322:1455-1457. [PMID: 31577031 DOI: 10.1001/jama.2019.14609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Irene Telias
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Sinai Health System, Toronto, Ontario, Canada
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Sinai Health System, Toronto, Ontario, Canada
- Departments of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
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Li J, Li R, Gao Y, Zhang J, Zhao Y, Zhang X, Wang G. Nocturnal Mean Arterial Pressure Rising Is Associated With Mortality in the Intensive Care Unit: A Retrospective Cohort Study. J Am Heart Assoc 2019; 8:e012388. [PMID: 31566067 PMCID: PMC6806033 DOI: 10.1161/jaha.119.012388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Disrupted circadian rhythm of blood pressure is commonly observed in patients in the intensive care unit (ICU). This study assessed the association of nocturnal mean arterial pressure rising (NMAPR) with short‐ and long‐term mortality in critically ill adult patients. Methods and Results Adult patients with a complete record of mean arterial pressure monitoring during the first 24 hours of ICU stay in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC‐II) database were included in this retrospective cohort study. All patients were divided into the non‐NMAPR group (≤1) or the NMAPR group (>1), according to the value of mean nighttime divided by daytime mean arterial pressure. The associations of NMAPR with ICU, hospital, 28‐day, and 1‐year mortality were assessed using multivariable logistic regression or a Cox proportional hazards model. Interaction and subgroup analyses were performed for those patients who had a first Sequential Organ Failure Assessment (SOFA) score of ≥8 or <8. The overall cohort comprised 5185 patients. The patients with NMAPR (n=1865) had higher ICU, hospital, 28‐day, and 1‐year mortality than the non‐NMAPR group (n=3320). After adjusting for covariates, the analysis showed that NMAPR was significantly associated with mortality in the ICU (odds ratio: 1.34; 95% CI, 1.10–1.65), in the hospital (odds ratio: 1.35; 95% CI, 1.12–1.63), at 28 days (hazard ratio: 1.27; 95% CI, 1.10–1.48), and at 1 year (hazard ratio: 1.24; 95% CI, 1.10–1.40). All results of the interaction analysis had no statistical significance, and similar results persisted in the patients with different SOFA scores. Conclusions NMAPR may aid in the early identification of critically ill patients at high risk of ICU, hospital, 28‐day, or 1‐year mortality.
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Affiliation(s)
- Jiamei Li
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ruohan Li
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ya Gao
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Jingjing Zhang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Yujie Zhao
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Xiaoling Zhang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Gang Wang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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