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Henríquez-Beltrán M, Vaca R, Benítez ID, González J, Santisteve S, Aguilà M, Minguez O, Moncusí-Moix A, Gort-Paniello C, Torres G, Labarca G, Caballero J, Barberà C, Torres A, de Gonzalo-Calvo D, Barbé F, Targa ADS. Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study. Crit Care Med 2024; 52:1206-1217. [PMID: 38597721 PMCID: PMC11239094 DOI: 10.1097/ccm.0000000000006298] [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: 04/11/2024]
Abstract
OBJECTIVES To investigate the sleep and circadian health of critical survivors 12 months after hospital discharge and to evaluate a possible effect of the severity of the disease within this context. DESIGN Observational, prospective study. SETTING Single-center study. PATIENTS Two hundred sixty patients admitted to the ICU due to severe acute respiratory syndrome coronavirus 2 infection. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cohort was composed of 260 patients (69.2% males), with a median (quartile 1-quartile 3) age of 61.5 years (52.0-67.0 yr). The median length of ICU stay was 11.0 days (6.00-21.8 d), where 56.2% of the patients required invasive mechanical ventilation (IMV). The Pittsburgh Sleep Quality Index (PSQI) revealed that 43.1% of the cohort presented poor sleep quality 12 months after hospital discharge. Actigraphy data indicated an influence of the disease severity on the fragmentation of the circadian rest-activity rhythm at the 3- and 6-month follow-ups, which was no longer significant in the long term. Still, the length of the ICU stay and the duration of IMV predicted a higher fragmentation of the rhythm at the 12-month follow-up with effect sizes (95% CI) of 0.248 (0.078-0.418) and 0.182 (0.005-0.359), respectively. Relevant associations between the PSQI and the Hospital Anxiety and Depression Scale (rho = 0.55, anxiety; rho = 0.5, depression) as well as between the fragmentation of the rhythm and the diffusing lung capacity for carbon monoxide (rho = -0.35) were observed at this time point. CONCLUSIONS Our findings reveal a great prevalence of critical survivors presenting poor sleep quality 12 months after hospital discharge. Actigraphy data indicated the persistence of circadian alterations and a possible impact of the disease severity on the fragmentation of the circadian rest-activity rhythm, which was attenuated at the 12-month follow-up. This altogether highlights the relevance of considering the sleep and circadian health of critical survivors in the long term.
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Affiliation(s)
- Mario Henríquez-Beltrán
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán, Chile
| | - Rafaela Vaca
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Maria Aguilà
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Olga Minguez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jesús Caballero
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, Hospital Universitari Santa Maria, Lleida, Spain
| | - Antoni Torres
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Adriano D S Targa
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
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Franzén S. It's All About the CREY! FUNCTION 2024; 5:zqae021. [PMID: 38984995 PMCID: PMC11237887 DOI: 10.1093/function/zqae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 07/11/2024] Open
Affiliation(s)
- Stephanie Franzén
- Department of Medicine, Division Nephrology, Section Cardio-Renal Physiology and Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Surgical Sciences, Division Anesthesiology and Intensive Care, Uppsala University, Uppsala, 75185, Sweden
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3
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Sagun E, Akyol A, Kaymak C. Chrononutrition in Critical Illness. Nutr Rev 2024:nuae078. [PMID: 38904422 DOI: 10.1093/nutrit/nuae078] [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: 06/22/2024] Open
Abstract
Circadian rhythms in humans are biological rhythms that regulate various physiological processes within a 24-hour time frame. Critical illness can disrupt the circadian rhythm, as can environmental and clinical factors, including altered light exposure, organ replacement therapies, disrupted sleep-wake cycles, noise, continuous enteral feeding, immobility, and therapeutic interventions. Nonpharmacological interventions, controlling the ICU environment, and pharmacological treatments are among the treatment strategies for circadian disruption. Nutrition establishes biological rhythms in metabolically active peripheral tissues and organs through appropriate synchronization with endocrine signals. Therefore, adhering to a feeding schedule based on the biological clock, a concept known as "chrononutrition," appears to be vitally important for regulating peripheral clocks. Chrononutritional approaches, such as intermittent enteral feeding that includes overnight fasting and consideration of macronutrient composition in enteral solutions, could potentially restore circadian health by resetting peripheral clocks. However, due to the lack of evidence, further studies on the effect of chrononutrition on clinical outcomes in critical illness are needed. The purpose of this review was to discuss the role of chrononutrition in regulating biological rhythms in critical illness, and its impact on clinical outcomes.
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Affiliation(s)
- Eylul Sagun
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Hacettepe University, Ankara, 06100, Turkey
| | - Asli Akyol
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Hacettepe University, Ankara, 06100, Turkey
| | - Cetin Kaymak
- Gülhane Faculty of Medicine, Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Training and Research Hospital, Intensive Care Unit, Ankara, 06230, Turkey
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4
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Kervezee L, Dashti HS, Pilz LK, Skarke C, Ruben MD. Using routinely collected clinical data for circadian medicine: A review of opportunities and challenges. PLOS DIGITAL HEALTH 2024; 3:e0000511. [PMID: 38781189 PMCID: PMC11115276 DOI: 10.1371/journal.pdig.0000511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
A wealth of data is available from electronic health records (EHR) that are collected as part of routine clinical care in hospitals worldwide. These rich, longitudinal data offer an attractive object of study for the field of circadian medicine, which aims to translate knowledge of circadian rhythms to improve patient health. This narrative review aims to discuss opportunities for EHR in studies of circadian medicine, highlight the methodological challenges, and provide recommendations for using these data to advance the field. In the existing literature, we find that data collected in real-world clinical settings have the potential to shed light on key questions in circadian medicine, including how 24-hour rhythms in clinical features are associated with-or even predictive of-health outcomes, whether the effect of medication or other clinical activities depend on time of day, and how circadian rhythms in physiology may influence clinical reference ranges or sampling protocols. However, optimal use of EHR to advance circadian medicine requires careful consideration of the limitations and sources of bias that are inherent to these data sources. In particular, time of day influences almost every interaction between a patient and the healthcare system, creating operational 24-hour patterns in the data that have little or nothing to do with biology. Addressing these challenges could help to expand the evidence base for the use of EHR in the field of circadian medicine.
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Affiliation(s)
- Laura Kervezee
- Group of Circadian Medicine, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hassan S. Dashti
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Luísa K. Pilz
- Department of Anesthesiology and Intensive Care Medicine CCM / CVK, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- ECRC Experimental and Clinical Research Center, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Chronobiology and Sleep Institute (CSI), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Marc D. Ruben
- Divisions of Pulmonary and Sleep Medicine and Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
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5
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Aldrich JC, Scheinfeld AR, Lee SE, Dusenbery KJ, Mahach KM, Van de Veire BC, Fonken LK, Gaudet AD. Effects of dim light at night in C57BL/6 J mice on recovery after spinal cord injury. Exp Neurol 2024; 375:114725. [PMID: 38365132 PMCID: PMC10981559 DOI: 10.1016/j.expneurol.2024.114725] [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] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
Spinal cord injury (SCI) can cause long-lasting locomotor deficits, pain, and mood disorders. Anatomical and functional outcomes are exacerbated by inflammation after SCI, which causes secondary damage. One promising target after SCI is manipulating the circadian system, which optimizes biology and behavior for time of day - including neuroimmune responses and mood-related behaviors. Circadian disruption after SCI is likely worsened by a disruptive hospital environment, which typically includes dim light-at-night (dLAN). Here, we hypothesized that mice subjected to SCI, then placed in dLAN, would exhibit worsened locomotor deficits, pain-like behavior, and anxiety-depressive-like symptoms compared to mice maintained in light days with dark nights (LD). C57BL/6 J mice received sham surgery or moderate T9 contusion SCI, then were placed permanently in LD or dLAN. dLAN after SCI did not worsen locomotor deficits; rather, SCI-dLAN mice showed slight improvement in open-field locomotion at the final timepoint. Although dLAN did not alter SCI-induced heat hyperalgesia, SCI-dLAN mice exhibited an increase in mechanical allodynia at 13 days post-SCI compared to SCI-LD mice. SCI-LD and SCI-dLAN mice had similar outcomes using sucrose preference (depressive-like) and open-field (anxiety-like) tests. At 21 dpo, SCI-dLAN mice had reduced preference for a novel juvenile compared to SCI-LD, implying that dLAN combined with SCI may worsen this mood-related behavior. Finally, lesion size was similar between SCI-LD and SCI-dLAN mice. Therefore, newly placing C57BL/6 J mice in dLAN after SCI had modest effects on locomotor, pain-like, and mood-related behaviors. Future studies should consider whether clinically-relevant circadian disruptors, alone or in combination, could be ameliorated to enhance outcomes after SCI.
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Affiliation(s)
- John C Aldrich
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Ashley R Scheinfeld
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Sydney E Lee
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kalina J Dusenbery
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kathryn M Mahach
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Brigid C Van de Veire
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Laura K Fonken
- Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin
| | - Andrew D Gaudet
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin, USA; Department of Neurology, Dell Medical School, The University of Texas at Austin.
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6
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Aldrich JC, Scheinfeld AR, Lee SE, Dusenbery KJ, Mahach KM, Van de Veire BC, Fonken LK, Gaudet AD. Effects of dim light at night in C57BL/6J mice on recovery after spinal cord injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.15.557980. [PMID: 37745393 PMCID: PMC10516041 DOI: 10.1101/2023.09.15.557980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Spinal cord injury (SCI) can cause long-lasting locomotor deficits, pain, and mood disorders. Anatomical and functional outcomes are exacerbated by inflammation after SCI, which causes secondary damage. One promising target after SCI is manipulating the circadian system, which optimizes biology and behavior for time of day - including neuroimmune responses and mood-related behaviors. Circadian disruption after SCI is likely worsened by a disruptive hospital environment, which typically includes dim light-at-night (dLAN). Here, we hypothesized that mice subjected to SCI, then placed in dLAN, would exhibit worsened locomotor deficits, pain-like behavior, and anxiety-depressive-like symptoms compared to mice maintained in light days with dark nights (LD). C57BL/6J mice received sham surgery or moderate T9 contusion SCI, then were placed permanently in LD or dLAN. dLAN after SCI did not worsen locomotor deficits; rather, SCI-dLAN mice showed slight improvement in open-field locomotion at the final timepoint. Although dLAN did not alter SCI-induced heat hyperalgesia, SCI-dLAN mice exhibited an increase in mechanical allodynia at 13 days post-SCI compared to SCI-LD mice. SCI-LD and SCI-dLAN mice had similar outcomes using sucrose preference (depressive-like) and open-field (anxiety-like) tests. At 21 dpo, SCI-dLAN mice had reduced preference for a novel juvenile compared to SCI-LD, implying that dLAN combined with SCI may worsen this mood-related behavior. Finally, lesion size was similar between SCI-LD and SCI-dLAN mice. Therefore, newly placing C57BL/6J mice in dLAN after SCI had modest effects on locomotor, pain-like, and mood-related behaviors. Future studies should consider whether clinically-relevant circadian disruptors, alone or in combination, could be ameliorated to enhance outcomes after SCI.
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Affiliation(s)
- John C Aldrich
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Ashley R Scheinfeld
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Sydney E Lee
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kalina J Dusenbery
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Kathryn M Mahach
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Brigid C Van de Veire
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Laura K Fonken
- Division of Pharmacology and Toxicology, College of Pharmacy, The University of Texas at Austin
| | - Andrew D Gaudet
- Department of Psychology, College of Liberal Arts, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
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Melone MA, Becker TC, Wendt LH, Ten Eyck P, Patel SB, Poston J, Pohlman AS, Pohlman M, Miller A, Nedeltcheva A, Hall JB, Van Cauter E, Zabner J, Gehlbach BK. Disruption of the circadian rhythm of melatonin: A biomarker of critical illness severity. Sleep Med 2023; 110:60-67. [PMID: 37541132 PMCID: PMC11386949 DOI: 10.1016/j.sleep.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
Circadian dysrhythmias occur commonly in critically ill patients reflecting variable effects of underlying illness, ICU environment, and treatments. We retrospectively analyzed the relationship between clinical outcomes and 24-h urinary 6-sulfatoxymelatonin (aMT6s) excretion profiles in 37 critically ill patients with shock and/or respiratory failure. Nonlinear regression was used to fit a 24-h cosine curve to each patient's aMT6s profile, with rhythmicity determined by the zero-amplitude test. From these curves we determined acrophase, amplitude, phase, and night/day ratio. After assessing unadjusted relationships, we identified the optimal multivariate models for hospital survival and for discharge to home (vs. death or transfer to another facility). Normalized aMT6s rhythm amplitude was greater (p = 0.005) in patients discharged home than in those who were not, while both groups exhibited a phase delay. Patients with rhythmic aMT6s excretion were more likely to survive (OR 5.25) and be discharged home (OR 8.89; p < 0.05 for both) than patients with arrhythmic profiles, associations that persisted in multivariate modelling. In critically ill patients with shock and/or respiratory failure, arrhythmic and/or low amplitude 24-h aMT6s rhythms were associated with worse clinical outcomes, suggesting a role for the melatonin-based rhythm as a novel biomarker of critical illness severity.
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Affiliation(s)
- Marie-Anne Melone
- Department of Pulmonary, Thoracic Oncology and Respiratory Intensive Care, Rouen University Hospital, Univ Rouen, F-76000, Rouen, France; CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821, Mont-Saint-Aignan, France.
| | - Taylor C Becker
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Linder H Wendt
- Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Patrick Ten Eyck
- Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Shruti B Patel
- Department of Internal Medicine, Loyola University of Chicago, Chicago, IL, USA
| | - Jason Poston
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anne S Pohlman
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Annette Miller
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Jesse B Hall
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Eve Van Cauter
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Joseph Zabner
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Brian K Gehlbach
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA
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8
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Deng H, Yu X, Liu Y, Li W, Fan J. Association between circadian body temperature rhythm during the first 24 hours of ICU stay and 28-day mortality in elderly critically ill patients: A retrospective cohort study. Chronobiol Int 2023; 40:1251-1260. [PMID: 37781772 DOI: 10.1080/07420528.2023.2259994] [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] [Received: 04/10/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
Disrupted circadian temperature rhythm is commonly observed in elderly patients in the intensive care unit (ICU), but the association between circadian temperature rhythm and mortality in elderly patients is unclear. Adult patients with a relatively complete record of body temperature (BT) during the first 24 hours of ICU stay in the Multi-parameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database were included in this retrospective cohort study. The circadian rhythm of body temperature was blunted as a ratio of the maximum BT between 12:00 and 24:00 divided by the minimum BT between 0:00 and 12:00, and we defined it as BT fluctuation ratio. The associations of BT fluctuation ratio with 28-day mortality were assessed separately using Cox proportional hazards model in elderly patients and non-elderly patients. The overall cohort comprised 12 767 patients. After adjusting for covariates, the analysis showed that the BT fluctuation ratio (%) was significantly associated with mortality at 28 days in total patients (hazard ratio: 1.044; 95% CI 1.001-1.088; P = 0.042), and still significantly in elderly patients (hazard ratio 1.055, 95% CI as 1.004-1.109, p = 0.035), but not significantly in non-elderly patients. The implementation of restricted cubic splines demonstrated a nonlinear correlation between the ratio of BT fluctuation and the hazard ratio of 28-day mortality, indicating that increased diurnal temperature fluctuations are linked to elevated risk of mortality. This study revealed that the augmented amplitude of the circadian rhythm of body temperature in the elderly patients constitutes a risk factor for the rise of 28-day mortality. Additionally, the circadian body temperature rhythm may facilitate the early detection of critically ill elderly patients.
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Affiliation(s)
- Hongbin Deng
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Xianqiang Yu
- School of Medicine, Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Yang Liu
- Department of Critical Care Medicine, Jinling Hospital, Medical School of Southeast University, Nanjing, Jiangsu, People's Republic of China
| | - Weiqin Li
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Jiemei Fan
- Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People's Republic of China
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9
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Craig T, Mathieu S, Morden C, Patel M, Matthews L. A prospective multicentre observational study to quantify nocturnal light exposure in intensive care. J Intensive Care Soc 2023; 24:133-138. [PMID: 37260432 PMCID: PMC10227891 DOI: 10.1177/17511437211045325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background Disrupted circadian rhythms can have a major effect on human physiology and healthcare outcomes, with proven increases in ICU morbidity, mortality and length of stay. Methods We performed a multicentre observational study to study the nocturnal lux exposure of patients in 3 intensive care units. Results The median light intensity recorded was 1 lux over the 6-hour recording period; however, this is deceptive as it hides short periods of high lux. When looked at in shorter time segments of 30 minutes, there were significant periods of lux higher than a crude median, especially in higher acuity patients. There was a positive correlation between acuity (as estimated by SOFA score) and maximum lux (R = 0.479, p = .0001), median lux (R = 0.35, p = .006) and cumulative lux (R = 0.55, p = .000001). There was no relationship between neighbouring patient acuity and lux. Conclusions Clinicians should practice vigilance at night to provide optimal environmental conditions for patients to minimise potential harm.
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Affiliation(s)
- Thomas Craig
- Anaesthetics Speciality Registrar,
Addenbrookes Hospital, Cambridge University Hospitals NHS
Foundation Trust, Cambridgeshire, UK
| | - Steve Mathieu
- Intensive Care Consultant, Portsmouth University Hospitals NHS
Trust, Portsmouth, UK
| | - Clare Morden
- Emergency Medicine and Intensive
Care Speciality Registrar, Portsmouth University Hospitals NHS
Trust, Portsmouth, UK
| | - Mitul Patel
- Anaesthetics Trainee, Portsmouth University Hospitals NHS
Trust, Portsmouth, UK
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Coiffard B, Merdji H, Boucekine M, Helms J, Clere-Jehl R, Mege JL, Meziani F. Changes in Body Temperature Patterns Are Predictive of Mortality in Septic Shock: An Observational Study. BIOLOGY 2023; 12:biology12050638. [PMID: 37237452 DOI: 10.3390/biology12050638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Biological rhythms are important regulators of immune functions. In intensive care unit (ICU), sepsis is known to be associated with rhythm disruption. Our objectives were to determine factors associated with rhythm disruption of the body temperature and to assess the relationship between temperature and mortality in septic shock patients; In a cohort of septic shock, we recorded body temperature over a 24-h period on day 2 after ICU admission. For each patient, the temperature rhythmicity was assessed by defining period and amplitude, and the adjusted average (mesor) of the temperature by sinusoidal regression and cosinor analysis. Analyses were performed to assess factors associated with the three temperature parameters (period, amplitude, and mesor) and mortality. 162 septic shocks were enrolled. The multivariate analysis demonstrates that the period of temperature was associated with gender (women, coefficient -2.2 h, p = 0.031) and acetaminophen use (coefficient -4.3 h, p = 0.002). The mesor was associated with SOFA score (coefficient -0.05 °C per SOFA point, p = 0.046), procalcitonin (coefficient 0.001 °C per ng/mL, p = 0.005), and hydrocortisone use (coefficient -0.5 °C, p = 0.002). The amplitude was associated with the dialysis (coefficient -0.5 °C, p = 0.002). Mortality at day 28 was associated with lower mesor (adjusted hazard ratio 0.50, 95% CI 0.28 to 0.90; p = 0.02), and higher amplitude (adjusted hazard ratio 5.48, 95% CI 1.66 to 18.12; p = 0.005) of temperature. Many factors, such as therapeutics, influence the body temperature during septic shock. Lower mesor and higher amplitude were associated with mortality and could be considered prognostic markers in ICU. In the age of artificial intelligence, the incorporation of such data in an automated scoring alert could compete with physicians to identify high-risk patients during septic shock.
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Affiliation(s)
- Benjamin Coiffard
- IHU-Méditerranée Infection, IRD, AP-HM, MEPHI, Aix Marseille Université, 13005 Marseille, France
- Médecine Intensive-Réanimation, APHM, Hôpital Nord, Aix Marseille Université, 13015 Marseille, France
| | - Hamid Merdji
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
| | - Mohamed Boucekine
- Health Service Research and Quality of Life Center, APHM, EA 3279 CEReSS, School of Medicine-La Timone Medical Campus, Aix Marseille Université, 13005 Marseille, France
| | - Julie Helms
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Raphaël Clere-Jehl
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Jean-Louis Mege
- IHU-Méditerranée Infection, IRD, AP-HM, MEPHI, Aix Marseille Université, 13005 Marseille, France
| | - Ferhat Meziani
- Service de Réanimation, Nouvel Hôpital Civil, Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
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11
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Knauert MP, Ayas NT, Bosma KJ, Drouot X, Heavner MS, Owens RL, Watson PL, Wilcox ME, Anderson BJ, Cordoza ML, Devlin JW, Elliott R, Gehlbach BK, Girard TD, Kamdar BB, Korwin AS, Lusczek ER, Parthasarathy S, Spies C, Sunderram J, Telias I, Weinhouse GL, Zee PC. Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e49-e68. [PMID: 36999950 PMCID: PMC10111990 DOI: 10.1164/rccm.202301-0184st] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background: Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods: We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results: We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions: ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.
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12
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Yang Z, Xie X, Zhang X, Li L, Bai R, Long H, Ma Y, Hui Z, Qi Y, Chen J. Circadian rhythms of vital signs are associated with in-hospital mortality in critically ill patients: A retrospective observational study. Chronobiol Int 2023; 40:262-271. [PMID: 36597185 DOI: 10.1080/07420528.2022.2163656] [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: 01/05/2023]
Abstract
Vital signs have been widely used to assess the disease severity of patients, but there is still a lack of research on their circadian rhythms. The objective is to explore the circadian rhythms of vital signs in critically ill patients and establish an in-hospital mortality prediction model. Study patients from the recorded eICU Collaborative Research Database were included in the present analyses. The circadian rhythms of vital signs are analyzed in critically ill patients using the cosinor method. Logistic regression was used to screen independent predictors and establish a prediction model for in-hospital mortality by multivariate logistic regression analysis and to show in the nomogram. Internal validation is used to evaluate the prediction model by bootstrapping with 1000 resamples. A total of 29,448 patients were included in the current analyses. The Mesor, Amplitude, and Peak time of vital signs, such as heart rate (HR), temperature, respiration rate (RR), pulse oximetry-derived oxygen saturation (SpO2), and blood pressure (BP), were significant differences between survivors and non-survivors . Logistic regression analysis showed that Mesor, Amplitude, and Peak time of HR, RR, and SpO2 were independent predictors for in-hospital mortality in critically ill patients. The area under the curve (AUC) and c-index of the prediction model for the Medical intensive care unit (MICU) and Surgical intensive care unit (SICU) were 0.807 and 0.801, respectively. The Hosmer-Lemeshow test P-values were 0.076 and 0.085, respectively, demonstrating a good fit for the prediction model. The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability. Internal validation assesses the consistency of the results. There were significant differences in the circadian rhythms of vital signs between survivors and non-survivors in critically ill patients. The prediction model established by the Mesor, Amplitude, and Peak time of HR, RR, and SpO2 combined with the Acute Physiology and Chronic Health Evaluation (APACHE) IV score has good predictive performance for in-hospital mortality and may eventually support clinical decision-making.Abbreviations: ICU: Intensive care unit; MICU: Medical intensive care unit; SICU: Surgical intensive care unit; HR: Heart rate; RR: Respiration rate; SpO2: Pulse oximetry-derived oxygen saturation; BP: Blood pressure; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; APACHE: Acute Physiology and Chronic Health Evaluation; bpm: beats per min; BMI: Body mass index; OR: Odd ratio; CI: Confidential interval; IQR: Interquartile range; SD: Standard deviation; ROC: Receiver operating characteristic; AUC: area under the curve; DCA: Decision curve analysis; IRB: Institutional review board.
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Affiliation(s)
- Zhengning Yang
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Xiaoxia Xie
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Xu Zhang
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Lan Li
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Ruoxue Bai
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Hui Long
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Yanna Ma
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Zhenliang Hui
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Yujie Qi
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Jun Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
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13
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Hollis HC, Francis JN, Anafi RC. Multi-tissue transcriptional changes and core circadian clock disruption following intensive care. Front Physiol 2022; 13:942704. [PMID: 36045754 PMCID: PMC9420996 DOI: 10.3389/fphys.2022.942704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Both critical illness and current care have been hypothesized to upset daily rhythms and impair molecular circadian function. However, the influence of critical illness on clock function in different tissues and on circadian output genes are unknown. Here we evaluate the effect of critical care and illness on transcription, focusing on the functional organization of the core circadian oscillator. Methods: We downloaded RNAseq count data from the Genotype-Tissue Expression (GTEx) project. Treating mechanical ventilation as a marker for intensive care, we stratified samples into acute death (AD) and intensive care (IC) groups based on the documented Hardy Death Scale. We restricted our analysis to the 25 tissues with >50 samples in each group. Using the edgeR package and controlling for collection center, gender, and age, we identified transcripts differentially expressed between the AD and IC groups. Overrepresentation and enrichment methods were used to identify gene sets modulated by intensive care across tissues. For each tissue, we then calculated the delta clock correlation distance (ΔCCD), a comparative measure of the functional organization of the core circadian oscillator, in the both the AD and IC groups. The statistical significance of the ΔCCD was assessed by permutation, modifying a pre-existing R package to control for confounding variables. Results: Intensive care, as marked by ventilation, significantly modulated the expression of thousands of genes. Transcripts that were modulated in ≥75% of tissues were enriched for genes involved in mitochondrial energetics, cellular stress, metabolism, and notably circadian regulation. Transcripts that were more markedly affected, in ≥10 tissues, were enriched for inflammation, complement and immune pathways. Oscillator organization, as assessed by ΔCCD, was significantly reduced in the intensive care group in 11/25 tissues. Conclusion: Our findings support the hypothesis that patients in intensive care have impaired molecular circadian rhythms. Tissues involved in metabolism and energetics demonstrated the most marked changes in oscillator organization. In adipose tissue, there was a significant overlap between transcripts previously established to be modulated by sleep deprivation and fasting with those modulated by critical care. This work suggests that intensive care protocols that restore sleep/wake and nutritional rhythms may be of benefit.
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Affiliation(s)
- Henry C. Hollis
- School of Biomedical Engineering and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Julian N. Francis
- Department of Mathematics, Howard University, Washington, DC, United States
| | - Ron C. Anafi
- Division of Sleep Medicine and Chronobiology and Sleep Institute, University of Pennsylvania, Philadelphia, PA, United States,*Correspondence: Ron C. Anafi,
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14
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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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15
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Abstract
To evaluate the sleep and circadian rest-activity pattern of critical COVID-19 survivors 3 months after hospital discharge.
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16
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Zhang J, Du L, Li J, Li R, Jin X, Ren J, Gao Y, Wang X. Association between circadian variation of heart rate and mortality among critically ill patients: a retrospective cohort study. BMC Anesthesiol 2022; 22:45. [PMID: 35151270 PMCID: PMC8840314 DOI: 10.1186/s12871-022-01586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Heart rate (HR) related parameters, such as HR variability, HR turbulence, resting HR, and nighttime mean HR have been recognized as independent predictors of mortality. However, the influence of circadian changes in HR on mortality remains unclear in intensive care units (ICU). The study is designed to evaluate the relationship between the circadian variation in HR and mortality risk among critically ill patients. Methods The present study included 4,760 patients extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. The nighttime mean HR/daytime mean HR ratio was adopted as the circadian variation in HR. According to the median value of the circadian variation in HR, participants were divided into two groups: group A (≤ 1) and group B (> 1). The outcomes included ICU, hospital, 30-day, and 1-year mortalities. The prognostic value of HR circadian variation was investigated by multivariable logistic regression models and Cox proportional hazards models. Results Patients in group B (n = 2,471) had higher mortality than those in group A (n = 2,289). Multivariable models revealed that the higher circadian variation in HR was associated with ICU mortality (odds ratio [OR], 1.393; 95% confidence interval [CI], 1.112–1.745; P = 0.004), hospital mortality (OR, 1.393; 95% CI, 1.112–1.745; P = 0.004), 30-day mortality (hazard ratio, 1.260; 95% CI, 1.064–1.491; P = 0.007), and 1-year mortality (hazard ratio, 1.207; 95% CI, 1.057–1.378; P = 0.005), especially in patients with higher SOFA scores. Conclusions The circadian variation in HR might aid in the early identification of critically ill patients at high risk of associated with ICU, hospital, 30-day, and 1-year mortalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01586-9.
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17
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Weinhouse GL, Kimchi E, Watson P, Devlin JW. Sleep Assessment in Critically Ill Adults: Established Methods and Emerging Strategies. Crit Care Explor 2022; 4:e0628. [PMID: 35156048 PMCID: PMC8824402 DOI: 10.1097/cce.0000000000000628] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sleep is a biological mandate with an integral role in optimizing functions that maintain psychological and physical health. During critical illness, however, sleep may be disrupted at best and elusive at worst. Sleep improvement efforts and research endeavors evaluating interventions to improve sleep in critically ill adults are hampered by limited methods available to measure sleep in this setting. This narrative review summarizes available modalities for sleep assessment in the ICU, describes new ICU sleep assessment methods under development, and highlights features of the ideal ICU sleep measurement tool. DATA SOURCES The most relevant literature and author experiences were assessed for inclusion from PubMed and textbooks. STUDY SELECTION The authors selected studies for inclusion by consensus. DATA EXTRACTION The authors reviewed each study and selected appropriate data for inclusion by consensus. DATA SYNTHESIS Currently available tools to measure sleep in critically ill adults have important flaws. Subjective measurements are limited by recall bias, the inability of many patients to communicate, and poorly correlate with objective measures when completed by surrogates. Actigraphy does not consider the effects of sedating medications or myopathy leading to an over estimation of sleep time. Polysomnography, the gold standard for sleep assessment, is limited by interpretation issues and practical application concerns. Single and multiple channel electroencephalogram devices offer real-time physiologic data and are more practical to use than polysomnography but are limited by the scope of sleep-specific information they can measure and poorly characterize the circadian system. CONCLUSIONS A measurement tool that offers real-time sleep and circadian assessment and is practical for broad application in the ICU does not exist. Newer sleep assessment devices have shown promise in measuring physiologic data in real time; when used in combination with other assessment modalities, and analyzed by computational techniques, they may revolutionize sleep monitoring in the ICU.
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Affiliation(s)
- Gerald L Weinhouse
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Eyal Kimchi
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Paula Watson
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John W Devlin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
- Department of Pharmacy and Health Systems Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
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18
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Boots R, Mead G, Rawashdeh O, Bellapart J, Townsend S, Paratz J, Garner N, Clement P, Oddy D. Temperature Profile and Adverse Outcomes After Discharge From the Intensive Care Unit. Am J Crit Care 2022; 31:e1-e9. [PMID: 34972850 DOI: 10.4037/ajcc2022223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A predictive model that uses the rhythmicity of core body temperature (CBT) could be an easily accessible clinical tool to ultimately improve outcomes among critically ill patients. OBJECTIVES To assess the relation between the 24-hour CBT profile (CBT-24) before intensive care unit (ICU) discharge and clinical events in the step-down unit within 7 days of ICU discharge. METHODS This retrospective cohort study in a tertiary ICU at a single center included adult patients requiring acute invasive ventilation for more than 48 hours and assessed major clinical adverse events (MCAEs) and rapid response system activations (RRSAs) within 7 days of ICU discharge (MCAE-7 and RRSA-7, respectively). RESULTS The 291 enrolled patients had a median mechanical ventilation duration of 139 hours (IQR, 50-862 hours) and at admission had a median Acute Physiology and Chronic Health Evaluation II score of 22 (IQR, 7-42). At least 1 MCAE or RRSA occurred in 64% and 22% of patients, respectively. Independent predictors of an MCAE-7 were absence of CBT-24 rhythmicity (odds ratio, 1.78 [95% CI, 1.07-2.98]; P = .03), Sequential Organ Failure Assessment score at ICU discharge (1.10 [1.00-1.21]; P = .05), male sex (1.72 [1.04-2.86]; P = .04), age (1.02 [1.00-1.04]; P = .02), and Charlson Comorbidity Index (0.87 [0.76-0.99]; P = .03). Age (1.03 [1.01-1.05]; P = .006), sepsis at ICU admission (2.02 [1.13-3.63]; P = .02), and Charlson Comorbidity Index (1.18 [1.02-1.36]; P = .02) were independent predictors of an RRSA-7. CONCLUSIONS Use of CBT-24 rhythmicity can assist in stratifying a patient's risk of subsequent deterioration during general care within 7 days of ICU discharge.
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Affiliation(s)
- Rob Boots
- Rob Boots is an associate professor, Thoracic Medicine, Royal Brisbane and Women’s Hospital, and Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gabrielle Mead
- Gabrielle Mead is an honors student, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Oliver Rawashdeh
- Oliver Rawashdeh is a senior lecturer,, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Judith Bellapart
- Judith Bellapart is a senior specialist, Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, and Burns, Trauma and Critical Care, The University of Queensland
| | - Shane Townsend
- Shane Townsend is director, Intensive Care Services, Royal Brisbane and Women’s Hospital
| | - Jenny Paratz
- Jenny Paratz is an associate professor and a senior research fellow, Burns, Trauma and Critical Care Research Centre, The University of Queensland School of Medicine
| | - Nicholas Garner
- Nicholas Garner is a PhD student, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland
| | - Pierre Clement
- Pierre Clement is the clinical information systems manager, Department of Intensive Care Services, Royal Brisbane and Women’s Hospital
| | - David Oddy
- David Oddy is the clinical data manager, Department of Intensive Care Services, Royal Brisbane and Women’s Hospital
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19
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Beyer H, Lange N, Podtschaske AH, Martin J, Albers L, von Werder A, Ruland J, Schneider G, Meyer B, Kagerbauer SM, Gempt J. Anterior Pituitary Hormones in Blood and Cerebrospinal Fluid of Patients in Neurocritical Care. Endocrinology 2022; 18:71-79. [PMID: 35949361 PMCID: PMC9354947 DOI: 10.17925/ee.2022.18.1.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
Background: Anterior pituitary hormones in blood follow a circadian rhythm, which
may be influenced by various factors such as intracranial pathologies. In
cerebrospinal fluid (CSF), pituitary hormones have been collected only
selectively and circadian rhythm has not yet been investigated. This pilot study
analysed diurnal variations of anterior pituitary hormones in patients in
neurocritical care to determine whether circadian rhythmicity exists in these
patients. Possible influences of intracranial pathologies were also
investigated. Blood and CSF concentrations were assessed simultaneously to
explore the value of blood concentrations as a surrogate parameter for CSF
levels. Methods: Blood and CSF samples of 20 non-sedated patients were collected
at 06:00, noon, 18:00 and midnight, and analysed for adrenocorticotropic hormone
(ACTH), cortisol, thyroid-stimulating hormone (TSH) and insulin-like growth
factor-1 (IGF-1) concentrations at each of the four time points. ACTH and IGF-1
were measured by sandwich chemiluminescence immunoassay. Cortisol and TSH were
measured by electrochemiluminescence immunoassay. Results: Results showed
inconsistent circadian rhythms. Less than 50% of the patients showed a circadian
rhythmicity of ACTH, cortisol, TSH or IGF-1. Significance of diurnal variations
was only present for blood concentrations of TSH. Correlations between blood and
CSF concentrations were strong for cortisol and TSH. Conclusions: CSF
concentrations were only in the measurable range in some of the patients. No
clear circadian rhythmicity could be identified, except for TSH in blood.
Absence of significant diurnal variations could be explained by the underlying
pathologies or disturbing influences of the intensive care unit. Blood
concentrations of cortisol and TSH may be suitable surrogate parameters for
CSF.
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Affiliation(s)
- Henriette Beyer
- Department of Neurosurgery, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Nicole Lange
- Department of Neurosurgery, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Armin H Podtschaske
- Department of Anesthesiology, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jan Martin
- Department of Anesthesiology, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Lucia Albers
- Department of Medical Informatics, Statistics and Epidemiology, Technical
University Munich, School of Medicine, Klinikum rechts der Isar Munich,
Germany
| | - Alexander von Werder
- Department of Neuroendocrinology, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jürgen Ruland
- Department of Clinical Chemistry, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Gerhard Schneider
- Department of Anesthesiology, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Simone M Kagerbauer
- Department of Anesthesiology, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Technical University Munich, School of
Medicine, Klinikum rechts der Isar, Munich, Germany
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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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21
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Trumpff C, Michelson J, Lagranha CJ, Taleon V, Karan KR, Sturm G, Lindqvist D, Fernström J, Moser D, Kaufman BA, Picard M. Stress and circulating cell-free mitochondrial DNA: A systematic review of human studies, physiological considerations, and technical recommendations. Mitochondrion 2021; 59:225-245. [PMID: 33839318 PMCID: PMC8418815 DOI: 10.1016/j.mito.2021.04.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/23/2021] [Accepted: 04/05/2021] [Indexed: 02/07/2023]
Abstract
Cell-free mitochondrial DNA (cf-mtDNA) is a marker of inflammatory disease and a predictor of mortality, but little is known about cf-mtDNA in relation to psychobiology. A systematic review of the literature reveals that blood cf-mtDNA varies in response to common real-world stressors including psychopathology, acute psychological stress, and exercise. Moreover, cf-mtDNA is inducible within minutes and exhibits high intra-individual day-to-day variation, highlighting the dynamic regulation of cf-mtDNA levels. We discuss current knowledge on the mechanisms of cf-mtDNA release, its forms of transport ("cell-free" does not mean "membrane-free"), potential physiological functions, putative cellular and neuroendocrine triggers, and factors that may contribute to cf-mtDNA removal from the circulation. A review of in vitro, pre-clinical, and clinical studies shows conflicting results around the dogma that physiological forms of cf-mtDNA are pro-inflammatory, opening the possibility of other physiological functions, including the cell-to-cell transfer of whole mitochondria. Finally, to enhance the reproducibility and biological interpretation of human cf-mtDNA research, we propose guidelines for blood collection, cf-mtDNA isolation, quantification, and reporting standards, which can promote concerted advances by the community. Defining the mechanistic basis for cf-mtDNA signaling is an opportunity to elucidate the role of mitochondria in brain-body interactions and psychopathology.
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Affiliation(s)
- Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Jeremy Michelson
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Claudia J Lagranha
- University of Pittsburgh, School of Medicine, Division of Cardiology, Center for Metabolism and Mitochondrial Medicine and Vascular Medicine Institute, Pittsburgh, PA, United States
| | - Veronica Taleon
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Kalpita R Karan
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Gabriel Sturm
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Daniel Lindqvist
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Sweden
| | - Johan Fernström
- Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden
| | - Dirk Moser
- Department of Genetic Psychology, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Brett A Kaufman
- University of Pittsburgh, School of Medicine, Division of Cardiology, Center for Metabolism and Mitochondrial Medicine and Vascular Medicine Institute, Pittsburgh, PA, United States
| | - Martin Picard
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA; Department of Neurology, H. Houston Merritt Center, Columbia Translational Neuroscience Initiative, Columbia University Medical Center, New York, USA; New York State Psychiatric Institute, NY, USA.
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22
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Rasulo FA, Seghelini E. Alterations of circadian rhythms in critically ill patients: can we sleep on it? Minerva Anestesiol 2021; 87:750-751. [PMID: 34134461 DOI: 10.23736/s0375-9393.21.15777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Frank A Rasulo
- Department of Medical, Surgical, Radiological Sciences and Public Health, Institute of Anesthesia, Intensive Care and Emergency Medicine, University of Brescia, Brescia, Italy -
| | - Elisa Seghelini
- Department of Medical, Surgical, Radiological Sciences and Public Health, Institute of Anesthesia, Intensive Care and Emergency Medicine, University of Brescia, Brescia, Italy
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23
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Guo Q, Li H, Ouyang H, Sun R, Wang J, Wu M, Pan Y, Wang J, Zhang Y. Heart Rate Fluctuation and Mortality in Critically Ill Myocardial Infarction Patients: A Retrospective Cohort Study. Front Cardiovasc Med 2021; 8:577742. [PMID: 34055921 PMCID: PMC8160095 DOI: 10.3389/fcvm.2021.577742] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Whether heart rate (HR) fluctuation after admission has an impact on the outcomes of critically ill myocardial infarction (MI) patients in intensive care unit remains unknown. Methods: A total of 2,031 MI patients were enrolled from the Medical Information Mart for Intensive Care (MIMIC-III) database. HR fluctuation was calculated as the maximum HR minus the minimum HR in the initial 24 h after admission. Participants were divided into 3 groups, namely, low HR fluctuation [<30 beats per minute (bpm)], medium HR fluctuation (30-49 bpm), and high HR fluctuation (≥ 50 bpm). The main outcomes were 30-day and 1-year mortality. Cox regression and restricted cubic spline model were used. Results: Each 10-bpm increase in HR fluctuation was associated with a higher risk of 30-day mortality and 1-year mortality, with adjusted hazard ratios of 1.122 (95% CI, 1.083-1.162) and 1.107 (95% CI, 1.074-1.140), respectively. Compared with the low HR fluctuation group, the high HR fluctuation group suffered a significantly higher risk of mortality after adjustment, with hazard ratios of 2.156 (95% CI, 1.483-3.134) for 30-day mortality and 1.796 (95% CI, 1.354-2.381) for 1-year mortality. A typical J-type curve was observed in restricted cubic splines for the association between HR fluctuation and 30-day or 1-year mortality of MI patients, with the lowest risk on the HR fluctuation of 30 bpm. Sensitivity analyses emphasized the robustness of our results. Conclusions: This retrospective cohort study revealed an independent positive association between HR fluctuation and 30-day and 1-year mortality in critically ill MI patients, which warrants further investigation.
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Affiliation(s)
- Qi Guo
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hongwei Li
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huijun Ouyang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Runlu Sun
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junjie Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Maoxiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yue Pan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuling Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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24
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Vethe D, Scott J, Engstrøm M, Salvesen Ø, Sand T, Olsen A, Morken G, Heglum HS, Kjørstad K, Faaland PM, Vestergaard CL, Langsrud K, Kallestad H. The evening light environment in hospitals can be designed to produce less disruptive effects on the circadian system and improve sleep. Sleep 2021; 44:5909282. [PMID: 32954412 PMCID: PMC7953207 DOI: 10.1093/sleep/zsaa194] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/02/2020] [Indexed: 01/12/2023] Open
Abstract
STUDY OBJECTIVES Blue-depleted lighting reduces the disruptive effects of evening artificial light on the circadian system in laboratory experiments, but this has not yet been shown in naturalistic settings. The aim of the current study was to test the effects of residing in an evening blue-depleted light environment on melatonin levels, sleep, neurocognitive arousal, sleepiness, and potential side effects. METHODS The study was undertaken in a new psychiatric hospital unit where dynamic light sources were installed. All light sources in all rooms were blue-depleted in one half of the unit between 06:30 pm and 07:00 am (melanopic lux range: 7-21, melanopic equivalent daylight illuminance [M-EDI] range: 6-19, photopic lux range: 55-124), whereas the other had standard lighting (melanopic lux range: 30-70, M-EDI range: 27-63, photopic lux range: 64-136), but was otherwise identical. A total of 12 healthy adults resided for 5 days in each light environment (LE) in a randomized cross-over trial. RESULTS Melatonin levels were less suppressed in the blue-depleted LE (15%) compared with the normal LE (45%; p = 0.011). Dim light melatonin onset was phase-advanced more (1:20 h) after residing in the blue-depleted LE than after the normal LE (0:46 h; p = 0.008). Total sleep time was 8.1 min longer (p = 0.032), rapid eye movement sleep 13.9 min longer (p < 0.001), and neurocognitive arousal was lower (p = 0.042) in the blue-depleted LE. There were no significant differences in subjective sleepiness (p = 0.16) or side effects (p = 0.09). CONCLUSIONS It is possible to create an evening LE that has an impact on the circadian system and sleep without serious side effects. This demonstrates the feasibility and potential benefits of designing buildings or hospital units according to chronobiological principles and provide a basis for studies in both nonclinical and clinical populations.
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Affiliation(s)
- Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Neurophysiology, St. Olav's University Hospital, Trondheim Norway
| | - Øyvind Salvesen
- Unit of Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Clinical Neurophysiology, St. Olav's University Hospital, Trondheim Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Hanne S Heglum
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Novelda AS, Trondheim, Norway
| | - Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Patrick M Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
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25
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Boots RJ, Mead G, Garner N, Rawashdeh O, Bellapart J, Townsend S, Paratz J, Clement P, Oddy D, Leong M, Zappala C. Temperature rhythms and ICU sleep: the TRIS study. Minerva Anestesiol 2021; 87:794-802. [PMID: 33853269 DOI: 10.23736/s0375-9393.21.15232-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Core body temperature (CBT) patterns associated with sleep have not been described in the critically ill. This study aimed to characterize night-time sleep and its relationship to CBT in ICU patients. METHODS A prospective study was performed in a 27-bed tertiary adult intensive care unit of 20 mechanically ventilated patients in the weaning stage of their critical illness. The study assessed sleep by polysomnography (PSG) during the evening between 21:00-7:00 hours, nursing interventions using the Therapeutic Intervention Scoring System (TISS), illness severity using SOFA and APACHE II scores and CBT 24-hour pattern. RESULTS Patients were awake for approximately half the study period (45.04%, IQR 13.81-77-17) with no REM (0%, IQR 0-0.04%) and median arousals of 19.5/hour (IQR 7.1-40.9). The 24-hour CBT had a rhythmic pattern in 13 (65%) patients with a highly variable phase of median peak time at 17:35 hours (IQR 12:40-19:39). No significant associations were found between CBT rhythmicity, sleep stages, sleep EEG frequency density, illness severity scores or TISS on the day of PSG. There was no relationship between time awake and CBT rhythmicity (P=0.48) or CBT peak time (P=0.82). The relationship between circadian rhythms and sleep patterns in the critically ill is complex. CONCLUSIONS Patients recovering in ICU commonly have CBT loss of rhythmicity or a significant phase shift with loss of normal night-time patterns of sleep architecture. Appropriate care plans to promote sleep and circadian rhythm require further investigation of contributing factors such as environment, clinical care routines, illness type and severity.
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Affiliation(s)
- Rob J Boots
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, Australia - .,Faculty of Medicine, University of Queensland, Herston, Australia - .,Department of Burns, Trauma and Critical Care, University of Queensland, Herston, Australia - .,Department of Intensive Care, Bundaberg Base Hospital, Bundaberg, Australia -
| | - Gabrielle Mead
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nicholas Garner
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Oliver Rawashdeh
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Judith Bellapart
- Department of Burns, Trauma and Critical Care, University of Queensland, Herston, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Shane Townsend
- Department of Burns, Trauma and Critical Care, University of Queensland, Herston, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Jenny Paratz
- Department of Burns, Trauma and Critical Care, University of Queensland, Herston, Australia
| | - Pierre Clement
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - David Oddy
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Matthew Leong
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Christopher Zappala
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
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26
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Beyer SE, Salgado C, Garçao I, Celi LA, Vieira S. Circadian rhythm in critically ill patients: Insights from the eICU Database. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:118-125. [PMID: 35265899 PMCID: PMC8890071 DOI: 10.1016/j.cvdhj.2021.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate the circadian variation among critically ill patients and its association with clinical characteristics and survival to hospital discharge in a large population of patients in the intensive care unit (ICU). Methods Circadian variation was analyzed by fitting cosinor models to hourly blood pressure (BP) measurements in patients of the eICU Collaborative Research Database with an ICU length of stay of at least 3 days. We calculated the amplitude of the 24-hour circadian rhythm and time of the day when BP peaked. We determined the association between amplitude and time of peak BP and severity of illness, medications, mechanical intubation, and survival to hospital discharge. Results Among 23,355 patients (mean age 65 years, 55% male), the mean amplitude of the 24-hour rhythm was 4.5 ± 3.1 mm Hg. Higher APACHE-IV scores, sepsis, organ dysfunction, and mechanical ventilation were associated with a lower amplitude and a shifted circadian rhythm (P < .05 for all). The timing of the BP peak was associated with in-hospital mortality (P < .001). Higher BP amplitude was associated with shorter ICU (2 mm Hg amplitude: 7.0 days, 8 mm Hg amplitude: 6.7 days) and hospital (2 mm Hg amplitude: 11.8 days, 8 mm Hg amplitude: 11.3 days) lengths of stay and lower in-hospital mortality (2 mm Hg amplitude: 18.2%, 8 mm Hg amplitude: 15.2%) (P < .001 for all). Conclusion The 24-hour rhythm is dampened and phase-shifted in sicker patients and those on mechanical ventilation, vasopressors, or inotropes. Dampening and phase shifting are associated with a longer length of stay and higher in-hospital mortality.
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27
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Haspel J, Kim M, Zee P, Schwarzmeier T, Montagnese S, Panda S, Albani A, Merrow M. A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care. J Biol Rhythms 2021; 36:55-70. [PMID: 33573430 PMCID: PMC7882674 DOI: 10.1177/0748730421992587] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.
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Affiliation(s)
- Jeffrey Haspel
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Minjee Kim
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Phyllis Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tanja Schwarzmeier
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | | | | | - Adriana Albani
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
- Department of Medicine IV, LMU Munich, Munich, Germany
| | - Martha Merrow
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
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28
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A Tangled Threesome: Circadian Rhythm, Body Temperature Variations, and the Immune System. BIOLOGY 2021; 10:biology10010065. [PMID: 33477463 PMCID: PMC7829919 DOI: 10.3390/biology10010065] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/14/2022]
Abstract
Simple Summary In mammals, including humans, the body temperature displays a circadian rhythm and is maintained within a narrow range to facilitate the optimal functioning of physiological processes. Body temperature increases during the daytime and decreases during the nighttime thus influencing the expression of the molecular clock and the clock-control genes such as immune genes. An increase in body temperature (daytime, or fever) also prepares the organism to fight aggression by promoting the activation, function, and delivery of immune cells. Many factors may affect body temperature level and rhythm, including environment, age, hormones, or treatment. The disruption of the body temperature is associated with many kinds of diseases and their severity, thus supporting the assumed association between body temperature rhythm and immune functions. Recent studies using complex analysis suggest that circadian rhythm may change in all aspects (level, period, amplitude) and may be predictive of good or poor outcomes. The monitoring of body temperature is an easy tool to predict outcomes and maybe guide future studies in chronotherapy. Abstract The circadian rhythm of the body temperature (CRBT) is a marker of the central biological clock that results from multiple complex biological processes. In mammals, including humans, the body temperature displays a strict circadian rhythm and has to be maintained within a narrow range to allow optimal physiological functions. There is nowadays growing evidence on the role of the temperature circadian rhythm on the expression of the molecular clock. The CRBT likely participates in the phase coordination of circadian timekeepers in peripheral tissues, thus guaranteeing the proper functioning of the immune system. The disruption of the CRBT, such as fever, has been repeatedly described in diseases and likely reflects a physiological process to activate the molecular clock and trigger the immune response. On the other hand, temperature circadian disruption has also been described as associated with disease severity and thus may mirror or contribute to immune dysfunction. The present review aims to characterize the potential implication of the temperature circadian rhythm on the immune response, from molecular pathways to diseases. The origin of CRBT and physiological changes in body temperature will be mentioned. We further review the immune biological effects of temperature rhythmicity in hosts, vectors, and pathogens. Finally, we discuss the relationship between circadian disruption of the body temperature and diseases and highlight the emerging evidence that CRBT monitoring would be an easy tool to predict outcomes and guide future studies in chronotherapy.
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29
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Solbiati S, Martin-Yebra A, Vaïda P, Caiani EG. Evaluation of Cardiac Circadian Rhythm Deconditioning Induced by 5-to-60 Days of Head-Down Bed Rest. Front Physiol 2021; 11:612188. [PMID: 33519517 PMCID: PMC7838678 DOI: 10.3389/fphys.2020.612188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
Head-down tilt (HDT) bed rest elicits changes in cardiac circadian rhythms, generating possible adverse health outcomes such as increased arrhythmic risk. Our aim was to study the impact of HDT duration on the circadian rhythms of heart beat (RR) and ventricular repolarization (QTend) duration intervals from 24-h Holter ECG recordings acquired in 63 subjects during six different HDT bed rest campaigns of different duration (two 5-day, two 21-day, and two 60-day). Circadian rhythms of RR and QTend intervals series were evaluated by Cosinor analysis, resulting in a value of midline (MESOR), oscillation amplitude (OA) and acrophase (φ). In addition, the QTc (with Bazett correction) was computed, and day-time, night-time, maximum and minimum RR, QTend and QTc intervals were calculated. Statistical analysis was conducted, comparing: (1) the effects at 5 (HDT5), 21 (HDT21) and 58 (HDT58) days of HDT with baseline (PRE); (2) trends in recovery period at post-HDT epochs (R) in 5-day, 21-day, and 60-day HDT separately vs. PRE; (3) differences at R + 0 due to bed rest duration; (4) changes between the last HDT acquisition and the respective R + 0 in 5-day, 21-day, and 60-day HDT. During HDT, major changes were observed at HDT5, with increased RR and QTend intervals' MESOR, mostly related to day-time lengthening and increased minima, while the QTc shortened. Afterward, a progressive trend toward baseline values was observed with HDT progression. Additionally, the φ anticipated, and the OA was reduced during HDT, decreasing system's ability to react to incoming stimuli. Consequently, the restoration of the orthostatic position elicited the shortening of RR and QTend intervals together with QTc prolongation, notwithstanding the period spent in HDT. However, the magnitude of post-HDT changes, as well as the difference between the last HDT day and R + 0, showed a trend to increase with increasing HDT duration, and 5/7 days were not sufficient for recovering after 60-day HDT. Additionally, the φ postponed and the OA significantly increased at R + 0 compared to PRE after 5-day and 60-day HDT, possibly increasing the arrhythmic risk. These results provide evidence that continuous monitoring of astronauts' circadian rhythms, and further investigations on possible measures for counteracting the observed modifications, will be key for future missions including long periods of weightlessness and gravity transitions, for preserving astronauts' health and mission success.
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Affiliation(s)
- Sarah Solbiati
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Institute of Electronics, Computer and Telecommunication Engineering, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Alba Martin-Yebra
- Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina, BSICoS Group, Universidad de Zaragoza, Zaragoza, Spain
| | - Pierre Vaïda
- College of Health Sciences, University of Bordeaux, Bordeaux, France
| | - Enrico G Caiani
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Institute of Electronics, Computer and Telecommunication Engineering, Consiglio Nazionale delle Ricerche, Milan, Italy
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Jobanputra AM, Scharf MT, Androulakis IP, Sunderram J. Circadian Disruption in Critical Illness. Front Neurol 2020; 11:820. [PMID: 32849248 PMCID: PMC7431488 DOI: 10.3389/fneur.2020.00820] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Circadian rhythms play a vital role in metabolic, hormonal, and immunologic function and are often disrupted in patients in the ICU. Circadian rhythms modulate the molecular machinery that responds to injury and illness which can impact recovery. Potential factors contributing to the alteration in circadian rhythmicity in intensive care unit (ICU) patients include abnormal lighting, noise, altered feeding schedules, extensive patient care interactions and medications. These alterations in circadian rhythms in ICU patients may affect outcomes and therefore, normalization of circadian rhythmicity in critically ill patients may be an important part of ICU care.
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Affiliation(s)
- Aesha M Jobanputra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Matthew T Scharf
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.,Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Ioannis P Androulakis
- Biomedical Engineering Department, Rutgers University, Piscataway, NJ, United States.,Chemical and Biochemical Engineering Department, Rutgers University, Piscataway, NJ, United States.,Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Jag Sunderram
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Abstract
Purpose of review Sleep is intimately involved in overall health and wellbeing. We provide a comprehensive report on the interplay between systemic diseases and sleep to optimize the outcomes of systemic disorders. Recent findings Spanning the categories of endocrinologic disorders, metabolic/toxic disturbances, renal, cardiovascular, pulmonary, gastrointestinal, infectious diseases, autoimmune disorders, malignancy, and critical illness, the review highlights the prevalent coexisting pathology of sleep across the spectrum of systemic disorders. Although it is rare that treating a sleep symptom can cure disease, attention to sleep may improve quality of life and may mitigate or improve the underlying disorder. Recent controversies in assessing the cardiovascular relationship with sleep have called into question some of the benefits of treating comorbid sleep disorders, thereby highlighting the need for an ongoing rigorous investigation into how sleep interplays with systemic diseases. Summary Systemic diseases often have sleep manifestations and this report will help the clinician identify key risk factors linking sleep disorders to systemic diseases so as to optimize the overall care of the patient.
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Affiliation(s)
- Eric M. Davis
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - Chintan Ramani
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, VA USA
| | - Mark Quigg
- Department of Neurology, University of Virginia, Charlottesville, VA USA
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Coiffard B, Diallo AB, Culver A, Antonini F, Hammad E, Leone M, Mege JL. Exacerbation of circadian rhythms of core body temperature and sepsis in trauma patients. J Crit Care 2020; 60:23-26. [PMID: 32731102 DOI: 10.1016/j.jcrc.2020.07.010] [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: 02/09/2020] [Revised: 07/11/2020] [Accepted: 07/11/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE This study aimed to describe by mathematical modeling an accurate course of core body temperature (CBT) in severe trauma patients and its relation to sepsis. METHODS In a cohort of severe trauma, the CBT measurements were collected for 24 h on day 2 after admission and rhythmicity assessed by Fourier transform and Cosinor analysis to describe circadian features (frequency and amplitude). CBT was compared between patients who developed sepsis or not during the early ICU stay. RESULTS 33 patients were included in this analysis. 24 patients (73%) had a predominant rhythm of 24 h (period). The main period was lower in the 9 remaining patients (6 of 12 h, 1 of 8 h, and 2 of 6 h). Other significant frequencies of oscillation (second and third frequencies) were found, which showed an association of several well-marked rhythms. Patients with sepsis (n = 12) had a significantly higher level of CBT, but also more intense rhythms and higher amplitudes of CBT. CONCLUSION Trauma patients exhibit complex temperature circadian rhythms. Early exacerbation of the temperature rhythmicity (in frequency and amplitude) is associated with the development of sepsis. This observation accentuates the concept of circadian disruption and sepsis in ICU patients.
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Affiliation(s)
- Benjamin Coiffard
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France; Aix Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive - Réanimation, Marseille, France.
| | - Aissatou B Diallo
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
| | - Aurélien Culver
- Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - François Antonini
- Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Emmanuelle Hammad
- Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Marc Leone
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France; Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Marseille, France
| | - Jean-Louis Mege
- Aix Marseille Université, Institut de Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Microbes Evolution Phylogénie et Infections (MEPHI), Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, Marseille, France
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Abstract
PURPOSE OF REVIEW The alteration of circadian rhythms in the postoperative period has been demonstrated to influence the outcomes. With this narrative review we would revise how anesthesia, surgery and intensive care can interfere with the circadian clock, how this could impact on the postsurgical period and how to limit the disruption of the internal clock. RECENT FINDINGS Anesthesia affects the clock in relation to the day-time administration and the type of anesthetics, N-methyl-D-aspartate receptor antagonists or gamma-aminobutyric acid receptors agonists. Surgery causes stress and trauma with consequent alteration in the circadian release of cortisol, cytokines and melatonin. ICU represents a further challenge for the patient internal clock because of sedation, immobility, mechanical ventilation and alarms noise. SUMMARY The synergic effect of anesthesia, surgery and postoperative intensive care on circadian rhythms require a careful approach to the patient considering a role for therapies and interventions aimed to re-establish the normal circadian rhythms. Over time, approach like the Awakening and Breathing Coordination, Delirium Monitoring and Management, Early Mobility and Family engagement and empowerment bundle can implement the clinical practice.
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Culver A, Coiffard B, Antonini F, Duclos G, Hammad E, Vigne C, Mege JL, Baumstarck K, Boucekine M, Zieleskiewicz L, Leone M. Circadian disruption of core body temperature in trauma patients: a single-center retrospective observational study. J Intensive Care 2020; 8:4. [PMID: 31921428 PMCID: PMC6945723 DOI: 10.1186/s40560-019-0425-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/29/2019] [Indexed: 01/14/2023] Open
Abstract
Background Circadian clock alterations were poorly reported in trauma patients, although they have a critical role in human physiology. Core body temperature is a clinical variable regulated by the circadian clock. Our objective was to identify the circadian temperature disruption in trauma patients and to determine whether these disruptions were associated with the 28-day mortality rate. Methods A retrospective and observational single-center cohort study was conducted. All adult severe trauma patients admitted to the intensive care unit of Aix Marseille University, North Hospital, from November 2013 to February 2018, were evaluated. The variations of core body temperature for each patient were analyzed between days 2 and 3 after intensive care unit admission. Core body temperature variations were defined by three parameters: mesor, amplitude, and period. A logistic regression model was used to determine the variables influencing these three parameters. A survival analysis was performed assessing the association between core body temperature rhythm disruption and 28-day mortality rate. A post hoc subgroup analysis focused on the patients with head trauma. Results Among the 1584 screened patients, 248 were included in this study. The period differed from 24 h in 177 (71%) patients. The mesor value (°C) was associated with body mass index and ketamine use. Amplitude (°C) was associated with ketamine use only. The 28-day mortality rate was 18%. For all trauma patients, age, body mass index, intracranial hypertension, and amplitude were independent risk factors. The patients with a mesor value < 36.9 °C (p < 0.001) and an amplitude > 0.6 °C (p < 0.001) had a higher 28-day mortality rate. Among the patients with head trauma, mesor and amplitude were identified as independent risk factors (HR = 0.40, 95% CI [0.23–0.70], p = 0.001 and HR = 4.73, 95% CI [1.38–16.22], p = 0.01). Conclusions Our results highlight an association between core body temperature circadian alteration and 28-day mortality rate. This association was more pronounced in the head trauma patients than in the non-head trauma patients. Further studies are needed to show a causal link and consider possible interventions.
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Affiliation(s)
- Aurélien Culver
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Benjamin Coiffard
- Médecine Intensive - Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Marseille, France.,3CNRS, IRD, MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - François Antonini
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Gary Duclos
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Emmanuelle Hammad
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Coralie Vigne
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Jean-Louis Mege
- 3CNRS, IRD, MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Karine Baumstarck
- 4APHM, EA 3279 CEReSS, School of Medicine - La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, Marseille, France
| | - Mohamed Boucekine
- 4APHM, EA 3279 CEReSS, School of Medicine - La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, Marseille, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Chemin des Bourrely, 13915 Marseille, France.,3CNRS, IRD, MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
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Czempik PF, Jarosińska A, Machlowska K, Pluta M. Impact of Light Intensity on Sleep of Patients in the Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2020; 24:33-37. [PMID: 32148346 PMCID: PMC7050169 DOI: 10.5005/jp-journals-10071-23323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and objectives Sleep deprivation in the intensive care unit (ICU) has been linked to numerous complications. Light levels might impact the sleep of patients in the ICU. The aim of the study was to measure light levels during sleep-protected time in the ICU and to assess the impact of light intensity on sleep quantity/quality. Materials and methods This prospective, observational study was conducted in a 10-bed, mixed surgical/medical ICU. For measuring light levels, a commercially available smartphone application was used. The measurements were performed between 23:30 and 06:15 hours at 15-minute intervals. To assess sleep quantity, we used Patient's Sleep Observation Behavioral Tool and to assess sleep quality, we used Richards-Campbell Sleep Scale. Results The median number of time points at which patients were asleep was 20 (interquartile range, IQR 14-23) out of 25 (5 hours). The median self-reported quality of sleep (overall score) was 49 (IQR 28-71). The median values for individual questions are: question 1 (sleep depth)-54.0 (IQR 37-78), question 2 (sleep latency)-40.5 (IQR 6-90), question 3 (awakenings)-52.5 (IQR 28-76), question 4 (returning to sleep)-25.5 (IQR 11-78), and question 5 (sleep quality)-67.5 (IQR 5-76). No correlation was found between self-reported sleep quality and time spent asleep (p = 0.36). There was no correlation between average light levels during sleep-protected time and sleep quantity (p = 0.42)/sleep quality (p = 0.13). There was a correlation between average (13 ± 5 lux) light levels before sleep-protected time and sleep quality (p = 0.008). Conclusion Mean light levels of 11 ± 9 lux during sleep-protected time have no negative impact on quantity and quality of sleep in intensive care unit patients. Light levels up to 18 lux directly before falling asleep improve patients' self-reported quality of sleep in the ICU. Clinical significance Finding safe levels of light intensity during sleep-protected time in ICU. How to cite this article Czempik PF, Jarosińska A, Machlowska K, Pluta M. Impact of Light Intensity on Sleep of Patients in the Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2020;24(1):33-37.
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Affiliation(s)
- Piotr F Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Jarosińska
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krystyna Machlowska
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Pluta
- Students' Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Pisani MA, D'Ambrosio C. Sleep and Delirium in Adults Who Are Critically Ill: A Contemporary Review. Chest 2019; 157:977-984. [PMID: 31874132 DOI: 10.1016/j.chest.2019.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 01/09/2023] Open
Abstract
Sleep is important to health and well-being, and studies in healthy adults have demonstrated that sleep deprivation impacts respiratory, immune, and cognitive function. Historically, because of the nature of critical illness, sleep has not been considered a priority for patient care in the ICU. More recently, research has demonstrated that sleep is markedly abnormal in patients who are critically ill. In addition, there is often disruption of circadian rhythms. Delirium is a syndrome of acute alteration in mental status that occurs in the setting of contributing factors such as serious illness, medication, and drug or alcohol intoxication or withdrawal. Delirium is a frequent occurrence in critical illness, and research has demonstrated several adverse outcomes associated with delirium including persistent cognitive impairment and increased mortality. Sleep deprivation and delirium share many common symptoms. The similarity in symptoms between sleep disruption and delirium have prompted experts to draw links between the two and question both the relationship and its direction. In addition, the inclusion of sleep disturbance to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition in its constellation of symptoms used in diagnosing delirium has increased awareness of the link between sleep and delirium. This paper will review the literature on sleep in critical illness and the potential mechanisms and pathways that may connect sleep and delirium.
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Li J, Li R, Gao Y, Zhang J, Zhao Y, Zhang X, Wang G. Nocturnal Mean Arterial Pressure Rising Is Associated With Mortality in the Intensive Care Unit: A Retrospective Cohort Study. J Am Heart Assoc 2019; 8:e012388. [PMID: 31566067 PMCID: PMC6806033 DOI: 10.1161/jaha.119.012388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Disrupted circadian rhythm of blood pressure is commonly observed in patients in the intensive care unit (ICU). This study assessed the association of nocturnal mean arterial pressure rising (NMAPR) with short‐ and long‐term mortality in critically ill adult patients. Methods and Results Adult patients with a complete record of mean arterial pressure monitoring during the first 24 hours of ICU stay in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC‐II) database were included in this retrospective cohort study. All patients were divided into the non‐NMAPR group (≤1) or the NMAPR group (>1), according to the value of mean nighttime divided by daytime mean arterial pressure. The associations of NMAPR with ICU, hospital, 28‐day, and 1‐year mortality were assessed using multivariable logistic regression or a Cox proportional hazards model. Interaction and subgroup analyses were performed for those patients who had a first Sequential Organ Failure Assessment (SOFA) score of ≥8 or <8. The overall cohort comprised 5185 patients. The patients with NMAPR (n=1865) had higher ICU, hospital, 28‐day, and 1‐year mortality than the non‐NMAPR group (n=3320). After adjusting for covariates, the analysis showed that NMAPR was significantly associated with mortality in the ICU (odds ratio: 1.34; 95% CI, 1.10–1.65), in the hospital (odds ratio: 1.35; 95% CI, 1.12–1.63), at 28 days (hazard ratio: 1.27; 95% CI, 1.10–1.48), and at 1 year (hazard ratio: 1.24; 95% CI, 1.10–1.40). All results of the interaction analysis had no statistical significance, and similar results persisted in the patients with different SOFA scores. Conclusions NMAPR may aid in the early identification of critically ill patients at high risk of ICU, hospital, 28‐day, or 1‐year mortality.
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Affiliation(s)
- Jiamei Li
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ruohan Li
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ya Gao
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Jingjing Zhang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Yujie Zhao
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Xiaoling Zhang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Gang Wang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients. Crit Care Med 2019; 46:e1167-e1174. [PMID: 30247271 DOI: 10.1097/ccm.0000000000003435] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association between mean arterial pressure fluctuations and mortality in critically ill patients admitted to the ICU. DESIGN Retrospective cohort. SETTING All adult ICUs at a tertiary care hospital. PATIENTS All adult patients with complete mean arterial pressure records were selected for analysis in the Multiparameter Intelligent Monitoring in Intensive Care II database. Patients in the external cohort were newly recruited adult patients in the Medical Information Mart for Intensive Care III database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The records of 8,242 patients were extracted. Mean arterial pressure fluctuation was calculated as follows: (mean nighttime mean arterial pressure - mean daytime mean arterial pressure)/mean arterial pressure. Patients were divided into two groups according to the degree of mean arterial pressure fluctuation: group A (between -5% and 5%) and group B (<-5% and >5%). The endpoints of this study were ICU and hospital mortality. Patients in group A (n = 4,793) had higher ICU and hospital mortality than those in group B (n = 3,449; 11.1% vs 8.1%, p < 0.001 and 13.8% vs 10.1%, p < 0.001, respectively). After adjusting for other covariates, the mean arterial pressure fluctuations between -5% and 5% were significantly correlated with ICU mortality (odds ratio, 1.296; 95% CI, 1.103-1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142-1.531; p < 0.001). This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitive analysis. Furthermore, external validation on a total of 4,502 individuals revealed that patients in group A still had significantly higher ICU (p < 0.001) and hospital mortality (p < 0.001) than those in group B. CONCLUSIONS The reduced mean arterial pressure fluctuation (within -5% and 5%) may be associated with ICU and hospital mortality in critically ill patients.
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Manou-Stathopoulou V, Korbonits M, Ackland GL. Redefining the perioperative stress response: a narrative review. Br J Anaesth 2019; 123:570-583. [PMID: 31547969 DOI: 10.1016/j.bja.2019.08.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/21/2019] [Accepted: 08/11/2019] [Indexed: 12/13/2022] Open
Abstract
The systemic stress response triggered by surgical trauma is characterised by sterile inflammation preceding metabolic and neuroendocrine dysregulation. However, the relevance of the classically described 'stress response' is now highly questionable in an era where profound physiological deconditioning is common in older, frail surgical patients. Commonly used assessment techniques do not accurately reflect hypothalamic-pituitary-adrenal axis integrity after major surgery. Clinical interpretation of plasma concentrations of cortisol, the prototypical stress hormone, is rarely accurate, because of study heterogeneity, the inherently dynamic characteristics of cortisol production, and assay variability. Before surgery, chronic psychosocial stress and common cardiorespiratory co-morbidities are clinically relevant modifiers of neuroendocrine activation to acute stress/inflammation. The frequent development of multi-morbidity after major surgery further clouds the compartmentalised, discrete model of neuroendocrine activation after initial tissue injury. Starvation, impaired mobility, and sepsis after surgery generate distinct neuroendocrine profiles that challenge the conventional model of neuroendocrine activation. Basic science studies suggest that high circulating levels of cortisol may directly cause organ injury. Conversely, randomised controlled clinical trials investigating glucocorticoid supplementation have delivered contrasting results, with some suggesting a protective effect in the perioperative period. Here, we consider many of the confounding factors that have emerged to challenge the conventional model of the surgical stress response, and suggest that a more nuanced understanding of changes in hypothalamic-pituitary-adrenal axis physiology is warranted to advance perioperative medicine. Re-examining the perioperative stress response presents opportunities for improving outcomes through enhancing the understanding of the neuroendocrine aspects of preparation for and recovery from surgery.
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Affiliation(s)
- Vasiliki Manou-Stathopoulou
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Gehlbach BK, Patel SB, Van Cauter E, Pohlman AS, Hall JB, Zabner J. The Effects of Timed Light Exposure in Critically Ill Patients: A Randomized Controlled Pilot Clinical Trial. Am J Respir Crit Care Med 2019. [PMID: 29529381 DOI: 10.1164/rccm.201801-0170le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Papaioannou VE, Sertaridou EN, Chouvarda IG, Kolios GC, Pneumatikos IN. Determining rhythmicity and determinism of temperature curves in septic and non-septic critically ill patients through chronobiological and recurrence quantification analysis: a pilot study. Intensive Care Med Exp 2019; 7:53. [PMID: 31486940 PMCID: PMC6728111 DOI: 10.1186/s40635-019-0267-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/27/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A few studies have demonstrated that critically ill patients exhibit circadian deregulation and reduced complexity of different time series, such as temperature. RESULTS In this prospective study, we enrolled 21 patients divided into three groups: group A (N = 10) included subjects who had septic shock at the time of ICU entry, group B (N = 6) included patients who developed septic shock during ICU stay, and group C consisted of 5 non-septic critically ill patients. Core body temperature (CBT) was recorded for 24 h at a rate of one sample per hour (average of CBT for that hour) and during different occasions: upon ICU entry and exit in groups A and C and upon entry, septic shock development, and exit in group B. Markers of circadian rhythmicity included mean values, amplitude that is the difference between peak and mean values, and peak time. Furthermore, recurrence quantification analysis (RQA) was employed for assessing different markers of complexity of temperature signals. Patients from group C exhibited higher temperature amplitude upon entry (0.45 ± 0.19) in relation with both groups A (0.28 ± 0.18, p < 0.05) and B (0.32 ± 0.13, p < 0.05). Circadian features did not differ within all groups. Temperature amplitude in groups B and C upon entry was negatively correlated with SAPS II (r = - 0.72 and - 0.84, p < 0.003) and APACHE II scores (r = - 0.70 and - 0.63, p < 0.003), respectively, as well as duration of ICU and hospital stay in group B (r = - 0.62 and - 0.64, p < 0.003) and entry SOFA score in group C (r = - 0.82, p < 0.003). Increased periodicity of CBT was found for all patients upon exit related to entry in the ICU. Different RQA features indicating periodic patterns of change of entry CBT were negatively correlated with severity of disease and length of ICU stay for all patients. CONCLUSIONS Increased temperature rhythmicity during ICU entry was related with lower severity of disease and better clinical outcomes, whereas the more deterministic CBT patterns were found in less critically ill patients with shorter ICU stay.
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Affiliation(s)
- Vasilios E Papaioannou
- Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Eleni N Sertaridou
- Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Ioanna G Chouvarda
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Faculty of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - George C Kolios
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Ioannis N Pneumatikos
- Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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Abstract
Hospitalized patients frequently have disordered and poor-quality sleep due to a variety of both intrinsic and extrinsic factors. These include frequent nighttime intrusions, insomnia related to pain and unfamiliar environments, dark conditions during the day with loss of natural light, and disruption of the natural sleep cycle due to illness. Sleep wake disturbances can result in a deleterious consequence on physical, emotional, and cognitive status, which may impact patient satisfaction, clinical recovery, and hospital length of stay. Despite this, clinicians frequently fail to document sleep disturbances and are generally unaware of the best practices to improve sleep quality in the hospital. A PubMed search was conducted using the terms: ("sleep and hospitalized patients") and ("sleep and hospitalization") to review the published data on the topic of sleep in hospitalized medical patients. The search was limited to English-language articles published between 2000 and 2018. Subsequent PubMed searches were performed to clarify the data described in the initial search, including the terms "hospital sleep protocols," "hospitalized patients sleep documentation," and "hospitalized patients sleep quality". The purpose of this review is to discuss sleep disturbances in hospitalized patients with a focus on causes of sleep disturbance, the effect of poor-quality sleep, high risk populations, considerations for surveillance and prevention, and pharmacologic and non-pharmacologic options for treatment.
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Affiliation(s)
- Anne Marie Morse
- Geisinger Commonwealth School of Medicine, Department of Child Neurology and Sleep Medicine Geisinger Medical Center, Janet Weis Children’s Hospital, 100 N. Academy Ave, Danville, PA 17820, USA
| | - Evin Bender
- Department of Neurology, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17820, USA
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43
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Sertaridou EN, Chouvarda IG, Arvanitidis KI, Filidou EK, Kolios GC, Pnevmatikos IN, Papaioannou VE. Melatonin and cortisol exhibit different circadian rhythm profiles during septic shock depending on timing of onset: a prospective observational study. Ann Intensive Care 2018; 8:118. [PMID: 30515638 PMCID: PMC6279676 DOI: 10.1186/s13613-018-0462-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/27/2018] [Indexed: 12/19/2022] Open
Abstract
Background Septic shock has been found to disrupt circadian rhythms. Moreover, timing of onset has been associated with different circadian profiles in experimental studies. Results In this prospective study, we enrolled 26 patients divided into two groups: Group A (N = 15) included subjects who had septic shock at the time of ICU admission and Group B (N = 11) included patients who developed septic shock during ICU admission. 6-Sulfatoxymelatonin (aMT6s) and cortisol levels were measured in urine samples every 4 h over a 24-h period. Two sets of samples were taken from Group A (entry/septic shock and exit) and three sets from Group B (entry, septic shock and exit). Mean, amplitude that is the difference between peak and mean values, as well as peak time, were estimated for both aMT6s and cortisol. In Group A, amplitude of aMT6s upon entry (septic shock) was reduced in relation to exit (437.2 ± 309.2 vs. 674.1 ± 657.6 ng/4 h, p < 0.05). Peak time occurred earlier (10:00 p.m. vs. 07:00 a.m, p < 0.05) and correlated with higher APACHE II score and longer ICU stay. In Group B, aMT6s mean values were significantly increased during septic shock (2492.2 ± 1709.1 ng/4 h) compared to both entry (895.4 ± 715.5 ng/4 h) and exit (1308.6 ± 1214.4 ng/4 h, p < 0.05 for all comparisons). Amplitude of aMT6s was also elevated during septic shock (794.8 ± 431.8 ng/4 h) in relation to entry (293.1 ± 275.9 ng/4 h, p < 0.05). Regarding cortisol rhythm in Group A, during septic shock amplitude was increased compared to exit (13.3 ± 31 ng/4 h vs. 8.7 ± 21.2 ng/4 h p < 0.05) and correlated with reduced hospital length of stay. In Group B, cortisol mean values and amplitude during septic shock (10 ± 5.3 and 3 ± 1.8 ng/4 h, respectively) were significantly reduced compared to both entry (30 ± 57.9 and 12.3 ± 27.3 ng/4 h) and exit (14.4 ± 20.7 and 6.6 ± 8.7 ng/4 h, p < 0.05 for all comparisons) and correlated with higher SOFA score and longer ICU and hospital stay. Conclusions Septic shock induced inverse changes of aMT6s and cortisol circadian rhythm profiles both within and between different groups of patients, depending on timing of onset. Reduced rhythmicity was correlated with severity of disease and longer ICU stay.
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Affiliation(s)
- Eleni N Sertaridou
- Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece.
| | - Ioanna G Chouvarda
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos I Arvanitidis
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece
| | - Eirini K Filidou
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece
| | - George C Kolios
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece
| | - Ioannis N Pnevmatikos
- Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece
| | - Vasilios E Papaioannou
- Intensive Care Unit, Alexandroupolis University Hospital, Democritus University of Thrace, 68100, Dragana, Alexandroupolis, Greece
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44
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Leak RK, Calabrese EJ, Kozumbo WJ, Gidday JM, Johnson TE, Mitchell JR, Ozaki CK, Wetzker R, Bast A, Belz RG, Bøtker HE, Koch S, Mattson MP, Simon RP, Jirtle RL, Andersen ME. Enhancing and Extending Biological Performance and Resilience. Dose Response 2018; 16:1559325818784501. [PMID: 30140178 PMCID: PMC6096685 DOI: 10.1177/1559325818784501] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022] Open
Abstract
Human performance, endurance, and resilience have biological limits that are genetically and epigenetically predetermined but perhaps not yet optimized. There are few systematic, rigorous studies on how to raise these limits and reach the true maxima. Achieving this goal might accelerate translation of the theoretical concepts of conditioning, hormesis, and stress adaptation into technological advancements. In 2017, an Air Force-sponsored conference was held at the University of Massachusetts for discipline experts to display data showing that the amplitude and duration of biological performance might be magnified and to discuss whether there might be harmful consequences of exceeding typical maxima. The charge of the workshop was "to examine and discuss and, if possible, recommend approaches to control and exploit endogenous defense mechanisms to enhance the structure and function of biological tissues." The goal of this white paper is to fulfill and extend this workshop charge. First, a few of the established methods to exploit endogenous defense mechanisms are described, based on workshop presentations. Next, the white paper accomplishes the following goals to provide: (1) synthesis and critical analysis of concepts across some of the published work on endogenous defenses, (2) generation of new ideas on augmenting biological performance and resilience, and (3) specific recommendations for researchers to not only examine a wider range of stimulus doses but to also systematically modify the temporal dimension in stimulus inputs (timing, number, frequency, and duration of exposures) and in measurement outputs (interval until assay end point, and lifespan). Thus, a path forward is proposed for researchers hoping to optimize protocols that support human health and longevity, whether in civilians, soldiers, athletes, or the elderly patients. The long-term goal of these specific recommendations is to accelerate the discovery of practical methods to conquer what were once considered intractable constraints on performance maxima.
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Affiliation(s)
- Rehana K. Leak
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Edward J. Calabrese
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | | | - Jeffrey M. Gidday
- Departments of Ophthalmology, Neuroscience, and Physiology, Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Thomas E. Johnson
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
| | - James R. Mitchell
- Department of Genetics and Complex Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C. Keith Ozaki
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Reinhard Wetzker
- Institute for Molecular Cell Biology, University of Jena, Jena, Germany
| | - Aalt Bast
- Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - Regina G. Belz
- Hans-Ruthenberg-Institute, Agroecology Unit, University of Hohenheim, Stuttgart, Germany
| | - Hans E. Bøtker
- Department of Clinical Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Sebastian Koch
- Department of Neurology, University of Miami, Miller School of Medicine, FL, USA
| | - Mark P. Mattson
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Roger P. Simon
- Departments of Medicine and Neurobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Randy L. Jirtle
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
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45
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Danielson SJ, Rappaport CA, Loher MK, Gehlbach BK. Looking for light in the din: An examination of the circadian-disrupting properties of a medical intensive care unit. Intensive Crit Care Nurs 2018; 46:57-63. [PMID: 29605239 DOI: 10.1016/j.iccn.2017.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/03/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Critically ill patients exhibit profound disturbances of circadian rhythmicity, most commonly in the form of a phase delay. We investigated the specific zeitgeber properties of a medical intensive care unit to develop a model that explained these abnormalities. RESEARCH METHODOLOGY Prospective, observational study conducted during 2013-2014. Twenty-four-hour ambient light (lux, 672 hours) and sound pressure levels (dBA, 504 hours) were measured in patient rooms. Patients and families were surveyed regarding their perceptions of the environment. SETTING University-based adult medical intensive care unit. MAIN OUTCOME MEASURES The timing and intensity of the ambient light-dark cycle and sound environment and the relationship of these measurements to patient/family perceptions. RESULTS Twenty-four-hour light-dark cycles were extremely weak and phase delayed relative to the solar cycle. Morning light averaged 12.1 (4.8, 37.2) lux, when only 24.9% ± 10.9% of available light was utilised; yet patients and families did not identify low daytime light levels as problematic. Median noise levels were invariably excessive (nighttime 47.9 [45.0, 51.3] dBA) with minimal variation, consistent with the absence of a defined rest period. CONCLUSION The intensive care unit functions as a near-constant routine protocol disconnected from solar time. Behavioural interventions to promote entrainment should be supported by objective measurements of light and sound.
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Affiliation(s)
- Samantha J Danielson
- University of Iowa, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Charles A Rappaport
- University of Iowa, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Michael K Loher
- University of Iowa, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Brian K Gehlbach
- University of Iowa, Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA; University of Iowa, Department of Neurology, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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46
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Craig T, Mathieu S. CANDLE: The critical analysis of the nocturnal distribution of light exposure - A prospective pilot study quantifying the nocturnal light intensity on a critical care unit. J Intensive Care Soc 2017; 19:196-200. [PMID: 30159010 DOI: 10.1177/1751143717748095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with critical illness have disrupted circadian rhythms, which can lead to increased morbidity, mortality and length of intensive care unit stay. Light intensity within the intensive care unit influences the circadian rhythm and may therefore impact on patient outcome. We performed an observational single-centre pilot study monitoring nocturnal light exposure of intensive care unit patients between November and December 2016. As there are currently no medical guidance on recommended light levels, we audited our findings against building regulation standards. The median light intensity was 1.5 lux, which is below the 20 lux standards; however, there were significant outliers. There was positive correlation between patient illness severity based on SOFA score and maximum lux (R = 0.45, P = 0.026); however, there was no relationship between patient illness severity and median lux exposure (R = 0.23, P = 0.28). As illness severity increased so did the time spent greater than 20 lux (R = 0.59, P = 0.0021), and the individual occasions where lux breached the 20 lux limit (R = 0.52, P = 0.009). There was no relationship between illness severity of neighbouring patients and maximum lux (R = -0.11, P = 0.69) or neighbouring illness severity and median lux (R = -0.04, P = 0.87). This preliminary work will form the basis of future projects, including national guidance and evaluating the impact of environmental light on patient-centred outcomes.
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Rao RT, Pierre KK, Schlesinger N, Androulakis IP. The Potential of Circadian Realignment in Rheumatoid Arthritis. Crit Rev Biomed Eng 2017; 44:177-191. [PMID: 28605351 DOI: 10.1615/critrevbiomedeng.2016018812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this short review, we discuss evidence supporting the modulation of peripheral circadian systems as a therapeutic strategy for rheumatoid arthritis (RA). We first review the role of proinflammatory cytokines and oxidative stress, two of the primary mediators of chronic inflammation in RA, and their regulation by circadian clock machinery. We further highlight the role of environmental and metabolic signals in regulating the central and peripheral circadian clocks, with an emphasis on seasonal variations in photoperiod and rhythmic metabolic input, respectively. Finally, we hypothesize that the entrainment and realignment of peripheral clock rhythms have the ability to modulate these mediators, improving clinical outcomes in RA patients. Our discussion emphasizes the use of light therapy and time-restricted feeding for entraining peripheral clocks either via the entrainment of the central circadian clock in suprachiasmatic nuclei (SCN) or directly by uncoupling the peripheral circadian clocks from SCN. In doing so, we highlight the use of nonpharmacologic interventions as a potential strategy for improving clinical outcomes in chronic inflammatory conditions such as RA.
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Affiliation(s)
- Rohit T Rao
- Chemical & Biochemical Engineering Department, Rutgers University, Piscataway, New Jersey
| | - Kamau K Pierre
- Biomedical Engineering Department, Rutgers University, Piscataway, New Jersey
| | - Naomi Schlesinger
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ioannis P Androulakis
- Chemical and Biochemical Engineering Department, Rutgers University, Piscataway, New Jersey; Biomedical Engineering Department, Rutgers University, Piscataway, New Jersey; Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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48
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Circadian disruption of ICU patients: A review of pathways, expression, and interventions. J Crit Care 2017; 38:269-277. [DOI: 10.1016/j.jcrc.2016.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 01/08/2023]
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49
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Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels. Ann Intensive Care 2017; 7:25. [PMID: 28255956 PMCID: PMC5334329 DOI: 10.1186/s13613-017-0248-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/18/2017] [Indexed: 01/23/2023] Open
Abstract
Background It is well recognized that sleep is severely disturbed in patients in intensive care units (ICU) and that this can compromise their rehabilitation potential. However, it is still difficult to objectively assess sleep quantity and quality and the determinants of sleep disturbance remain unclear. The aim of this study was therefore to evaluate carefully the impact of ICU sound intensity levels and their sources on ICU patients’ sleep over a 24-h period.
Methods Sleep and sound levels were recorded in 11 ICU intubated patients who met the criteria. Sleep was recorded using a miniaturized multi-channel ambulatory recording device. Sound intensity levels and their sources were recorded with the Nox-T3 monitor. A 30-s epoch-by-epoch analysis of sleep stages and sound data was carried out. Multinomial and binomial logistic regressions were used to associate sleep stages, wakefulness and sleep–wake transitions with sound levels and their sources.
Results The subjects slept a median of 502.2 [283.2–718.9] min per 24 h; 356.9 [188.6–590.9] min at night (22.00–08.00) and 168.5 [142.5–243.3] during daytime (8 am–10 pm). Median sound intensity level reached 70.2 [65.1–80.3] dBC at night. Sound thresholds leading to disturbed sleep were 63 dBC during the day and 59 dBC during the night. With levels above 77 dBC, the incidence of arousals (OR 3.9, 95% CI 3.0–5.0) and sleep-to-wake transitions (OR 7.6, 95% CI 4.1–14) increased. The most disturbing noises sources were monitor alarms (OR 4.5, 95% CI 3.5–5.6) and ventilator alarms (OR 4.2, 95% CI 2.9–6.1). Conclusions We have shown, in a small group of 11 non-severe ICU patients, that sound level intensity, a major disturbance factor of sleep continuity, should be strictly controlled on a 24-h profile.
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50
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McKenna HT, Reiss IK, Martin DS. The significance of circadian rhythms and dysrhythmias in critical illness. J Intensive Care Soc 2017; 18:121-129. [PMID: 28979558 DOI: 10.1177/1751143717692603] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Many physiological and cellular processes cycle with time, with the period between one peak and the next being roughly equal to 24 h. These circadian rhythms underlie 'permissive homeostasis', whereby anticipation of periods of increased energy demand or stress may enhance the function of individual cells, organ systems or whole organisms. Many physiological variables related to survival during critical illness have a circadian rhythm, including the sleep/wake cycle, haemodynamic and respiratory indices, immunity and coagulation, but their clinical significance remains underappreciated. Critically ill patients suffer from circadian dysrhythmia, manifesting overtly as sleep disturbance and delirium, but with widespread covert effects on cellular and organ function. Environmental and pharmacological strategies that ameliorate or prevent circadian dysrhythmia have demonstrated clinical benefit. Harnessing these important biological phenomena to match metabolic supply to demand and bolster cell defenses at the apposite time may be a future therapeutic strategy in the intensive care unit.
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Affiliation(s)
- Helen T McKenna
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Critical Care Unit, The London Clinic, London, UK.,Intensive Care Unit, Royal Free Hospital, London, UK
| | - Irwin Km Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus University Hospital, Rotterdam, the Netherlands
| | - Daniel S Martin
- University College London Centre for Altitude Space and Extreme Environment Medicine, UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, London, UK.,Intensive Care Unit, Royal Free Hospital, London, UK.,University College London Division of Surgery and Interventional Science, Royal Free Hospital, London, UK
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