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Singh G, Nguyen C, Kuschner W. Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review. J Intensive Care Med 2024:8850666241255345. [PMID: 38881385 DOI: 10.1177/08850666241255345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background: Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. Methods: PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Results: Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. Conclusions: While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects.
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Affiliation(s)
- Gaurav Singh
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Christopher Nguyen
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Ware Kuschner
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
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Sirilaksanamanon P, Thawitsri T, Charuluxananan S, Chirakalwasan N. Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit. Indian J Crit Care Med 2023; 27:795-800. [PMID: 37936795 PMCID: PMC10626235 DOI: 10.5005/jp-journals-10071-24555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023] Open
Abstract
Purpose Monitoring and improving sleep quality may help recovery from major illness. Polysomnography is a gold standard for measuring sleep quality, but routine use is not practical. The goal of this study is to investigate the diagnostic accuracy of an alternative monitor, the Bispectral Index (BIS), for evaluating the quality of sleep-in postoperative patients in the intensive care unit (ICU). Study design An observational study. Materials and methods Patients admitted to postoperative ICU after elective major noncardiac surgery were monitored with both BIS and PSG during the first night. The temporally synchronized data from both monitors were obtained for measurement of the association. Clinical outcomes were compared between patients with different postoperative sleep quality. Results Thirty-three patients were enrolled in this study. For determining the average BIS index associated with good postoperative sleep quality, receiver operating characteristics (ROC) curve was generated. Area under the ROC curve (AUC) was 0.65. The cutoff with best discriminability was 75 with a sensitivity of 68% and a specificity of 56%. Compared with those with good and poor postoperative sleep quality, there were no differences in main postoperative outcomes including duration of mechanical ventilation and ICU stay. Although the quality of sleep after surgery of all subjects with postoperative delirium was poor, the incidence of delirium between the groups did not significantly differ (0% vs 10.3%; p = 0.184). Conclusion The monitoring of BIS is a viable tool for evaluating sleep quality in mechanically ventilated patients in the postoperative ICU with acceptable precision. Trial registration www.clinicaltrials.in.th, TCTR20200310005. How to cite this article Sirilaksanamanon P, Thawitsri T, Charuluxananan S, Chirakalwasan N. Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit. Indian J Crit Care Med 2023;27(11):795-800.
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Affiliation(s)
- Pongpol Sirilaksanamanon
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thammasak Thawitsri
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Younes M. New insights and potential clinical implications of the odds ratio product. Front Neurol 2023; 14:1273623. [PMID: 37885480 PMCID: PMC10598615 DOI: 10.3389/fneur.2023.1273623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
The odds ratio product (ORP) is a continuous metric of sleep depth that ranges from 0 (very deep sleep) to 2. 5 (full wakefulness). Its advantage over the conventional method recommended by AASM is that it discloses different levels of stage wake (sleep propensity) and different sleep depths within the same sleep stage. As such, it can be used to identify differences in sleep depth between subjects, and in the same subjects under different circumstances, when differences are not discernible by conventional staging. It also identifies different sleep depths within stage rapid-eye-movement sleep, with possible implications to disorders during this stage. Epoch-by-epoch ORP can be displayed graphically across the night or as average values in conventional sleep stages. In addition, ORP can be reported as % of recording time in specific ORP ranges (e.g., deciles of the total ORP range) where it produces distinct distribution patterns (ORP-architecture) that have been associated with different clinical disorders and outcomes. These patterns offer unique research opportunities to identify different mechanisms and potential therapy for various sleep complaints and disorders. In this review I will discuss how ORP is measured, its validation, differences from delta power, and the various phenotypes, and their postulated mechanisms, identified by ORP architecture and the opportunities for research to advance management of sleep-disordered breathing, insomnia and idiopathic hypersomnia.
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Affiliation(s)
- Magdy Younes
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Jamil R, Goins T, Partlow K, Barger K, Mihalek AD. Application of the Plan-Do-Study-Act method to optimize the ordering and administration of dexmedetomidine for sleep hygiene in the intensive care unit. Am J Health Syst Pharm 2023; 80:S97-S102. [PMID: 36477261 DOI: 10.1093/ajhp/zxac360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
PURPOSE To describe the Plan-Do-Study-Act (PDSA) methodology utilized by a multidisciplinary team to address the discordance between ordering and administration of dexmedetomidine for sleep hygiene in the intensive care unit (ICU). SUMMARY The addition of sleep hygiene as an indication for the use of dexmedetomidine at University of Virginia (UVA) Health led to discordance between the medication orders in the electronic medical record and the subsequent administration of dexmedetomidine. A multidisciplinary team implemented interventions that included modifying the order panel, streamlining the institutional formulary, developing institutional practice guidelines, and providing education to healthcare team members. After completion of the first PDSA cycle, the mean number of discordant order elements decreased to 1.96 out of 5 possible order elements from an initial 2.5 out of 5 elements before the interventions, meeting the aim to reduce the mean to less than 2. There was a significant decrease in the discordance in the duration of infusion (discordant for 14 of 30 orders before the interventions vs 1 of 28 orders after the interventions, P = 0.0002) but a significant increase in the discordance in the titration dose (discordant for 13 of 30 orders before the interventions vs 24 of 28 orders after the interventions, P < 0.0001). Other discordant order elements including the starting dose, maximum rate, and titration interval time decreased in frequency after the interventions, although the differences were not statistically significant. The interventions made during the first PDSA cycle are anticipated to lead to an estimated cost savings of up to $180,000 per year within the UVA Health system. CONCLUSION The multidisciplinary team utilizing a PDSA method to modify the order panel, streamline the institutional formulary, develop institutional practice guidelines, and provide education to healthcare team members was effective at reducing overall discordance between order intent and administration of dexmedetomidine for sleep hygiene in the ICU.
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Affiliation(s)
- Rita Jamil
- University of Virginia Health, Charlottesville, VA, USA
| | - Taylor Goins
- University of Virginia Health, Charlottesville, VA, USA
| | - Karen Partlow
- University of Virginia Health, Charlottesville, VA, USA
| | - Kendall Barger
- Department of Medical ICU, University of Virginia Health, Charlottesville, VA, USA
| | - Andrew D Mihalek
- Division of Pulmonary and Critical Care Medicine, University of Virginia Health, Charlottesville, VA, USA
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5
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Ahn YH, Lee HY, Lee SM, Lee J. Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea. Acute Crit Care 2023; 38:278-285. [PMID: 37562953 PMCID: PMC10497899 DOI: 10.4266/acc.2023.00514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND As sleep disturbances are common in the intensive care unit (ICU), this study assessed the sleep quality in the ICU and identified barriers to sleep. METHODS Patients admitted to the ICUs of a tertiary hospital between June 2022 and December 2022 who were not mechanically ventilated at enrollment were included. The quality of sleep (QoS) at home was assessed on a visual analog scale as part of an eight-item survey, while the QoS in the ICU was evaluated using the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ). Good QoS was defined by a score of ≥50. RESULTS Of the 30 patients in the study, 19 reported a QoS score <50. The Spearman correlation coefficient showed no meaningful relationship between the QoS at home and the overall K-RCSQ QoS score in the ICU (r=0.16, P=0.40). The most common barriers to sleep were physical discomfort (43%), being awoken for procedures (43%), and feeling unwell (37%); environmental factors including noise (30%) and light (13%) were also identified sources of sleep disruption. Physical discomfort (median [interquartile range]: 32 [28.0-38.0] vs. 69 [42.0-80.0], P=0.004), being awoken for procedures (36 [20.0-48.0] vs. 54 [36.0-80.0], P=0.04), and feeling unwell (31 [18.0-42.0] vs. 54 [40.0-76.0], P=0.01) were associated with lower K-RCSQ scores. CONCLUSIONS In the ICU, physical discomfort, patient care interactions, and feeling unwell were identified as barriers to sleep.
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Affiliation(s)
- Yoon Hae Ahn
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Min Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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6
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Park SH, Shin HK, Kim KW. COVID-19 hospital indoor environments and how it helped patients' recovery and staff's work: a case study in South Korea. Front Psychol 2023; 14:1192842. [PMID: 37484076 PMCID: PMC10359886 DOI: 10.3389/fpsyg.2023.1192842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023] Open
Abstract
The indoor environment has been recognized as a crucial factor that can influence health and wellbeing of occupants. This is particularly true in hospital settings, where various environmental attributes can significantly affect patients' recovery and staff members' productivity. The present study aimed to investigate how occupants in hospitals perceived indoor environment, focusing specifically on COVID-19 hospitals across Republic of Korea. The study recruited two groups of participants: patients (n = 100) who had been hospitalized in COVID-19 hospitals and staff members (n = 103) who worked in COVID-19 hospitals. The data collected from the participants were analyzed using multiple regression models to determine which environmental attributes significantly affected their perception of the indoor environment. The study revealed that satisfaction with indoor acoustic environment and odor were significant predictors for how patients perceived the indoor environment as helpful for their recovery from COVID-19. On the other hand, odor was also the significant factor affecting staff members' perceived helpfulness for work. The results suggested that different environmental attributes can have a significant impact on the perception of the indoor environment, depending on the characteristics of occupancy. The study's findings provided insights into the certain environmental factors that COVID-19 hospitals can prioritize. These insights can help policymakers and hospital administrators to develop strategies to create hospital environments that meet the needs of both groups. The study also suggested that further research is needed to investigate additional factors affecting occupants' perception of the indoor environment in hospital settings.
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Affiliation(s)
| | | | - Kyoung-Woo Kim
- Department of Building Research, Korea Institute of Civil Engineering and Building Technology, Goyang-si, Republic of Korea
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Dulko E, Jedrusiak M, Osuru HP, Atluri N, Illendula M, Davis EM, Beenhakker MP, Lunardi N. Sleep Fragmentation, Electroencephalographic Slowing, and Circadian Disarray in a Mouse Model for Intensive Care Unit Delirium. Anesth Analg 2023; 137:209-220. [PMID: 37192134 DOI: 10.1213/ane.0000000000006524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND We aimed to further validate our previously published animal model for delirium by testing the hypothesis that in aged mice, Anesthesia, Surgery and simulated ICU conditions (ASI) induce sleep fragmentation, electroencephalographic (EEG) slowing, and circadian disarray consistent with intensive care unit (ICU) patients with delirium. METHODS A total of 41 mice were used. Mice were implanted with EEG electrodes and randomized to ASI or control groups. ASI mice received laparotomy, anesthesia, and simulated ICU conditions. Controls did not receive ASI. Sleep was recorded at the end of ICU conditions, and hippocampal tissue was collected on EEG recording. Arousals, EEG dynamics, and circadian gene expression were compared with t tests. Two-way repeated measures analysis of variance (RM ANOVA) was used to assess sleep according to light. RESULTS ASI mice experienced frequent arousals (36.6 ± 3.2 vs 26.5 ± 3.4; P = .044; 95% confidence interval [CI], 0.29-19.79; difference in mean ± SEM, 10.04 ± 4.62) and EEG slowing (frontal theta ratio, 0.223 ± 0.010 vs 0.272 ± 0.019; P = .026; 95% CI, -0.091 to -0.007; difference in mean ± SEM, -0.05 ± 0.02) relative to controls. In ASI mice with low theta ratio, EEG slowing was associated with a higher percentage of quiet wakefulness (38.2 ± 3.6 vs 13.4 ± 3.8; P = .0002; 95% CI, -35.87 to -13.84; difference in mean ± SEM, -24.86 ± 5.19). ASI mice slept longer during the dark phases of the circadian cycle (nonrapid eye movement [NREM], dark phase 1 [D1]: 138.9 ± 8.1 minutes vs 79.6 ± 9.6 minutes, P = .0003, 95% CI, -95.87 to -22.69, predicted mean difference ± SE: -59.28 ± 13.89; NREM, dark phase 2 (D2): 159.3 ± 7.3 minutes vs 112.6 ± 15.5 minutes, P = .006, 95% CI, -83.25 to -10.07, mean difference ± SE, -46.66 ± 13.89; rapid eye movement (REM), D1: 20.5 ± 2.1 minutes vs 5.8 ± 0.8 minutes, P = .001, 95% CI, -24.60 to -4.71, mean difference ± SE, -14. 65 ± 3.77; REM, D2: 21.0 ± 2.2 minutes vs 10.3 ± 1.4 minutes, P = .029, 95% CI, -20.64 to -0.76, mean difference ± SE, -10.70 ± 3.77). The expression of essential circadian genes was also lower in ASI mice (basic helix-loop-helix ARNT like [BMAL1] : -1.3 fold change; circadian locomotor output cycles protein kaput [CLOCK] : -1.2). CONCLUSIONS ASI mice experienced EEG and circadian changes mimicking those of delirious ICU patients. These findings support further exploration of this mouse approach to characterize the neurobiology of delirium.
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Affiliation(s)
| | | | | | | | | | | | - Mark P Beenhakker
- Pharmacology, University of Virginia Health, Charlottesville, Virginia
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Oxlund J, Knudsen T, Leonthin H, Toft P, Jennum PJ. Subjective sleep assessment compared to polysomnography in mechanically ventilated critically ill ICU patients. Acta Anaesthesiol Scand 2023; 67:311-318. [PMID: 36576326 DOI: 10.1111/aas.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
Sleep deprivation is expected in the intensive care unit (ICU) and is associated with delirium and increased mortality. Polysomnography (PSG) is the gold standard for sleep assessment, but practical issues limit the method. Hence, many ICUs worldwide use subjective sleep assessment (SSA) for sleep monitoring, but the agreement between SSA and PSG is unknown. The hypothesis was that the level of agreement between SSA and PSG was low and that total sleep time (TST) assessed with SSA would be overestimated compared to PSG in this existing cohort database. In this sub-analysis, 30 consecutive study participants underwent 15-h PSG recordings during two consecutive nights. The attending nurse performed an hourly subjective observer rating of sleep quantity during both nights, and the agreement between SSA and PSG was determined along with mean TST. Primary outcome: The level of agreement between SSA and PSG determined by Bland-Altman analysis. Secondary outcome: (1) The overall mean TST estimated by SSA compared to PSG in all study participants enrolled in the main study during both study nights, (2) TST for all study participants evaluated hourly during both study nights, (3) TST assessed with SSA compared to PSG in study participants sedated with dexmedetomidine during the second night and for study participants treated with placebo or non-sedation the first and second nights. The level of agreement between SSA and PSG was low. Mean TST estimated by SSA during the time interval 4.00 p.m. to 7.00 a.m. was 481 min (428;534, 95% CI) vs. PSG at 437 min (386;488, 95% CI) (p = .05). When sedated with dexmedetomidine, TST estimated using SSA was 650 min (571;729, 95% CI) versus PSG which was 588 min (531;645, 95% CI) (p = 0.56). For participants treated with placebo or non-sedation TST estimated with SSA was 397 min (343;450, 95% CI) versus PSG at 362 min (302;422, 95% CI) versus (p = 0.17). In mechanically ventilated critically ill ICU patients, the level of agreement between SSA and PSG was low, and there was a significant overestimation of mean TST. SSA should only be used under awareness that it is imprecise and overestimates TST.
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Affiliation(s)
- Jakob Oxlund
- Department of Anesthesiology and Intensive Care, Hospital of Southwest Jutland Esbjerg, Esbjerg, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Hospital of Southwest Jutland Esbjerg, Esbjerg, Denmark
| | - Helle Leonthin
- Department of Neurophysiology Rigshospitalet, Danish Center of Sleep Medicine (DCSM), Glostrup, Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Poul Jørgen Jennum
- Department of Neurophysiology Rigshospitalet, Danish Center of Sleep Medicine (DCSM), Glostrup, Denmark
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Oxlund J, Knudsen T, Sörberg M, Strøm T, Toft P, Jennum PJ. Sleep quality and quantity determined by polysomnography in mechanically ventilated critically ill patients randomized to dexmedetomidine or placebo. Acta Anaesthesiol Scand 2023; 67:66-75. [PMID: 36194395 PMCID: PMC10092531 DOI: 10.1111/aas.14154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/24/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Abnormal sleep is commonly observed in the ICU and is associated with delirium and increased mortality. If sedation is necessary, it is often performed with gamma-aminobutyric acid agonists such as propofol or midazolam leading to an absence of restorative sleep. We aim to evaluate the effect of dexmedetomidine on sleep quality and quantity. METHODS Thirty consecutive patients were included. The study was conducted as a double-blinded, randomized, placebo-controlled trial with two parallel groups: 20 patients were treated with dexmedetomidine, and 10 with placebo. Two 16 h of polysomnography recordings were done for each patient on two consecutive nights. Patients were randomized to dexmedetomidine or placebo after the first recording, thus providing a control recording for all patients. Dexmedetomidine was administered during the second recording (6 p.m.-6 a.m.). OBJECTIVE To compare the effect of dexmedetomidine versus. placebo on sleep - quality and quantity. PRIMARY OUTCOME Sleep quality, total sleep time (TST), Sleep efficiency (SE), and Rapid Eye Movement (REM) sleep determined by Polysomnography (PSG). SECONDARY OUTCOME Delirium and daytime function determined by Confusion Assessment Method of the Intensive Care Unit and physical activity. Alertness and wakefulness were determined by RASS (Richmond Agitation and Sedation Scale). RESULTS SE were increased in the dexmedetomidine group by; 37.6% (29.7;45.6 95% CI) versus 3.7% (-11.4;18.8 95% CI) (p < .001) and TST were prolonged by 271 min. (210;324 95% CI) versus 27 min. (-82;135 95% CI), (p < .001). No significant difference in REM sleep, delirium physical activity, or RASS score was found except for RASS night two. CONCLUSION Total sleep time and sleep efficiency were significantly increased, without elimination of REM sleep, in mechanically ventilated ICU patients randomized to dexmedetomidine, when compared to a control PSG recording performed during non-sedation/standard care.
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Affiliation(s)
- Jakob Oxlund
- Department of Anesthesiology and Intensive Care, Hospital of Southwest Jutland Esbjerg, Esbjerg, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Hospital of Southwest Jutland Esbjerg, Esbjerg, Denmark
| | - Mikael Sörberg
- Departments of Infectious Diseases, Karolinska university hospital, Solna, Sweden
| | - Thomas Strøm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Poul Jørgen Jennum
- Department of Neurophysiology, Danish Center of Sleep Medicine (DCSM), Glostrup, Denmark
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Ganglberger W, Krishnamurthy PV, Quadri SA, Tesh RA, Bucklin AA, Adra N, Da Silva Cardoso M, Leone MJ, Hemmige A, Rajan S, Panneerselvam E, Paixao L, Higgins J, Ayub MA, Shao YP, Coughlin B, Sun H, Ye EM, Cash SS, Thompson BT, Akeju O, Kuller D, Thomas RJ, Westover MB. Sleep staging in the ICU with heart rate variability and breathing signals. An exploratory cross-sectional study using deep neural networks. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1120390. [PMID: 36926545 PMCID: PMC10013021 DOI: 10.3389/fnetp.2023.1120390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023]
Abstract
Introduction: To measure sleep in the intensive care unit (ICU), full polysomnography is impractical, while activity monitoring and subjective assessments are severely confounded. However, sleep is an intensely networked state, and reflected in numerous signals. Here, we explore the feasibility of estimating conventional sleep indices in the ICU with heart rate variability (HRV) and respiration signals using artificial intelligence methods Methods: We used deep learning models to stage sleep with HRV (through electrocardiogram) and respiratory effort (through a wearable belt) signals in critically ill adult patients admitted to surgical and medical ICUs, and in age and sex-matched sleep laboratory patients Results: We studied 102 adult patients in the ICU across multiple days and nights, and 220 patients in a clinical sleep laboratory. We found that sleep stages predicted by HRV- and breathing-based models showed agreement in 60% of the ICU data and in 81% of the sleep laboratory data. In the ICU, deep NREM (N2 + N3) proportion of total sleep duration was reduced (ICU 39%, sleep laboratory 57%, p < 0.01), REM proportion showed heavy-tailed distribution, and the number of wake transitions per hour of sleep (median 3.6) was comparable to sleep laboratory patients with sleep-disordered breathing (median 3.9). Sleep in the ICU was also fragmented, with 38% of sleep occurring during daytime hours. Finally, patients in the ICU showed faster and less variable breathing patterns compared to sleep laboratory patients Conclusion: The cardiovascular and respiratory networks encode sleep state information, which, together with artificial intelligence methods, can be utilized to measure sleep state in the ICU.
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Affiliation(s)
- Wolfgang Ganglberger
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.,Sleep and Health Zurich, University of Zurich, Zurich, Switzerland.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Parimala Velpula Krishnamurthy
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Syed A Quadri
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Ryan A Tesh
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Abigail A Bucklin
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Noor Adra
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Madalena Da Silva Cardoso
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Michael J Leone
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Aashritha Hemmige
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Subapriya Rajan
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Ezhil Panneerselvam
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Luis Paixao
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Jasmine Higgins
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Muhammad Abubakar Ayub
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Yu-Ping Shao
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Brian Coughlin
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | - Elissa M Ye
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - B Taylor Thompson
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
| | | | - Robert J Thomas
- Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Department of Medicine, Division of Pulmonary, Critical Care and Sleep, Boston, MA, United States
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, MGH, Boston, MA, United States.,Clinical Data Animation Center (CDAC), Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States
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11
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Mansour W, Knauert M. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Clin Chest Med 2022; 43:287-303. [PMID: 35659026 PMCID: PMC9177053 DOI: 10.1016/j.ccm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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12
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Oxlund J, Toft P, Sörberg M, Knudsen T, Jørgen Jennum P. Dexmedetomidine and sleep quality in mechanically ventilated critically ill patients: study protocol for a randomised placebo-controlled trial. BMJ Open 2022; 12:e050282. [PMID: 35351693 PMCID: PMC8961120 DOI: 10.1136/bmjopen-2021-050282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Sleep deprivation, which is a common complication in the intensive care unit (ICU), is associated with delirium and increased mortality. Sedation with gamma-aminobutyric acid agonists (propofol, benzodiazepine) results in significant disturbance of the sleep architecture. Dexmedetomidine is a lipophilic imidazole with an affinity for α2-adrenoceptors and it has sedative and analgesic properties. It has been reported to enhance sleep efficiency, thus sedate while preserving sleep architecture. METHODS AND ANALYSIS Thirty consecutive patients are planned to be included, at the Department of Anesthesia and Intensive Care at the Hospital of Southwest Jutland, Denmark. The study is a double-blinded, randomised, controlled trial with two parallel groups (2:1 allocation ratio). Screening and inclusion will be done on day 1 from 8:00 to 16:00. Two 16 hours PSG (polysomnography) recording will be done starting at 16:00 on day 1 and day 2. Randomisation is performed if the first recording is of acceptable quality, otherwise the patient is excluded before randomisation. Dexmedetomidine/placebo will be administered during the second recording from 18:00 on day 2 to 6:00 on day 3. PRIMARY ENDPOINT Improvement of total sleep time and sleep quality of clinical significance determined by PSG. SECONDARY ENDPOINTS Sleep phases determined by PSG. Daytime function and delirium determined by Confusion Assessment Method-ICU. Alertness and wakefulness determined by Richmonde Agitation Sedation Scale. The objective is to compare the effect of dexmedetomidine versus placebo on sleep quality in critical ill mechanically ventilated patients. ETHICS AND DISSEMINATION The trial investigate the potential benefit of dexmedetomidine on clinically relevant endpoints. If a beneficial effect is shown, this would have a large impact on future treatment of mechanically ventilated critically ill patients. Publication in peer-reviewed journal are plannedand the study has been approved by the National Committee on Health Research Ethics (ID:S-20180214). TRIAL REGISTRATION NUMBER EudraCT (2017-001612-11DK) and Danish National Committee on Health Research Ethics (ID:S-20180214). The study related to pre-results.
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Affiliation(s)
- Jakob Oxlund
- Anaesthesia and Intensive Care, Hospital of South West Jutland, Esbjerg, Denmark
| | - Palle Toft
- Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Mikael Sörberg
- Departments of Infectious Diseases, Karolinska University Hospital, Solna, Sweden
| | - Torben Knudsen
- Gastroenterology, Hospital South West Jutland, Esbjerg, Denmark
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine. Department of Clinical Neurophysiology, Rigshospital - Glostrup Hostpital, Copenhagen, Denmark
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13
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Zhou Y, Zhao G, Li J, Sun G, Qian X, Moody B, Mark RG, Lehman LWH. A contrastive learning approach for ICU false arrhythmia alarm reduction. Sci Rep 2022; 12:4689. [PMID: 35304473 PMCID: PMC8933571 DOI: 10.1038/s41598-022-07761-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
The high rate of false arrhythmia alarms in Intensive Care Units (ICUs) can lead to disruption of care, negatively impacting patients’ health through noise disturbances, and slow staff response time due to alarm fatigue. Prior false-alarm reduction approaches are often rule-based and require hand-crafted features from physiological waveforms as inputs to machine learning classifiers. Despite considerable prior efforts to address the problem, false alarms are a continuing problem in the ICUs. In this work, we present a deep learning framework to automatically learn feature representations of physiological waveforms using convolutional neural networks (CNNs) to discriminate between true vs. false arrhythmia alarms. We use Contrastive Learning to simultaneously minimize a binary cross entropy classification loss and a proposed similarity loss from pair-wise comparisons of waveform segments over time as a discriminative constraint. Furthermore, we augment our deep models with learned embeddings from a rule-based method to leverage prior domain knowledge for each alarm type. We evaluate our method using the dataset from the 2015 PhysioNet Computing in Cardiology Challenge. Ablation analysis demonstrates that Contrastive Learning significantly improves the performance of a combined deep learning and rule-based-embedding approach. Our results indicate that the final proposed deep learning framework achieves superior performance in comparison to the winning entries of the Challenge.
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Affiliation(s)
| | | | - Jun Li
- Nanjing University of Science and Technology, Nanjing, China
| | - Gan Sun
- Chinese Academy of Sciences, Shenyang, China
| | | | - Benjamin Moody
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Roger G Mark
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Li-Wei H Lehman
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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14
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Respective Impact of Day and Night Bed Baths on Critical Care Patients. Dimens Crit Care Nurs 2022; 41:103-109. [PMID: 35099157 DOI: 10.1097/dcc.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite data supporting the reduction of interactions with patients during nighttime, bed bathing is sometimes performed within this period in sedated patients unable to manage their own hygiene care. OBJECTIVES To compare patient physiologic variables and adverse effect incidence between night and day bed baths. METHODS This was a single-center prospective observational study in a 12-bed intensive care unit during 2 months. Night period was defined to run from 10 pm to 6 am. Night bed baths were provided to sedated ventilated patients whatever their sedation, if their Richmond Agitation Sedation Scale score was -2 or deeper. Bed bath-induced changes in physiological variables, treatments, and related unscheduled events were registered during both night and day bed baths. RESULTS Twenty-one patients (aged 62.9 [52.5-73.2] years, 14 male patients) were included. We registered 97 night bed baths and 95 day bed baths. Heart rate increased only after day bed baths (85 beats/min [bpm] [69-97 bpm] vs 88 bpm [73-98 bpm], P = .02). Increase in Richmond Agitation Sedation Scale score occurred, respectively, during 13 (13.4%) and 8 (8.4%) night and day bed baths, without significant differences. Body temperature significantly decreased during both night and day bed baths (respectively, 37°C [36.6°C-37.4°C] vs 36.6°C [36.2°C-37.2°C], P < .0001; and 36.9°C [36.5°C-37.2°C] vs 36.7°C [36.2°C-37.2°C], P = .0006). Overall, unscheduled events, whether physiologic changes, pain, or calling a physician in rescue occurred in 97 procedures (50.5%), irrespective of their timing (night vs day, respectively 53% [54.6%] vs 44% [46.3%], P = .31). DISCUSSION Although unscheduled events occurred in half of bed baths, differences evidenced between nighttime and daytime bed baths were scarce. The appropriateness of nighttime bed bathing remains questionable.
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15
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Beltrami FG, John ÂB, de Macedo BR, Corrêa Júnior V, Nguyen XL, Pichereau C, Maury E, Fleury B, Gus M, Fagondes SC. A multi-intervention protocol to improve sleep quality in a coronary care unit. Eur J Cardiovasc Nurs 2021; 21:464-472. [PMID: 34935040 DOI: 10.1093/eurjcn/zvab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/17/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022]
Abstract
AIMS Poor sleep is a frequent occurrence in the critical illness. Evaluate sleep quality and test the effect of a multi-intervention sleep care protocol in improving sleep quality in a coronary care unit (CCU). METHODS AND RESULTS Quasi-experimental study, carried out in two phases. During the first phase, the control group (n = 58 patients) received usual care. Baseline sleep data were collected through the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the Intensive Care Unit Questionnaire (SICUQ). During the second phase (n = 55 patients), a sleep care protocol was implemented. Interventions included actions to promote analgesia, reduce noise, brightness, and other general measures. Sleep data were collected again to assess the impact of these interventions. The intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); P = 0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); P = 0.011]; return to sleep [90 (69.7-100) vs. 71.2 (40.7-96.5); P = 0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); P = 0.026]; and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); P = 0.002] than the baseline group. The main barriers to sleep were pain [1 (1.0-5.5)], light [1 (1.0-5.0)], and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intravenous pump alarm [1.5 (1.0-5.00)]. and mechanical ventilator alarm [1 (1.0-5.0)]. All were significantly lower in the intervention group than in the baseline group. CONCLUSION A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and reducing some barriers to sleep in CCU patients.
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Affiliation(s)
- Flávia Gabe Beltrami
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Ângela Beatriz John
- Laboratório do Sono, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2050, 90035-003 Porto Alegre, RS, Brazil
| | - Bruno Rocha de Macedo
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Vicente Corrêa Júnior
- Ambulatório de Hipertensão do Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Xuân-Lan Nguyen
- Unité de Somnologie et Fonction Respiratoire, Département de Physiologie Respiratoire et Sommeil, Hôpital Saint-Antoine, Paris, France
| | - Claire Pichereau
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Bernard Fleury
- Collège de Médecine des Hôpitaux de Paris, Département de Physiologie Respiratoire et Sommeil, Hôpital Saint-Antoine, Paris, France
| | - Miguel Gus
- Unidade de Cuidados Cardiovasculares, Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simone Chaves Fagondes
- Laboratório do Sono, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2050, 90035-003 Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
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16
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Effects of Sedatives on Sleep Architecture Measured With Odds Ratio Product in Critically Ill Patients. Crit Care Explor 2021; 3:e0503. [PMID: 34396142 PMCID: PMC8357257 DOI: 10.1097/cce.0000000000000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Evaluation of sleep quality in critically ill patients is difficult using conventional scoring criteria. The aim of this study was to examine sleep in critically ill patients with and without light sedation using the odds ratio product, a validated continuous metric of sleep depth (0 = deep sleep; 2.5 = full wakefulness) that does not rely on the features needed for conventional staging. DESIGN: Retrospective study. SETTINGS: A 16-bed medical-surgical ICU. PATIENTS: Twenty-three mechanically ventilated patients who had previously undergone two nocturnal sleep studies, one without and one with sedation (propofol, n = 12; dexmedetomidine, n = 11). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sleep architecture was evaluated with odds ratio product analysis by the distribution of 30-second epochs with different odds ratio product values. Electroencephalogram spectral patterns and frequency of wake intrusions (3-s odds ratio product > 1.75) were measured at different odds ratio product levels. Thirty-seven normal sleepers were used as controls. Compared with normal sleepers, unsedated critically ill patients spent little time in stable sleep (percent odds ratio product < 1.0: 31% vs 63%; p < 0.001), whereas most of the time were either in stage wake (odds ratio product > 1.75) or in a transitional state (odds ratio product 1.0–1.75), characterized by frequent wake intrusions. Propofol and dexmedetomidine had comparable effects on sleep. Sedation resulted in significant shift in odds ratio product distribution toward normal; percent odds ratio product less than 1.0 increased by 54% (p = 0.006), and percent odds ratio product greater than 1.75 decreased by 48% (p = 0.013). In six patients (26%), sedation failed to improve sleep. CONCLUSIONS: In stable critically ill unsedated patients, sleep quality is poor with frequent wake intrusions and little stable sleep. Light sedation with propofol or dexmedetomidine resulted in a shift in sleep architecture toward normal in most, but not all, patients.
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17
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Sundstrøm M, Sverresvold C, Trygg Solberg M. Factors contributing to poor sleep in critically ill patients: A systematic review and meta-synthesis of qualitative studies. Intensive Crit Care Nurs 2021; 67:103108. [PMID: 34247939 DOI: 10.1016/j.iccn.2021.103108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the causes of poor sleep in critically ill patients from nurses' experiences. REVIEW METHODOLOGY A meta-synthesis following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was conducted. Articles were searched systematically in the CINAHL, MEDLINE and Embase databases up to January 2020. Study selection and data extraction were performed by two authors working independently. Included articles were critically evaluated by both authors using the Critical Appraisal Screening Programme tool. FINDINGS The meta-synthesis resulted in four analytical themes: (1) Inherent factors of critical illness, (2) Lack of implementation of evidence-based practice, (3) Lack of relational collaboration, (4) Hospital organisation and culture. CONCLUSION This literature review indicates that promoting critically ill patients' sleep is difficult. Evidence-based interventions should be implemented into practice in order for nurses to be able to meet the patients' needs and improve sleep. Furthermore, the team surrounding the patient must have support from the health care organisation, and a culture change is necessary to improve communication between them to reach a shared goal to improve critically ill patients' sleep.
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Affiliation(s)
- Maria Sundstrøm
- Intensive Care Nurse Specialist, Master of Nursing Sci., Lovisenberg Diaconal University College, Department for Postgraduate Studies, Oslo, Norway; Oslo University Hospital, Oslo, Norway.
| | - Camilla Sverresvold
- Intensive Care Nurse Specialist, Master of Nursing Sci., Lovisenberg Diaconal University College, Department for Postgraduate Studies, Oslo, Norway; Oslo University Hospital, Oslo, Norway.
| | - Marianne Trygg Solberg
- Intensive Care Nurse Specialist, Master of Nursing Sci., Lovisenberg Diaconal University College, Department for Postgraduate Studies, Oslo, Norway.
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18
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Godeberge C, Deneux-Tharaux C, Seco A, Rossignol M, Chantry AA, Bonnet MP. Maternal Intensive Care Unit Admission as an Indicator of Severe Acute Maternal Morbidity: A Population-Based Study. Anesth Analg 2021; 134:581-591. [PMID: 33989204 DOI: 10.1213/ane.0000000000005578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Severe acute maternal morbidity (SAMM) accounts for any life-threatening complication during pregnancy or after delivery. Measuring and monitoring SAMM seem critical to assessing the quality of maternal health care. The objectives were to explore the validity of intensive care unit (ICU) admission as an indicator of SAMM by characterizing the profile of women admitted to an ICU and of their ICU stay, according to the association with other SAMM criterion. METHODS We performed a secondary analysis of the 2540 women with SAMM included in the epidemiology of severe acute maternal morbidity (EPIMOMS) multiregional prospective population-based study (2012-2013, n = 182,309 deliveries). The EPIMOMS definition of SAMM, based on national experts' consensus, is a combination of diagnosis, organ dysfunctions, and intervention criteria, including ICU admission. Among women with SAMM, we identified characteristics associated with maternal ICU admission with or with no other SAMM criterion compared with ICU admission, by using multivariable multinomial logistic regression models. RESULTS Overall, 511 women were admitted to an ICU during or up to 42 days after pregnancy, for a population-based rate of 2.8 of 1000 deliveries (511/182,309; 95% confidence interval [CI], 2.6-3.1); 15.5% of them (79/511; 95% CI, 12.4-18.9) had no other SAMM criterion compared with ICU admission. Among women with SAMM, the odds of ICU admission with no other morbidity criterion were increased in women with preexisting medical conditions (adjusted odds ratio (aOR), 2.13; 95% CI, 1.17-3.86) and cesarean before labor (aOR, 3.12; 95% CI, 1.47-6.64). Women admitted to ICU with no other SAMM criterion had more often decompensation of a preexisting condition, no interventions for organ support, and a shorter length of stay than women admitted with other SAMM criteria. CONCLUSIONS Among women with SAMM, 1 in 5 is admitted to an ICU; 15.5% of those admitted in ICU have no other SAMM criterion and a less acute condition. These results challenge the use of ICU admission as a criterion of SAMM.
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Affiliation(s)
- Charlotte Godeberge
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Department of Anesthesia and Intensive Care, Cochin hospital
| | - Catherine Deneux-Tharaux
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France
| | - Aurélien Seco
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Clinical Research Unit of Paris Descartes Necker Cochin
| | | | - Anne Alice Chantry
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Baudelocque Midwifery School
| | - Marie-Pierre Bonnet
- From the Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris University, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Recherche Agronomique (INRA), Paris, France.,Department of Anesthesia and Intensive Care, Sorbonne University, Armand Trousseau hospital, Groupe de Recherche Clinique 29 (GRC 29), Département Médico-Universitaire (DMU) DREAM, Assistance Publique des Hôpitaux de Paris, Paris, France
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19
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Abstract
Sleep affects physiologic and psychological recovery throughout critical illness. Patients often describe poor sleep as a major source of distress while hospitalized in an intensive care unit. The intensive care unit environment poses unique challenges for sleep assessment and monitoring. The purpose of this literature review is to discuss methods of assessment and monitoring of sleep within the intensive care unit setting. The advantages and disadvantages of physiologic monitoring of sleep (eg, polysomnography, bispectral index, and actigraphy) are compared with those of subjective measures of sleep quality (eg, validated patient-oriented sleep questionnaires, and informal nursing assessments).
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20
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Chen L, Zheng J, Lv S, Li B, Yang L. Impact of a sleep promotion protocol on off-pump coronary artery bypass graft patients. Nurs Crit Care 2021; 27:214-222. [PMID: 33880854 DOI: 10.1111/nicc.12637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep abnormalities frequently occur in intensive care unit (ICU) patients, and the consequences of sleep abnormalities in patients who undergo off-pump coronary artery bypass graft (OPCABG) surgery are particularly significant. Although many interventions have been reported to improve sleep, few sleep promotion protocols have been designed specifically for patients in cardiac ICUs. AIMS AND OBJECTIVES This study aimed to explore the effects of an evidence-based sleep promotion protocol on patients who underwent OPCABG in a cardiac ICU. DESIGN A quasi-experimental study was conducted in a comprehensive hospital in Shandong province of China. METHODS Overall, 67 participants were recruited (37 in the control group and 30 in the intervention group). An evidence-based sleep promotion protocol was developed by a 10-member interprofessional collaborative team and then applied. Sound levels, light intensity, and the number of nocturnal interventions were compared between groups. The Chinese version of the Richards-Campbell Sleep Questionnaire (RCSQ) was used to compare intergroup sleep status on two consecutive postoperative nights. RESULTS No significant differences were found for demographics or disease severity between the groups. In the intervention group, sound levels and light intensity were significantly lower at various times, and nocturnal interventions were significantly less frequent over the two consecutive nights. RCSQ scores were significantly higher in the intervention group for both nights. CONCLUSIONS The sleep promotion protocol reduced sound levels, night-time light intensity, the number of nocturnal interventions, and improved sleep among OPCABG patients in a cardiac ICU. RELEVANCE TO CLINICAL PRACTICE Evidence-based practice can help to promote good quality of care, improve patient outcomes, and advance nursing in clinical settings.
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Affiliation(s)
- Lin Chen
- CCU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing Zheng
- Cardiac Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shanshan Lv
- Cardiac Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Baobao Li
- Cardiac Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Lijuan Yang
- Nursing Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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21
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Elías MN, Munro CL, Liang Z. Daytime-to-Nighttime Sleep Ratios and Cognitive Impairment in Older Intensive Care Unit Survivors. Am J Crit Care 2021; 30:e40-e47. [PMID: 33644810 PMCID: PMC10467820 DOI: 10.4037/ajcc2021221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Sleep duration and proportion of daytime versus nighttime sleep may affect cognitive function in older patients in the transition out of the intensive care unit. OBJECTIVE To explore the relationship between the daytime-to-nighttime sleep ratio and cognitive impairment in older intensive care unit survivors. METHODS The study enrolled 30 older adults within 24 to 48 hours after intensive care unit discharge. All participants were functionally independent before admission and underwent mechanical ventilation in the intensive care unit. Actigraphy was used to estimate daytime (6 AM to 9:59 PM) and nighttime (10 PM to 5:59 AM) total sleep duration. Daytime-to-nighttime sleep ratios were calculated by dividing the proportion of daytime sleep by the proportion of nighttime sleep. The National Institutes of Health Toolbox Cognition Battery Dimensional Change Card Sort Test (DCCST) was used to assess cognition. Associations between sleep and cognition were explored using multivariate regression after adjusting for covariates. RESULTS The mean (SD) daytime sleep duration was 7.55 (4.30) hours (range, 0.16-14.21 hours), and the mean (SD) nighttime sleep duration was 4.99 (1.95) hours (range, 0.36-7.21 hours). The mean (SD) daytime-to-nighttime sleep ratio was 0.71 (0.30) (range, 0.03-1.10). Greater daytime sleep duration (β = -0.351, P = .008) and higher daytime-to-nighttime sleep ratios (β = -0.373, P = .008) were negatively associated with DCCST scores. CONCLUSIONS The daytime-to-nighttime sleep ratio was abnormally high in the study population, revealing an altered sleep/wake cycle. Higher daytime-to-nighttime sleep ratios were associated with worse cognition, suggesting that proportionally greater daytime sleep may predict cognitive impairment.
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Affiliation(s)
- Maya N Elías
- Maya N. Elías is a postdoctoral research fellow, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Cindy L Munro
- Cindy L. Munro is dean and a professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Zhan Liang
- Zhan Liang is an assistant professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
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Locihová H, Axmann K, Žiaková K, Šerková D, Černochová S. Sleep quality assessment in intensive care: actigraphy vs. Richards-Campbell sleep questionnaire. SLEEP SCIENCE (SAO PAULO, BRAZIL) 2021; 13:235-241. [PMID: 33564370 PMCID: PMC7856668 DOI: 10.5935/1984-0063.20190145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction It has been repeatedly shown that sleep of intensive care unit (ICU) patients is fragmented and its architecture is impaired. As sleep disorders have numerous negative effects on the organism, there have been efforts to implement sleep-promoting strategies into practice. When comparing the effectiveness of such measures, sleep quality assessment itself is a considerable problem. Objective The study aimed to assess the quality and quantity of night sleep in ICU patients simultaneously with actigraphy (ACT) and the Richards-Campbell Sleep Questionnaire (RCSQ). The secondary goals were to test the performance and effectiveness of the above methods and to verify correlations between selected RCSQ items and actigraph parameters. Methods A single-center prospective observational study (20 patients staying in a Interdisciplinary Intensive Care Unit). The quality of sleep was assessed using a Czech version of the RCSQ and ACT. The obtained data were analyzed and their dependence or correlations were verified by selected statistical tests. Results The mean RCSQ score was 47.6 (SD 24.4). The worst results were found for sleep latency (44.4; SD 31.2); the best results were for sleep quality (50.2; SD 29.4). The mean sleep effciency measured with ACT reached 86.6% (SD 9.2); the mean number of awakenings per night was 17.1 (SD 8.5). The RCSQ total parameter with a cutoff of 50 (RCSQ total = 50 good sleep / RCSQ total < 50 poor sleep) was shown to be suitable for discrimination of subjectively perceived sleep quality in ICU patients. However, the study failed to show statistically significant relations between subjectively perceived sleep quality (RCSQ) and ACT measurements. Conclusion The RCSQ appears to be a suitable instrument for assessing night sleep quality in ICU patients. On the other hand, the study showed a very low level of agreement between subjective sleep quality assessment and objective ACT measurements. The main drawback of ACT is low reliability of obtained data. Further research is needed to determine its role in sleep quality assessment in the ICU setting.
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Affiliation(s)
- Hana Locihová
- Department of Nursing, Jesseniuss Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia.,AGEL Educational and Research Institute (VAVIA), Prostějov, Czech Republic
| | - Karel Axmann
- Department of Anaesthesiology and Resuscitation and Intensive Care Medicine, University Hospital Olomouc.,Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Katarína Žiaková
- Department of Nursing, Jesseniuss Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia
| | - Dagmar Šerková
- Department of Nursing and Midwifery, Ostrava, University of Ostrava, Faculty of Medicine, Czech Republic.,Interdisciplinary Intensive Care Unit, Hospital Nový Jičín, Czech Republic
| | - Simona Černochová
- Interdisciplinary Intensive Care Unit, Hospital Nový Jičín, Czech Republic
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Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients. Crit Care 2020; 24:652. [PMID: 33218354 PMCID: PMC7677450 DOI: 10.1186/s13054-020-03357-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Pressure support ventilation (PSV) should allow spontaneous breathing with a “normal” neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 h the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of “Low” and/or “High” neuro-ventilatory drive during clinical application of PSV.
Method In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdiPEAK), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTPDI/b and PTPDI/min, respectively), breathing pattern and major asynchronies were continuously monitored for 12 h (from 8 a.m. to 8 p.m.). We identified breaths with “Normal” (EAdiPEAK 5–15 μV), “Low” (EAdiPEAK < 5 μV) and “High” (EAdiPEAK > 15 μV) neuro-ventilatory drive. Results Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdiPEAK, was “Low” in 50.116 breath (28%), “Normal” in 88.419 breaths (50%) and “High” in 38.582 breaths (22%). The average times spent in “Low”, “Normal” and “High” class were 1.37, 3.67 and 0.55 h, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the “Low” neuro-ventilatory drive class for more than 1 h, median 6.1 [3.9–8.5] h and 6 in the “High” neuro-ventilatory drive class, median 3.4 [2.2–7.8] h. The asynchrony index was significantly higher in the “Low” neuro-ventilatory class, mainly because of a higher number of missed efforts.
Conclusions We observed wide variations in EAdi amplitude and unevenly distributed “Low” and “High” neuro ventilatory drive periods during 12 h of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.
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A key role of gut microbiota-vagus nerve/spleen axis in sleep deprivation-mediated aggravation of systemic inflammation after LPS administration. Life Sci 2020; 265:118736. [PMID: 33176177 DOI: 10.1016/j.lfs.2020.118736] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
AIMS Sleep deprivation (SD) correlates with exacerbated systemic inflammation after sepsis. However, the underlying mechanisms remain unclear. This study aimed to evaluate the roles and mechanisms of SD in inflammatory organ injury after lipopolysaccharide (LPS) administration. MAIN METHODS Mice were intraperitoneally injected with LPS followed by 3 consecutive days of SD. The pseudo germ-free (PGF) mice received fecal microbiota transplant by being gavaged with supernatant from fecal suspension of septic mice with or without SD. The subdiaphragmatic vagotomy (SDV) or splenectomy was performed 14 days prior to LPS injection or antibiotics administration. KEY FINDINGS Post-septic SD increased the plasma levels of interleukin (IL)-6 and tumor necrosis factor-α (TNF-α), reduced IL-10 plasma level, increased spleen weight, and promoted inflammatory injury of the lung, liver and kidney. The relative abundance of Proteobacteria and its subgroups were increased after post-septic SD. PGF mice transplanted with fecal bacteria from septic mice subjected to SD developed splenomegaly, systemic inflammation, organ inflammation and damage as their donors did. Intriguingly, SDV abolished the aggravated effects of SD on splenomegaly and inflammatory organ injury in septic mice received SD or in PGF mice transplanted with fecal bacteria from septic mice subjected to SD. Furthermore, splenectomy also abrogated the increase in IL-6 and TNF-α plasma levels and the decrease in IL-10 plasma level in PGF mice transplanted with fecal bacteria from septic mice subjected to SD. SIGNIFICANCE Gut microbiota-vagus nerve axis and gut microbiota-spleen axis play key roles in modulating systemic inflammation induced by SD after LPS administration.
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Locihová H, Axmann K, Žiaková K. Sleep-disrupting effects of nocturnal nursing interventions in intensive care unit patients: A systematic review. J Sleep Res 2020; 30:e13223. [PMID: 33128479 DOI: 10.1111/jsr.13223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night-time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).
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Affiliation(s)
- Hana Locihová
- AGEL Research and Training Institute, Prostějov, AGEL Nemocnice Valašské Meziříčí, AGEL Střední zdravotnická škola, Ostrava, Czech Republic
| | - Karel Axmann
- Fakultní nemocnice Olomouc, Palacky University in Olomouc, Faculty of Medicine and Dentistry, Olomouc, Czech Republic
| | - Katarína Žiaková
- Comenius University in Bratislava Jessenius Faculty of Nursing in Martin, Martin, Slovakia
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26
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Kim JK, Park JH, Cho J, Lee SM, Lee J. Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire. Acute Crit Care 2020; 35:164-168. [PMID: 32907309 PMCID: PMC7483016 DOI: 10.4266/acc.2020.00339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/05/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sleep disorders are common in critically ill patients. Unfortunately, sleep assessment is challenging in many intensive care units (ICUs). The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple subjective tool that has been validated and used in many countries. This study aimed to evaluate the reliability of the Korean version of the RCSQ (K-RCSQ). METHODS This prospective, cross-sectional, observational study was conducted in the ICUs of two hospitals. In total, 52 consenting patients answered questionnaires regarding their previous night's sleep (K-RCSQ) and the noise they experienced (range, 0-100). RESULTS The K-RCSQ showed excellent internal consistency of 0.960 by Cronbach's alpha. The mean total score of the K-RCSQ was 41.9±28.9 (range, 0-100). The mean perceived ICU noise score was 40.7±28.1 (range, 0-90). There was a significant linear correlation between noise score and average K-RCSQ score (r=-0.37, P<0.001). CONCLUSIONS The K-RCSQ demonstrated excellent reliability (internal consistency). This simple tool may help assess sleep quality in critically ill patients and improve the quality of ICU care.
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Affiliation(s)
- Jae Kyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ju-Hee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, SNU-SMG Boramae Medical Center, Seoul, Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jensen PS, Specht K, Mainz H. Sleep quality among orthopaedic patients in Denmark - A nationwide cross-sectional study. Int J Orthop Trauma Nurs 2020; 40:100812. [PMID: 33495139 DOI: 10.1016/j.ijotn.2020.100812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hospitalised patients sleep less and have a lower quality of sleep compared to patients who recover in their own home. Low sleep quality is associated with complications such as increased pain sensation, delirium and reduced rehabilitation capacity. PURPOSE To investigate patients' self-reported sleep quality and factors related to sleep quality during admission to a department of Orthopaedic Surgery. METHODS The Richard-Campbell Sleep Questionnaire was used to assess patients' sleep quality, measured using a VAS 0-100 scale, (a higher score indicating good sleep quality). The moderated Pittsburgh Sleep Quality Index assessed the most severe and frequent barriers to high sleep quality. RESULTS A total of 533 patients undergoing orthopaedic surgery participated. There was an overall mean sleep quality score of 54. The most common and severe factors impacting sleep quality were; waking during the night, difficulties falling asleep, waking early, waking for toileting or pain. The intensity of the pain was found to be proportional to the quality of sleep. CONCLUSION Patients reported their overall quality of sleep to be moderately good due to difficulties falling asleep, waking up during the night or early morning and having pain. The results call for better pain management and non-pharmacological nursing interventions to optimise sleep quality.
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Affiliation(s)
- Pia Søe Jensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Kirsten Specht
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark; Department of Orthopaedic Surgery, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Hanne Mainz
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark; Danish Orthopaedic Nursing Knowledge and Science Centre (VIDOKS), Denmark
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Azimaraghi O, Hammer M, Santer P, Platzbecker K, Althoff FC, Patrocinio M, Grabitz SD, Wongtangman K, Rumyantsev S, Xu X, Schaefer MS, Fuller PM, Subramaniam B, Eikermann M. Study protocol for a randomised controlled trial evaluating the effects of the orexin receptor antagonist suvorexant on sleep architecture and delirium in the intensive care unit. BMJ Open 2020; 10:e038474. [PMID: 32690536 PMCID: PMC7371384 DOI: 10.1136/bmjopen-2020-038474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Insomnia frequently occurs in patients admitted to an intensive care unit (ICU). Sleep-promoting agents may reduce rapid eye movement sleep and have deliriogenic effects. Suvorexant (Belsomra) is an orexin receptor antagonist with Food and Drug Administration (FDA) approval for the treatment of adult insomnia, which improves sleep onset and maintenance as well as subjective measures of quality of sleep. This trial will evaluate the efficacy of postoperative oral suvorexant treatment on night-time wakefulness after persistent sleep onset as well as the incidence and duration of delirium among adult cardiac surgical patients. METHODS AND ANALYSIS In this single-centre, randomised, double-blind, placebo-controlled trial, we will enrol 120 patients, aged 60 years or older, undergoing elective cardiac surgery with planned postoperative admission to the ICU. Participants will be randomised to receive oral suvorexant (20 mg) or placebo one time a day starting the night after extubation. The primary outcome will be wakefulness after persistent sleep onset. The secondary outcome will be total sleep time. Exploratory outcomes will include time to sleep onset, incidence of postoperative in-hospital delirium, number of delirium-free days and subjective sleep quality. ETHICS AND DISSEMINATION Ethics approval was obtained through the 'Committee on Clinical Investigations' at Beth Israel Deaconess Medical Center (protocol number 2019P000759). The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER This trial has been registered at clinicaltrials.gov on 17 September 2019 (NCT04092894).
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Affiliation(s)
- Omid Azimaraghi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maximilian Hammer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Santer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Katharina Platzbecker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Friederike C Althoff
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Patrocinio
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Karuna Wongtangman
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sandra Rumyantsev
- Pharmacy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick M Fuller
- Department of Neurology, Program in Neuroscience and Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Balachundhar Subramaniam
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Aydın Sayılan A, Kulakaç N, Sayılan S. The effects of noise levels on pain, anxiety, and sleep in patients. Nurs Crit Care 2020; 26:79-85. [PMID: 32621391 DOI: 10.1111/nicc.12525] [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: 11/07/2019] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intensive care is a noisy environment for patients and one that affects pain, anxiety levels, and sleep quality. AIMS AND OBJECTIVES To determine the relationship between noise levels and pain, anxiety, and sleep levels in patients in intensive care units. DESIGN A descriptive and observational study design was used. METHODS This study was conducted between June and December 2018 in a public hospital and included 111 patients admitted to surgical critical care for at least 24 hours. Three Benetech Gm1351 manual sound level metres were used to measure noise. A Patient Information Form, a pain Visual Analog Scale (VAS), the Spielberger State-Trait Anxiety Inventory, and the Richards Campbell Sleep Questionnaire (RCSQ) were used for data collection. RESULTS The mean age of the patients was 57.29 years. The mean noise level detected in the intensive care unit was 66.52 dB (dB). Patients' mean pain VAS score was 3.79 ± 1.72, the mean State Anxiety Inventory score was 39.74 ± 2.98, and the mean total RCSQ score was 25.10 ± 13.17. Our findings show that patients in the intensive care unit are exposed to high noise levels and that, while this has no effect on pain, it significantly impacts anxiety and quality of sleep. CONCLUSIONS Noise levels in intensive care units significantly exceed recommended thresholds, and this adversely affects patients' anxiety levels and sleep quality. It is important for suitably restful conditions to be provided for patients, to be aware of the potential for anxiety, and for these factors to be borne in mind when planning nursing interventions. RELEVANCE TO CLINICAL PRACTICE Further studies on the effects of noise levels on pain, anxiety, and sleep levels in patients admitted to intensive care units are needed.
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Affiliation(s)
- Aylin Aydın Sayılan
- Department of Nursing, School of Health Sciences, Kırklareli University, Kırklareli, Turkey
| | - Nurşen Kulakaç
- Department of Nursing, Gümüşhane University Faculty of Health Sciences, Gümüşhane, Turkey
| | - Samet Sayılan
- Kirklareli Government Hospital, Internal Medicine Clinic, Kırklareli, Turkey
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Biazim SK, Souza DA, Carraro Junior H, Richards K, Valderramas S. The Richards-Campbell Sleep Questionnaire and Sleep in the Intensive Care Unit Questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil. ACTA ACUST UNITED AC 2020; 46:e20180237. [PMID: 32490911 PMCID: PMC7567626 DOI: 10.36416/1806-3756/e20180237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 05/06/2019] [Indexed: 01/22/2023]
Abstract
Objective: To translate the Richards-Campbell Sleep Questionnaire (RCSQ) and Sleep in the Intensive Care Unit Questionnaire (SICUQ) to Portuguese, making the appropriate cross-cultural adaptations for their use in Brazil, as well as to determine the interobserver reliability of the instruments. Methods: In this study, we evaluated medical and surgical patients admitted to the adult ICU of the Federal University of Paraná Hospital de Clínicas, in the city of Curitiba, Brazil, between June of 2017 and January of 2018. The translation and cross-cultural adaptation of the questionnaires involved the following steps: translation, synthesis, back-translation, revision by an expert panel, approval of the back-translation by the original authors, pretesting, and creation of the final versions. Two researchers applied the Portuguese-language versions in the evaluation of critically ill patients. Interobserver reliability was assessed by calculating the intraclass correlation coefficient (ICC) and 95% CI. Results: The sample comprised 50 patients, of whom 27 (54%) were women. The mean age was 47.7 ± 17.5 years. The main reason for ICU admission, in 10 patients (20%), was cancer. The interobserver reliability of the questionnaires ranged from good to excellent. For the RCSQ, the ICC was 0.84 (95% CI: 0.71-0.90). For SICUQ domains 1-5 (sleep quality and daytime sleepiness), the ICC was 0.75 (95% CI: 0.55-0.86), whereas it was 0.86 (95% CI: 0.76-0.92) for SICUQ domains 6 and 7 (causes of sleep disruption). Conclusions: The cross-culturally adapted, Portuguese-language versions of the RCSQ and SICUQ appear to have good interobserver reliability.
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Affiliation(s)
- Samia Khalil Biazim
- Programa de Pós-Graduação em Medicina Interna, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | - Kathy Richards
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Silvia Valderramas
- Departamento de Prevenção e Reabilitação em Fisioterapia, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Younis MB, Hayajneh F, Rubbai Y. Factors influencing sleep quality among Jordanian intensive care patients. ACTA ACUST UNITED AC 2020; 29:298-302. [PMID: 32167811 DOI: 10.12968/bjon.2020.29.5.298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Sleep disturbance is common in patients in the intensive care unit (ICU). Numerous factors can contribute to this. High noise and light levels, nursing interventions and medication administration are major factors. This study investigated the demographic and environmental factors that might adversely affect ICU patients' quality of sleep. Data were collected from 103 patients using a demographic data sheet, the Freedman Quality of Sleep Scale and the Richards-Campbell Sleep Scale. Patients' demographic characteristics were found to have no significant effects on their perceived quality of sleep. Environmental factors, including noise, light, nursing interventions, diagnostic testing, the administration of medication, talking and phones ringing, were significantly related to the patients' perceived quality of sleep.
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Affiliation(s)
- Mohammad Bani Younis
- Assistant Professor, Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
| | - Feryal Hayajneh
- Professor, Faculty of Nursing, University of Jordan, Amman, Jordan
| | - Yousef Rubbai
- Lecturer, Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
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Kim IJ. Hospital flooring safety and health: knowledge gaps and suggestions. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 27:1116-1135. [PMID: 31679473 DOI: 10.1080/10803548.2019.1688473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.
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Affiliation(s)
- In-Ju Kim
- College of Engineering, University of Sharjah, United Arab Emirates
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Huang Q, Chen G, Huang Y, Li J, Ding Y, Zhang S, Chi X, Xie Q, Ning Q, Xu L, Zhang J. Genetic variant rs3750625 in the 3'UTR of ADRA2A affects the sleep quality of patients in the ICU by promoting miR‑34a binding to ADRA2A. Int J Mol Med 2020; 45:910-918. [PMID: 31922215 DOI: 10.3892/ijmm.2020.4456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/10/2019] [Indexed: 11/06/2022] Open
Abstract
Poor sleep is very common in patients in the ICU and hence, sleep quality is considered an important aspect of intensive care; however, the underlying mechanisms of poor sleep in patients in the ICU remain unknown. In this study, we aimed to explore the role of rs3750625, which is located in the 3'UTR of adrenoceptor alpha 2A (ADRA2A), in sleep quality. For this purpose, luciferase assay was conducted to investigate the association between miR‑34a and ADRA2A, and the effect of rs3750625 on the binding affinity between miR‑34a and ADRA2A was examined. RT‑qPCR and western blot analysis were carried out to examine the regulatory association between miR‑34a and ADRA2A. The differences in sleep time and efficiency were compared between groups carrying the AC and CC genotypes of rs3750625, respectively. According to the results from an online search, miR‑34a could directly bind to the 3'UTR of ADRA2A, and such binding was confirmed by the observation that miR‑34a inhibited the luciferase activity of major or minor ADRA2A 3'UTR in a dose‑dependent manner in HCN‑1A and U251 cells. In addition, the ADRA2A protein and mRNA levels in the HCN‑1A and U251 cells were evidently decreased following transfection with miR‑34a precursors. Notably, patients in the AC group exhibited a similar level of miR‑34a mRNA expression compared with patients in the CC group; however, the ADRA2A mRNA and protein levels in the CC group were significantly increased in comparison with those in the AC group. In addition, the sleep time and sleep efficiency in the CC group were much higher than those in the AC group. Furthermore, the mean arterial pressure (MAP) values in both the AC and CC groups remained stable from 22:00 to 08:00, and the respiratory rates in both groups were quite similar. However, the heart rate of patients in the CC group was much lower than that of patients in the AC group. On the whole, the findings of this study suggest that the genetic variant rs3750625 in the 3'UTR of ADRA2A affects the sleep quality of patients in the ICU by promoting the binding of miR‑34a to ADRA2A, and hence it may serve as a novel biomarker for the prediction of the sleep quality of patients in the ICU.
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Affiliation(s)
- Qingping Huang
- ICU, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Ganhai Chen
- ICU, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Yanfang Huang
- Nursing Department, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Jinting Li
- ICU, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Yanjing Ding
- ICU, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Shuqing Zhang
- Nursing Department, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Xiuwen Chi
- School of Nursing, Guangdong Medical University, Dongguan, Guangdong 523808, P.R. China
| | - Qiong Xie
- Nursing Department, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Qinrong Ning
- Department of General Surgery, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Liuqin Xu
- Nursing Department, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
| | - Jianrong Zhang
- Nursing Department, Dongguan Houjie Hospital, Dongguan, Guangdong 523945, P.R. China
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Ramakrishnan N. Promoting Clinical Practices to Sleep Better: A Dream Intensive Care Unit? Indian J Crit Care Med 2020; 24:1-2. [PMID: 32148340 PMCID: PMC7050175 DOI: 10.5005/jp-journals-10071-23338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Ramakrishnan N. Promoting Clinical Practices to Sleep Better: A Dream Intensive Care Unit? Indian J Crit Care Med 2020;24(1):1-2.
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Macfarlane M, Rajapakse S, Loughran S. What prevents patients sleeping on an acute medical ward? An actigraphy and qualitative sleep study. Sleep Health 2019; 5:666-669. [DOI: 10.1016/j.sleh.2019.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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Actigraphic measures of sleep on the wards after ICU discharge. J Crit Care 2019; 54:163-169. [DOI: 10.1016/j.jcrc.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022]
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Abstract
The primary purpose of mechanical ventilation is to decrease work of breathing. Achieving this goal requires that cycling of the ventilator be carefully aligned with the intrinsic rhythm of a patient's respiratory center output. Problems arise at the point of ventilator triggering, post-trigger inflation, and inspiration-expiration switchover. Careful, iterative adjustments of ventilator settings are required to minimize work of breathing. Use of protocols for the selection of ventilator settings can lead to complications (including alveolar overdistention) and risk of death. Because complications are axiomatic to mechanical ventilation, it should be discontinued at the earliest possible time. To shorten ventilator time, the critical step is to screen for weanability through use of weaning predictor tests. Use of T-tube trials circumvents the impossibility of estimating patient work of breathing during pressure support. Before extubation, patients should demonstrate the ability to breathe successfully in the absence of pressure support and positive end-expiratory pressure.
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Bosch-Alcaraz A, Jordan I, Rodríguez-Martín D, Falcó-Pegueroles A. Meaning and comfort factors in the paediatric intensive care unit from an adult perspective: a descriptive phenomenological study. Scand J Caring Sci 2019; 34:627-635. [PMID: 31614019 DOI: 10.1111/scs.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
AIMS To explore the meaning of comfort and know the factors that contribute to it from the point of view of the young adults who received care in a paediatric intensive care unit, the family of the patient and the interdisciplinary team attending the patient. FINDINGS A total of 30 people were invited to participate in the focus groups; 24 did so. Thematic analysis yielded the following common categories: meaning of comfort, environmental factors in paediatric intensive care unit, family accompaniment during paediatric intensive care unit stay, management of information in the paediatric intensive care unit and, finally, the intimacy and privacy of the critically ill paediatric patient and their family. CONCLUSIONS Paediatric intensive care unit professionals need to consider not only the environmental input that may lead to discomfort but also aspects such as continuous family accompaniment, the sharing of complete information with the family and the promoting of privacy.
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Affiliation(s)
- Alejandro Bosch-Alcaraz
- Hospital Sant Joan de Déu, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Hospital Sant Joan de Déu, Barcelona, Spain.,Medicine Unit of Training and Research, University of Barcelona, Barcelona, Spain
| | - Dolors Rodríguez-Martín
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Dixit MK, Singh S, Lavy S, Yan W. Floor finish selection in health-care facilities: a systematic literature review. FACILITIES 2019. [DOI: 10.1108/f-03-2018-0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose
The purpose of this paper is to identify, analyze and discuss floor finishes used in health-care facilities and their selection criteria in the form of advantages and disadvantages. The authors also identify the top three health-care floor finishes and selection criteria based on the literature review results. Although flooring materials have a considerable impact on the life-cycle cost and indoor environment of health-care facilities, what criteria may be used for such flooring choices is not thoroughly studied.
Design/methodology/approach
The authors performed a systematic review of the literature on certain flooring systems currently used in health-care facilities and the criteria applied for their selection. Peer-reviewed studies and articles published after Year 2000 consistent with the research design were included.
Findings
Sixteen different selection criteria that influence the choice of floor finishes in health-care facilities were determined and discussed. The results show that the top three-floor finish materials preferred in health-care facilities are sheet vinyl, rubber and carpet, and the top three selection criteria for floor finishes are indoor air quality, patient safety and infection control.
Originality/value
The results of this study will assist building owners, architects and interior designers with implementing an informed design decision-making process, particularly in relation to floor finish selection. The findings will also provide guidance to floor finish manufacturers to improve their products based on facility managers’ preferences.
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Prendiville R, Umana E, Avalos G, McNicholl B. No rest for the weary: a cross-sectional study comparing patients' sleep in the emergency department to those on the ward. Emerg Med J 2019; 37:42-44. [PMID: 31439716 DOI: 10.1136/emermed-2017-207371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/30/2019] [Accepted: 07/26/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Boarding in emergency departments (EDs) is a persistent problem worldwide. We hypothesised that patients sleeping while being boarded in EDs have worse self-rated sleep than those admitted from EDs who sleep on the ward. METHODS Prospective cross-sectional study conducted at the University College Hospital, Galway between October and November 2016. Self-rated sleep in patients boarded in EDs from 23:00 to 07:00 was compared with those admitted to the ward before 23:00. Patients rated their sleep using the Richards-Campbell Sleep Questionnaire. Patients were excluded if they had cognitive impairment, were unable or incapacitated or had evidence of alcohol or drug use in the previous 24 hours. Continuous data are shown as medians (IQRs 25th-75th percentiles). Linear regression models of log-transformed outcome variables were performed. RESULTS Ninety-three patients were included and 22 were excluded. Patients who boarded in the ED were significantly more likely to be medical patients (78% vs 21%, p<0.001), to be older (median age (IQR)=60 (39-71) vs 47 (32-68), p=0.04) and have more urgent presentations (74% vs 48% presenting as Manchester triage category 1 or 2, p=0.01) than patients who sleep on a ward. Patients who slept on the ward had significantly better sleep scores (mean log-transformed sleep scores (SD)=2.92 (1.05) vs 3.72 (0.66), p<0.001)). Those sleeping in the ED reported greater noisiness than those sleeping on the ward (mean log-transformed noisiness scores (SD)=3.18 (1.10) vs 4.15 (0.57), p<0.001). These significant differences in sleep scores and noisiness ratings persisted after adjustment for age, triage category and admitting service. CONCLUSION We found those who sleep boarded in EDs have worse self-rated sleep than those who sleep on the ward.
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Affiliation(s)
| | - Etimbuk Umana
- Emergency Department, University College Hospital, Galway, Galway, Ireland
| | - Gloria Avalos
- Department of Medicine, National University of Ireland, Galway, Ireland
| | - Brian McNicholl
- Emergency Medicine, University College Hospital, Galway, Ireland
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Georgopoulos D, Vaporidi K. Sleep and Wakefulness Evaluation in Critically Ill Patients. One Step Forward. Am J Respir Crit Care Med 2019; 199:1051-1052. [PMID: 30818967 PMCID: PMC6515880 DOI: 10.1164/rccm.201902-0275ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Katerina Vaporidi
- 1 University Hospital of Heraklion University of Crete Heraklion, Crete, Greece
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Fiorelli S, Creazzola F, Massullo D, Defraia V, Maggi L, Rocco M, Rendina EA. Dexmedetomidine Sedation After Tracheal Surgery: A Prospective Pilot Study. Ann Thorac Surg 2019; 108:256-261. [DOI: 10.1016/j.athoracsur.2019.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/03/2019] [Accepted: 01/16/2019] [Indexed: 02/01/2023]
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Alsulami G, Rice AM, Kidd L. Prospective repeated assessment of self-reported sleep quality and sleep disruptive factors in the intensive care unit: acceptability of daily assessment of sleep quality. BMJ Open 2019; 9:e029957. [PMID: 31227541 PMCID: PMC6596998 DOI: 10.1136/bmjopen-2019-029957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite the importance of sleep, the assessment of sleep quality does not form part of standard clinical care in intensive care unit (ICU). Continuous assessment of self-reported quality of ICU patients' sleep has been strongly recommended. Prior to implementing such an assessment in the ICU, it is important to assess the acceptability of this method of assessment to the ICU's patients. The aims of this study were to assess the acceptability to ICU patients of completing daily self-reports on sleep quality during their ICU stay and to assess ICU patients' self-reported sleep quality and sleep disruptive factors during their time in ICU. METHODS An observational prospective-repeated assessment was conducted on n=120 patients in an ICU in Saudi Arabia. The participants were both intubated and non-intubated. OUTCOMES MEASURES Over a 3-month period, sleep quality was assessed using the Arabic version of the Richards-Campbell Sleep Questionnaire (RCSQ-A), and self-reported sleep disruptive factors were identified. Clinical factors, such as ICU interventions, and previously administered sedatives were also examined. The patients' acceptance of completing daily RCSQ-A reports was assessed using various indicators of acceptability. RESULTS A total of 381 self-reports (RCSQ-A) were collected for this analysis. The patients reported 34.4±5.60, indicating that sleep quality was poor on average. The group of intubated patients reported much poorer sleep quality during intubation than after extubation. In the multivariate analysis, factors which most significantly affected sleep (exp(b), p value) were midazolam (-6.424, p<0.0005), propofol (-3.600, p<0.05), noise (-1.033, p<0.05), gender (1.836, p<0.05), daytime sleepiness (0.856, p<0.05) and the presence of mechanical ventilation (-1.218, p<0.05). CONCLUSION The acceptability and feasibility of using daily RCSQ-A for sleep quality assessment was demonstrated. Sleep quality was reported as poor by all participants and the factors affecting sleep were varied. This study provided various recommendations for healthcare providers and researchers in terms of evaluating and improving sleep quality in ICU patients.
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Affiliation(s)
- Ghaida Alsulami
- Nursing, University of Glasgow School of Veterinary Medicine, Glasgow, UK
- Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ann Marie Rice
- University of Glasgow School of Medicine Dentistry and Nursing, Glasgow, UK
| | - Lisa Kidd
- School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Pagnucci N, Tolotti A, Cadorin L, Valcarenghi D, Forfori F. Promoting nighttime sleep in the intensive care unit: Alternative strategies in nursing. Intensive Crit Care Nurs 2019; 51:73-81. [DOI: 10.1016/j.iccn.2018.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/05/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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Bliefnick JM, Ryherd EE, Jackson R. Evaluating hospital soundscapes to improve patient experience. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 145:1117. [PMID: 30823810 DOI: 10.1121/1.5090493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
Hospital soundscapes can be difficult environments to assess acoustically due to alarms, medical equipment, and the continuous activity within units. Routinely, patients perceive these soundscapes to be poor when rating their hospital experience on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys administered after discharge. In this study, five hospital units of widely varying HCAHPS "quietness" performance were analyzed. Sound pressure levels were measured in 15 patient rooms and 5 nursing stations over 24-h periods. HCAHPS "quietness of the hospital environment" patient survey data were correlated with measured acoustical data at a room-level, revealing acoustical metrics linked to patient perceptions of hospital soundscape conditions. Metrics found to be statistically correlated (p < 0.05) included the absolute LAMIN levels in patient rooms, which found significantly higher HCAHPS quietness scores in units with average LAMIN levels below 35 dBA, in addition to specific low frequency octave bands and occurrence rates. Many other standard acoustical metrics (such as LAEQ, LAMAX, LCPEAK, and LA90) were not found to be statistically correlated between measured acoustical data and HCAHPS quietness patient responses. Taken as a whole, this study provides insights into the potential relationships between hospital noise and patient satisfaction.
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Affiliation(s)
- Jay M Bliefnick
- Durham School of Architectural Engineering and Construction, Peter Kiewit Institute, University of Nebraska-Lincoln, 1110 South 67th Street, Omaha, Nebraska 68182-0816, USA
| | - Erica E Ryherd
- Durham School of Architectural Engineering and Construction, Peter Kiewit Institute, University of Nebraska-Lincoln, 1110 South 67th Street, Omaha, Nebraska 68182-0816, USA
| | - Rebecca Jackson
- Patient and Community Engagement, Nebraska Medicine, 986826 Nebraska Medical Center, Omaha, Nebraska 68198-6826, USA
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Park MY, Chai CG, Lee HK, Moon H, Noh JS. The Effects of Natural Daylight on Length of Hospital Stay. ENVIRONMENTAL HEALTH INSIGHTS 2018; 12:1178630218812817. [PMID: 30546262 PMCID: PMC6287302 DOI: 10.1177/1178630218812817] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE While providing medical services, hospitals generate many data about patients. Such medical data could contribute to better treatments once their associations or patterns have been identified. With properly analyzed medical data, traditional knowledge at an individual level could be further extended to broader populations. This comprehensive study was performed to demonstrate the effectiveness of light using medical data accumulated over 15 years. METHODS Patients who were admitted to the window or door side of a six-bedded room were included. Patients admitted to the emergency room and elderly people aged >80 years were excluded. Patients' length of stay was compared per what bed they were in (excluding middle beds). A multiple regression analysis was performed with patients admitted to the window or door side to determine whether the window affected their hospital stay. In addition, a multiple regression analysis was performed after adjusting for confounders by 1:1 matching between the two groups (ie, age, sex, and admitting department). RESULTS Participants were 38 788 patients with a bed near the window and 46 233 patients with a bed near the door. Results revealed that patients' length of stay was shorter for those near the window compared with those near the door, which was also true after group matching (33 921 participants in each group). CONCLUSIONS Clinical trials that test evidence-based designs of physical environments in wards or hospital rooms are usually difficult to perform. As an alternative strategy, using accumulated electronic medical data, we assessed this key element of hospital design.
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Affiliation(s)
- Man Young Park
- Future Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Choul-Gyun Chai
- Department of Architecture, College of Engineering, Kwangwoon University, Seoul, Korea
| | - Hae-Kyung Lee
- Architectural Environment Research Institute, Borie, Seoul, Korea
| | - Hani Moon
- Department of Architecture, College of Engineering, Kwangwoon University, Seoul, Korea
| | - Jai Sung Noh
- Department of Psychiatry, School of Medicine, Ajou University, Suwon, Korea
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Schabus M, Wislowska M, Angerer M, Blume C. Sleep and circadian rhythms in severely brain-injured patients – A comment. Clin Neurophysiol 2018; 129:1780-1784. [DOI: 10.1016/j.clinph.2018.03.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 12/23/2022]
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Abstract
Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.
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Locihová H, Žiaková K. The effects of mechanical ventilation on the quality of sleep of hospitalised patients in the Intensive Care Unit. Rom J Anaesth Intensive Care 2018; 25:61-72. [PMID: 29756065 DOI: 10.21454/rjaic.7518.251.ven] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aim To examine the effects of mechanical ventilation on the quality of sleep in patients in the intensive care unit (ICU) using recent and relevant literature. Methods To verify the examined objective, the results of the analysis of available original scientific works have been used including defined inclusion/exclusion criteria and search strategy. Appropriate works found were analysed further. The applied methodology was in line with the general principles of Evidence-Based Medicine. The following literary databases were used: CINAHL, Medline and gray literature: Google Scholar. Results A total of 91 trials were found. Eleven of these relevant to the follow-up analysis were selected: all trials were carried out under real ICU conditions and the total of 192 patients were included in the review. There is an agreement within all trials that sleep in patients requiring mechanical ventilation is disturbed. Most reviewed trials have shown that mechanical ventilation is probably not the main factor causing sleep disturbances, but an appropriate ventilation strategy can significantly help to improve its quality by reducing the frequency of the patient-ventilator asynchrony. Conclusion Based on the analysis, it appears that an appropriate ventilation mode setting can have a beneficial effect on the quality of sleep in ICU patients.
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Affiliation(s)
- Hana Locihová
- Department of Nursing, Jesseniuss Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic.,AGEL Educational and Research Institute (VAVIA), Prostějov, Czech Republic
| | - Katarína Žiaková
- Department of Nursing, Jesseniuss Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
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Lewis SR, Pritchard MW, Schofield‐Robinson OJ, Alderson P, Smith AF. Melatonin for the promotion of sleep in adults in the intensive care unit. Cochrane Database Syst Rev 2018; 5:CD012455. [PMID: 29746721 PMCID: PMC6353085 DOI: 10.1002/14651858.cd012455.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients in the intensive care unit (ICU) experience sleep deprivation caused by environmental disruption, such as high noise levels and 24-hour lighting, as well as increased patient care activities and invasive monitoring as part of their care. Sleep deprivation affects physical and psychological health, and patients perceive the quality of their sleep to be poor whilst in the ICU. Artificial lighting during night-time hours in the ICU may contribute to reduced production of melatonin in critically ill patients. Melatonin is known to have a direct effect on the circadian rhythm, and it appears to reset a natural rhythm, thus promoting sleep. OBJECTIVES To assess whether the quantity and quality of sleep may be improved by administration of melatonin to adults in the intensive care unit. To assess whether melatonin given for sleep promotion improves both physical and psychological patient outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8), MEDLINE (1946 to September 2017), Embase (1974 to September 2017), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to September 2017), and PsycINFO (1806 to September 2017). We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. SELECTION CRITERIA We included randomized and quasi-randomized controlled trials with adult participants (over the age of 16) admitted to the ICU with any diagnoses given melatonin versus a comparator to promote overnight sleep. We included participants who were mechanically ventilated and those who were not mechanically ventilated. We planned to include studies that compared the use of melatonin, given at an appropriate clinical dose with the intention of promoting night-time sleep, against no agent; or against another agent administered specifically to promote sleep. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesized findings. We assessed the quality of evidence with GRADE. MAIN RESULTS We included four studies with 151 randomized participants. Two studies included participants who were mechanically ventilated, one study included a mix of ventilated and non-ventilated participants and in one study participants were being weaned from mechanical ventilation. Three studies reported admission diagnoses, which varied: these included sepsis, pneumonia and cardiac or cardiorespiratory arrest. All studies compared melatonin against no agent; three were placebo-controlled trials; and one compared melatonin with usual care. All studies administered melatonin in the evening.All studies reported adequate methods for randomization and placebo-controlled trials were blinded at the participant and personnel level. We noted high risk of attrition bias in one study and were unclear about potential bias introduced in two studies with differences between participants at baseline.It was not appropriate to combine data owing to differences in measurement tools, or methods used to report data.The effects of melatonin on subjectively rated quantity and quality of sleep are uncertain (very low certainty evidence). Three studies (139 participants) reported quantity and quality of sleep as measured through reports of participants or family members or by personnel assessments. Study authors in one study reported no difference in sleep efficiency index scores between groups for participant assessment (using Richards-Campbell Sleep Questionnaire) and nurse assessment. Two studies reported no difference in duration of sleep observed by nurses.The effects of melatonin on objectively measured quantity and quality of sleep are uncertain (very low certainty evidence). Two studies (37 participants) reported quantity and quality of sleep as measured by polysomnography (PSG), actigraphy, bispectral index (BIS) or electroencephalogram (EEG). Study authors in one study reported no difference in sleep efficiency index scores between groups using BIS and actigraphy. These authors also reported longer sleep in participants given melatonin which was not statistically significant, and improved sleep (described as "better sleep") in participants given melatonin from analysis of area under the curve (AUC) of BIS data. One study used PSG but authors were unable to report data because of a large loss of participant data.One study (82 participants) reported no evidence of a difference in anxiety scores (very low certainty evidence). Two studies (94 participants) reported data for mortality: one study reported that overall one-third of participants died; and one study reported no evidence of difference between groups in hospital mortality (very low certainty). One study (82 participants) reported no evidence of a difference in length of ICU stay (very low certainty evidence). Effects of melatonin on adverse events were reported in two studies (107 participants), and are uncertain (very low certainty evidence): one study reported headache in one participant given melatonin, and one study reported excessive sleepiness in one participant given melatonin and two events in the control group (skin reaction in one participant, and excessive sleepiness in another participant).The certainty of the evidence for each outcome was limited by sparse data with few participants. We noted study limitations in some studies due to high attrition and differences between groups in baseline data; and doses of melatonin varied between studies. Methods used to measure data were not consistent for outcomes, and use of some measurement tools may not be effective for use on the ICU patient. All studies included participants in the ICU but we noted differences in ICU protocols, and one included study used a non-standard sedation protocol with participants which introduced indirectness to the evidence. AUTHORS' CONCLUSIONS We found insufficient evidence to determine whether administration of melatonin would improve the quality and quantity of sleep in ICU patients. We identified sparse data, and noted differences in study methodology, in ICU sedation protocols, and in methods used to measure and report sleep. We identified five ongoing studies from database and clinical trial register searches. Inclusion of data from these studies in future review updates would provide more certainty for the review outcomes.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Michael W Pritchard
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Oliver J Schofield‐Robinson
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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