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Yang X, Hu JH, Fan LP, Peng HP, Shi HJ, Zhuang MY, Ji FH, Peng K. Intraoperative dexmedetomidine on postoperative sleep disturbance in older patients undergoing major abdominal surgery: A randomized controlled trial protocol. Heliyon 2024; 10:e31668. [PMID: 38845907 PMCID: PMC11153091 DOI: 10.1016/j.heliyon.2024.e31668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
Background Postoperative sleep disturbance (PSD) occurs frequently in patients who undergo major abdominal surgical procedures. Dexmedetomidine is a promising agent to improve the quality of sleep for surgical patients. We designed this trial to investigate the effects of two different doses of intraoperative dexmedetomidine on the occurrence of PSD in elderly patients who have major abdominal surgery. Methods In this randomized, double-blind, controlled trial, 210 elderly patients aged ≥65 years will be randomized, with an allocation ratio of 1:1:1, to two dexmedetomidine groups (intraoperative infusion of 0.3 or 0.6 μg/kg/h) and a normal saline placebo group. The primary endpoint is the occurrence of PSD on the first night after surgery, assessed using the Athens Insomnia Scale. The secondary endpoints are (1) the incidence of PSD during the 2nd, 3rd, 5th, 7th, and 30th nights postoperatively; (2) pain at rest and on movement at 24 and 48 h postoperatively, assessed using the Numerical Rating Scale; (3) the incidence of postoperative delirium during 0-7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method; (4) depressive symptoms during 0-7 days postoperatively or until hospital discharge, assessed using the 15-items Geriatric Depression Scale; and (5) quality of recovery on postoperative days 1, 2, and 3, assessed using the 15-items Quality of Recovery Scale. Patients' sleep data will also be collected by Xiaomi Mi Band 7 for further analysis. Discussion The findings of this trial will provide clinical evidence for improving the quality of sleep among elderly patients undergoing major abdominal surgery. Ethics and dissemination This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University (No. 2023-160). The results will be published in a peer-reviewed journal. Trial registration Chinese Clinical Trial Registry (ChiCTR2300073163).
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Affiliation(s)
- Xiu Yang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Jing-hui Hu
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Li-ping Fan
- Jintan Traditional Chinese Medicine Hospital, Changzhou, Jiangsu, China
| | - Hui-ping Peng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Hai-jing Shi
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Min-yuan Zhuang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Fu-hai Ji
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
| | - Ke Peng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, China
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Soh PQP, Wong WHT, Roy T, Tam WWS. Effectiveness of non-pharmacological interventions in improving sleep quality after cardiac surgery: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2084-2098. [PMID: 38477050 DOI: 10.1111/jocn.17115] [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: 07/06/2023] [Revised: 10/21/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Sleep disturbance is highly prevalent among post-operative cardiac patients, with negative impacts on surgical recovery and rehabilitation. Post-operative pain and anxiety commonly seen in cardiac surgery patients are associated with poor sleep. Sleep medications commonly used are not ideal with prolonged usage, and non-pharmacological interventions can be good alternatives or complements. AIM To examine effectiveness of non-pharmacological interventions in post-operative cardiac settings on sleep quality, pain intensity and anxiety. DESIGN Systematic review and meta-analysis. METHODS PubMed, CENTRAL, Embase, CINAHL, Scopus, CNKI and ProQuest Dissertations and Theses were searched on 12 October 2022. Randomised controlled trials of non-pharmacological interventions examining sleep quality for adult post-operative cardiac patients were included. Included studies were appraised using Cochrane Risk of Bias tool version 1. Meta-analysis was conducted using RevMan version 5.4.1, and heterogeneity was assessed using I2 statistics and Cochran Q's test. RESULTS Eighteen studies involving 1701 participants were identified. Coronary artery bypass graft was most common. Non-pharmacological interventions varied in types and duration. All intervention groups were compared to usual care, placebo, no interventions or active comparators. Statistically significant improvement in sleep quality (SMD = -.91, 95% CI = -1.17 to -.65) was found among intervention groups that explored cognitive behavioural therapy, relaxation techniques, exercise, massage, acupressure, aromatherapy, music, eye mask and earplugs. Pain intensity was reduced (SMD = -.63, 95% CI = -1.05 to -.20) with cognitive behavioural therapy, relaxation techniques, massage, music and eye mask. Anxiety was improved (SMD = -.21, 95% CI = -.38 to -.04) with exercise and music. CONCLUSION The overall use of non-pharmacological interventions can optimise sleep after cardiac surgery. Further research with greater methodological rigour is needed to investigate different intervention-related characteristics while considering potential confounders. RELEVANCE TO CLINICAL PRACTICE Post-operative cardiac settings can consider incorporating non-pharmacological interventions. Patients and healthcare providers can be better informed about the use of such interventions to improve sleep. REGISTRATION PROSPERO CRD42022384991.
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Affiliation(s)
- Pei Qi Peggy Soh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Hao Timothy Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Tanushri Roy
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Cui M, Xing T, Zhao A, Zheng L, Zhang X, Xue H, Wu Z, Wang F, Zhao P. Effects of intraoperative sodium oxybate infusion on post-operative sleep quality in patients undergoing gynecological laparoscopic surgery: A randomized clinical trial. J Clin Anesth 2024; 93:111349. [PMID: 38039631 DOI: 10.1016/j.jclinane.2023.111349] [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: 06/21/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
STUDY OBJECTIVE Post-operative sleep quality is an important factor that influences post-operative recovery. Sodium oxybate has been used to treat sleep disturbances associated with various pathological conditions. However, whether intraoperative intravenous infusion of sodium oxybate improves post-operative sleep quality is unknown. This study aimed to examine the effects of sodium oxybate on the post-operative sleep quality of patients who underwent gynecological laparoscopic surgery. DESIGN A single-center, prospective, two-arm, double-blinded randomized controlled trial. SETTING The Shengjing Hospital of China Medical University in Liaoning, China. PATIENTS We enrolled 180 adult patients (90 for each group) undergoing elective gynecological laparoscopic surgery, and 178 patients (89 for each group) were included in the final analysis. INTERVENTIONS Patients were randomly allocated in a 1:1 ratio to receive either sodium oxybate (30 mg kg-1) or an equivalent volume of saline after intubation. The patients, anesthetists, and follow-up staff were blinded to group assignment. MEASUREMENTS The primary outcome was sleep quality measured using the Richards-Campbell Sleep Questionnaire (RCSQ) on post-operative days (PODs) one and three. Secondary outcomes included post-operative pain measured using the visual analog scale, sleep quality at one and three months post-operatively measured using the Pittsburgh Sleep Quality Index, and factors associated with post-operative sleep quality. MAIN RESULTS Analysis with generalized estimating equations showed that sodium oxybate significantly improved post-operative sleep quality, as represented by increased total RCSQ scores (mean difference (95% CI); 9 (2, 16), P = 0.010) over PODs one and three. There was no difference in post-operative pain between the two groups over PODs one and three or in post-operative sleep quality over one and three months post-operatively. Age, surgery type, start time of surgery, and use of sufentanil-based patient-controlled intravenous analgesia were significantly associated with post-operative sleep quality. CONCLUSIONS Intraoperative sodium oxybate infusion improved post-operative sleep in patients who underwent gynecological laparoscopic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry, Clinical trial number: ChiCTR2200061460.
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Affiliation(s)
- Meiying Cui
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tianyi Xing
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Anqi Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lanlan Zheng
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xinping Zhang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hang Xue
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fang Wang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Du J, Zhang H, Ding Z, Wu X, Chen H, Ma W, Qiu C, Zhu S, Kang X. Development and validation of a nomogram for postoperative sleep disturbance in adults: a prospective survey of 640 patients undergoing spinal surgery. BMC Anesthesiol 2023; 23:154. [PMID: 37142982 PMCID: PMC10157914 DOI: 10.1186/s12871-023-02097-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Postoperative sleep disturbance (PSD) is a prevalent clinical complication that may arise due to various factors. The purpose of this investigation is to identify the risk factors for PSD in spinal surgery and establish a risk prediction nomogram. METHODS The clinical records of individuals who underwent spinal surgery from January 2020 to January 2021 were gathered prospectively. The least absolute shrinkage and selection operator (LASSO) regression, along with multivariate logistic regression analysis, was employed to establish independent risk factors. A nomogram prediction model was devised based on these factors. The nomogram's effectiveness was evaluated and verified via the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). RESULTS A total of 640 patients who underwent spinal surgery were analyzed in this investigation, among which 393 patients experienced PSD with an incidence rate of 61.4%. After conducting LASSO regression and logistic regression analyses using R software on the variables in training set, 8 independent risk factors associated to PSD were identified, including female, preoperative sleep disorder, high preoperative anxiety score, high intraoperative bleeding volume, high postoperative pain score, dissatisfaction with ward sleep environment, non-use of dexmedetomidine and non-use of erector spinae plane block (ESPB). The nomogram and online dynamic nomogram were constructed after incorporating these variables. In the training and validation sets, the area under the curve (AUC) in the receiver operating characteristic (ROC) curves were 0.806 (0.768-0.844) and 0.755 (0.667-0.844), respectively. The calibration plots indicated that the mean absolute error (MAE) values in both sets were respectively 1.2% and 1.7%. The decision curve analysis demonstrated the model had a substantial net benefit within the range of threshold probabilities between 20% and 90%. CONCLUSIONS The nomogram model proposed in this study included eight frequently observed clinical factors and exhibited favorable accuracy and calibration. TRIAL REGISTRATION The study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2200061257, 18/06/2022).
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Affiliation(s)
- Jin Du
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honggang Zhang
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Ding
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaobin Wu
- Department of Anesthesiology, China Coast Guard Hospital of the People ' s Armed Police Force, Jiaxing, China
| | - Hua Chen
- Department of Anesthesiology, China Coast Guard Hospital of the People ' s Armed Police Force, Jiaxing, China
| | - Weibin Ma
- Department of Anesthesiology, China Coast Guard Hospital of the People ' s Armed Police Force, Jiaxing, China
| | - Canjin Qiu
- Department of Anesthesiology, China Coast Guard Hospital of the People ' s Armed Police Force, Jiaxing, China
| | - Shengmei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Xianhui Kang
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Prevalence of Comorbid Depression and Insomnia Among Veterans Hospitalized for Heart Failure with Alzheimer Disease and Related Disorders. Am J Geriatr Psychiatry 2023; 31:428-437. [PMID: 36863973 DOI: 10.1016/j.jagp.2023.01.026] [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: 10/25/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient characteristics as a function of comorbid insomnia and/or depression among heart failure (HF) patients discharged from hospitals. DESIGN Retrospective cohort descriptive epidemiology study. SETTING VA Hospitals. PARTICIPANTS N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September 30, 2020. MEASUREMENTS We examined VA and Center for Medicare & Medicaid Services (CMS) coding in the year prior to admission using published ICD-9/10 codes for dementia, insomnia, and depression. The primary outcome was the prevalence of ADRD and the secondary outcomes were 30-day and 365-day mortality. RESULTS The cohort were predominantly older adults (mean age = 72 years, SD = 11), male (97%), and White (73%). Dementia prevalence in participants without insomnia or depression was 12%. In those with both insomnia and depression, dementia prevalence was 34%. For insomnia alone and depression alone, dementia prevalence was 21% and 24%, respectively. Mortality followed a similar pattern with highest 30-day and 365-day mortality higher in those with both insomnia and depression. CONCLUSIONS These results suggest that persons with both insomnia and depression are at an increased risk of ADRD and mortality compared to persons with one or neither condition. Screening for both insomnia and depression, especially in patients with other ADRD risk factors, could lead to earlier identification of ADRD. Understanding comorbid conditions which may represent earlier signs of ADRD may be critical in the identification of ADRD risk.
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Zhang ZF, Su X, Zhao Y, Zhong CL, Mo XQ, Zhang R, Wang K, Zhu SN, Shen YE, Zhang C, Wang DX. Effect of mini-dose dexmedetomidine supplemented intravenous analgesia on sleep structure in older patients after major noncardiac surgery: A randomized trial. Sleep Med 2023; 102:9-18. [PMID: 36587547 DOI: 10.1016/j.sleep.2022.12.006] [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: 06/21/2022] [Revised: 10/17/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES In previous studies, low-dose dexmedetomidine supplemented opioid analgesia improved sleep architecture but increased sedation level. Herein we tested the hypothesis that mini-dose dexmedetomidine supplemented analgesia improves sleep structure without increasing sedation. METHODS In this randomized trial, 118 older patients (≥65 years) following major noncardiac surgery were randomized to receive patient-controlled intravenous analgesia supplemented with either placebo or dexmedetomidine (median 0.02 μg kg-1 h-1) for up to 3 days. Polysomnogram was monitored from 9:00 p.m. on the day of surgery until 6:00 a.m. on the first day after surgery. Our primary outcome was the percentage of non-rapid eye movement stage 2 (N2) sleep. Secondary outcomes included other sleep structure parameters during the night of surgery and the sedation score during the first five postoperative days. RESULTS All 118 patients completed the study; of these, 85 were included in sleep structure analysis. Dexmedetomidine supplemented analgesia increased the percentage of N2 sleep (median difference, 10%; 95% CI, 1%-20%; P = 0.03). It also prolonged total sleep time (median difference, 78 min; 95% CI, 21 to 143; P = 0.01), increased sleep efficiency (median difference, 14%; 95% CI, 4%-26%; P = 0.01), decreased percentage of N1 sleep (median difference, -10%; 95% CI, -20% to -1%; P = 0.04), and lowered sleep fragmentation index (median difference, -1.6 times⋅h-1; 95% CI, -3.7 to 0.1; P = 0.04). Sedation score within 5 days did not differ between the two groups. CONCLUSIONS Supplementing intravenous analgesia with mini-dose dexmedetomidine improved sleep structure without increasing sedation in older patients recovering from major surgery. CLINICAL TRIALS www. CLINICALTRIALS gov (NCT03117790), registered 2 April 2017.
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Affiliation(s)
- Ze-Fei Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xian Su
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yi Zhao
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Chong-Lin Zhong
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Xiao-Qian Mo
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Rui Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Kun Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Sai-Nan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Yan-E Shen
- Department of Respiratory and Critical Medicine, Peking University First Hospital, Beijing, China
| | - Cheng Zhang
- Department of Respiratory and Critical Medicine, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China.
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The Association between General Anesthesia and New Postoperative Uses of Sedative-Hypnotics: A Nationwide Matched Cohort Study. J Clin Med 2022; 11:jcm11123360. [PMID: 35743431 PMCID: PMC9224548 DOI: 10.3390/jcm11123360] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Abstract
Sedative−hypnotic misuse is associated with psychiatric diseases and overdose deaths. It remains uncertain whether types of anesthesia affect the occurrence of new postoperative uses of sedative−hypnotics (NPUSH). We used reimbursement claims data of Taiwan’s National Health Insurance and conducted propensity score matching to compare the risk of NPUSH between general and neuraxial anesthesia among surgical patients who had no prescription of oral sedative−hypnotics or diagnosis of sleep disorders within the 12 months before surgery. The primary outcome was NPUSH within 180 days after surgery. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 92,222 patients were evaluated after matching. Among them, 15,016 (16.3%) had NPUSH, and 2183 (4.7%) were made a concomitant diagnosis of sleep disorders. General anesthesia was significantly associated both with NPUSH (aOR: 1.17, 95% CI: 1.13−1.22, p < 0.0001) and NPUSH with sleep disorders (aOR: 1.11, 95% CI: 1.02−1.21, p = 0.0212) compared with neuraxial anesthesia. General anesthesia was also linked to NPUSH that occurred 90−180 days after surgery (aOR: 1.12, 95% CI: 1.06−1.19, p = 0.0002). Other risk factors for NPUSH were older age, female, lower insurance premium, orthopedic surgery, specific coexisting diseases (e.g., anxiety disorder), concurrent medications (e.g., systemic steroids), postoperative complications, perioperative blood transfusions, and admission to an intensive care unit. Patients undergoing general anesthesia had an increased risk of NPUSH compared with neuraxial anesthesia. This finding may provide an implication in risk stratification and prevention for sedative−hypnotic dependence after surgery.
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The Effect of Improving Preoperative Sleep Quality on Perioperative Pain by Zolpidem in Patients Undergoing Laparoscopic Colorectal Surgery: A Prospective, Randomized Study. Pain Res Manag 2022; 2022:3154780. [PMID: 35069955 PMCID: PMC8767387 DOI: 10.1155/2022/3154780] [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: 07/18/2021] [Revised: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
Methods A prospective, randomized study was conducted with 88 patients undergoing laparoscopic colorectal surgery. The experimental group (S group, n = 44) was given 10 mg of zolpidem tartrate one night before the surgical procedure, while no medication was given to the control group (C group, n = 44). The primary outcome was the intraoperative remifentanil consumption. Sufentanil consumption, average patient-controlled analgesia (PCA) effective press times, the visual analog scale (VAS) scores, and incidences of postoperative nausea and vomiting (PONV) were recorded at 6 h (T1), 12 h (T2), and 24 h (T3) postoperatively. Results The intraoperative remifentanil consumption was significantly lower in the S group than that in the C group (p < 0.01). Sufentanil consumption at 6 h and 12 h postoperatively was significantly lower in the S group than that in the C group (p < 0.05); average PCA effective press times and VAS scores, at 6 h and 12 h postoperatively, were significantly lower in the S group than those in the C group (p < 0.01); differences between groups 24 h postoperatively were not significant. No significant between-group difference was noted in the incidence of nausea and vomiting. Conclusion Improving patients' sleep quality the night before surgical procedure by zolpidem can decrease the usage of intraoperative analgesics and reduce postoperative pain.
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Yang R, Xu XX, Liu H, Dai W, Zhang ZQ, Wang TT, Chen SS, Gu EW, Liu XS, Mei B. The Impact of Morning Surgery or Afternoon Surgery on Postoperative Sleep Quality and Melatonin Levels of Elderly Patients: A Prospective, Randomized Study. Nat Sci Sleep 2022; 14:1677-1686. [PMID: 36172082 PMCID: PMC9512024 DOI: 10.2147/nss.s377209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Postoperative sleep disturbance after surgery is not conducive to the recovery of patients. The purpose of this study was to determine the influence of the timing of surgery (morning vs afternoon) on the postoperative sleep quality of elderly patients and to analyze the relationship between the timing of surgery and the change in the melatonin level. METHODS Sixty patients who received hip surgery were randomly assigned to the Morning Group (Group M) or the Afternoon Group (Group A). The sleep quality was assessed by the Richards-Campbell Sleep Questionnaire. Before and after surgery, the nocturnal urine was collected over a 12-h period, and the 6-sulfatoxymelatonin concentration was measured. Also, the incidence of postoperative delirium (POD) was observed. RESULTS On the first and second nights after surgery, the sleep quality scores of the patients in Group A were greater than those in Group M, and there was no difference in the sleep quality scores between the two groups on the third night after surgery (P=0.000, P=0.002, P>0.05, respectively). In addition, the urine 6-sulphatoxymelatonin concentration was found to be greater in Group A than in Group M on the first night of surgery (P=0.00). Both the postoperative sleep quality scores and urine 6-sulphatoxymelatonin concentration were significantly less than those before surgery (P=0.00, P=0.00). CONCLUSION The postoperative sleep quality scores and melatonin levels of elderly patients who received hip surgery under general anesthesia were significantly less than those of the patients before surgery. Furthermore, the short-term sleep quality of the patients who received surgery in the afternoon was better than that of the patients who received surgery in the morning. This difference may be related to the short-term change of the melatonin level after surgery.
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Affiliation(s)
- Rui Yang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Xiao-Xia Xu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Hu Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wei Dai
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zheng-Qin Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Ting-Ting Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Shi-Shou Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Er-Wei Gu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Xue-Sheng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Bin Mei
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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The Effects of Melatonin Supplementation on Sleep Quality and Assessment of the Serum Melatonin in ICU Patients: A Randomized Controlled Trial. Crit Care Med 2021; 48:e1286-e1293. [PMID: 33048904 DOI: 10.1097/ccm.0000000000004690] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate whether the use of exogenous melatonin affects sleep, reduces the prevalence of delirium, and decreases the need for analgosedation and to assess whether serum melatonin indices correlate with exogenous administration in critically ill patients. DESIGN Double-blind, randomized, placebo-controlled study. SETTING Multicenter ICUs of two tertiary hospitals. PATIENTS A total of 203 adult patients who were admitted to the ICU and administered with analgesics and/or sedatives. INTERVENTIONS Oral melatonin (10 mg) or placebo for up to seven consecutive nights. MEASUREMENTS AND MAIN RESULTS The number of observed sleeping hours at night was assessed by the bedside nurse. Sleep quality was evaluated using the Richards Campbell Questionnaire Sleep (RCSQ). The prevalence of delirium, pain, anxiety, adverse reactions, duration of mechanical ventilation, length of ICU and hospital stays, and doses of sedative and analgesic drugs administered were recorded. The use of analgesics and sedatives was assessed daily. Melatonin levels were determined by enzyme-linked immunosorbent assay. Based on the RCSQ results, sleep quality was assessed to be better in the melatonin group than that in the placebo group with a mean (SD) of 69.7 (21.2) and 60.7 (26.3), respectively (p = 0.029). About 45.8% and 34.4% of participants in the melatonin and placebo groups had very good sleep (risk ratio, 1.33; 95% CI, 0.94-1.89), whereas 3.1% and 14.6% had very poor sleep (risk ratio, 0.21; 95% CI, 0.06-0.71), respectively. No significant difference was observed regarding the days free of analgesics or sedatives, the duration of night sleep, and the occurrence of delirium, pain, and anxiety. Melatonin serum peak levels at 2 AM were 150 pg/mL (range, 125-2,125 pg/mL) in the melatonin group and 32.5 pg/mL (range, 18.5-35 pg/mL) in the placebo group (p < 0.001). CONCLUSIONS Melatonin was associated with better sleep quality, which suggests its possible role in the routine care of critically ill patients in the future.
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Leong RW, Davies LJ, Fook-Chong S, Ng SY, Lee YL. Effect of the use of earplugs and eye masks on the quality of sleep after major abdominal surgery: a randomised controlled trial. Anaesthesia 2021; 76:1482-1491. [PMID: 33881774 DOI: 10.1111/anae.15468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/29/2022]
Abstract
Significant sleep disturbance can occur following major abdominal surgery. We aimed to evaluate the effectiveness of earplugs and eye masks in improving sleep quality and patient satisfaction, reducing nursing demands and in the incidence of delirium in patients after major abdominal surgery. We conducted a randomised controlled trial in 100 patients undergoing major abdominal surgery. We randomly allocated participants to sleep with or without earplugs and eye masks on postoperative days 1-3. The primary outcome measure was sleep quality as measured by the Richards-Campbell Sleep Questionnaire. Secondary outcomes were patient satisfaction, frequency of nursing demand and incidence of delirium measured by the Neelon and Champagne Confusion Scale. Median (IQR [range]) sleep scores were 64 (38-74 [0-100] and 60 (44-82 [18-100]) for the control and intervention groups, respectively (p = 0.310). Age and Pittsburgh Sleep Quality Index scores were found to be significant factors affecting sleep quality. There were no differences in patient satisfaction, reduction in frequency of nursing demands or incidence of delirium on postoperative days 1-3 after major abdominal surgery. The compliance rate in the intervention group was 60-65%. This study has demonstrated that the use of earplugs and eye masks did not contribute to improvements in sleep quality. Of note, sleep quality was moderate, with higher age and worse baseline sleep quality contributing to worse sleep scores. More studies are needed to investigate interventions to improve sleep quality after major abdominal surgery.
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Affiliation(s)
- R W Leong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - L J Davies
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - S Fook-Chong
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - S Y Ng
- Department of Surgical Intensive Care, Anaesthesia, Singapore General Hospital, Singapore
| | - Y L Lee
- Department of Surgical Intensive Care, Anaesthesia, Singapore General Hospital, Singapore
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Incidence and Risk Factors of Postoperative Severe Discomfort After Elective Surgery Under General Anesthesia: A Prospective Observational Study. J Perianesth Nurs 2021; 36:253-261. [PMID: 33640290 DOI: 10.1016/j.jopan.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Patient comfort is an important concern in patients receiving surgery, but the seriousness of discomfort during recovery is unknown. We investigated the incidence of postoperative discomfort based on the Standardized Endpoints in Perioperative Medicine initiative for patient comfort, and identified the risk factors. DESIGN This was a single-center prospective observational study. METHODS We enrolled adult patients who underwent elective surgery under general anesthesia between July and December 2018 at West China Hospital of Sichuan University (ChiCTR1800017324). The primary outcome was the incidence of postoperative severe discomfort (PoSD), defined as occurring when a patient experienced a severe rating in two or more domains in the six domains in the Standardized Endpoints in Perioperative Medicine initiative on the same day, including rest pain, postoperative nausea, and vomiting, dissatisfaction of gastrointestinal recovery, dissatisfaction of mobilization, sleep disturbance, and recovery. A generalized estimated equation was constructed to find risk factors of PoSD. FINDINGS In total, 440 patients completed the study. The incidence of PoSD was 28% on postoperative day (POD) 1, 13% on POD 2, 9% on POD 3, and 3.6% on both POD 5 and 7. The most common discomfort was serious sleep disturbance, ranging from 43% to 10% in the first week after surgery. Longer operative time (odds ratio [95% confidence interval]: 1.56 [1.19 to 2.05], P = .001), gastrointestinal surgery (5.03[2.08,12.17], P < .001), orthopaedic surgery (3.03 [1.35,6.79], P = .007), ear, nose, and throat (ENT) surgery (3.50 [1.22,10.02], P = .020) and postoperative complications (1.77 [1.03-3.04], P = .038) were significant risk factors of PoSD. CONCLUSIONS The incidence of PoSD after elective surgery under general anesthesia is high. Sleep disturbance was the most common problem identified. Anesthesia providers and perianesthesia nurses may need to optimize anesthetic application, combine different anesthesia methods, improve perioperative management, and provide interventions to reduce and to treat discomfort after surgeries.
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Amofah HA, Broström A, Instenes I, Fridlund B, Haaverstad R, Kuiper K, Ranhoff AH, Norekvål TM. Octogenarian patients' sleep and delirium experiences in hospital and four years after aortic valve replacement: a qualitative interview study. BMJ Open 2021; 11:e039959. [PMID: 33414142 PMCID: PMC7797265 DOI: 10.1136/bmjopen-2020-039959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Sleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation. DESIGN An explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed. SETTING Patients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation. PARTICIPANTS Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment. RESULTS For the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences. CONCLUSIONS For octogenarian patients, sleep disturbances and delirium are long-term burdens and need a greater attention in order to improve patient care.
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Affiliation(s)
| | - Anders Broström
- School of Health and Welfare, Jönköping University, Jonkoping, Sweden
- Department of Clinical Neurophysiology, Linkoping University Faculty of Medicine, Linkoping, Sweden
| | - Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Karel Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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Sleep Deprivation from the Perspective of a Patient Hospitalized in the Intensive Care Unit-Qualitative Study. Healthcare (Basel) 2020; 8:healthcare8030351. [PMID: 32967235 PMCID: PMC7551405 DOI: 10.3390/healthcare8030351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
(1) Introduction: Sleep architecture of Intensive Care Unit (ICU) patients is altered, with over 60% of them reporting sleep disorders or even sleep deprivation during their stay. The aim of the study was to describe the experiences related to sleep and nighttime rest of patients hospitalized in the ICU. (2) Method: the study used a qualitative project based on phenomenology as a research method. A semi-structured interview was used as the method to achieve the goal. The patients’ answers were recorded and transcribed. The data were coded and cross-processed. (3) Results: twenty-three patients were surveyed, fifteen men and eight women. The average age was 49.7 years. The average time of hospitalization was 34.3 days. During the ICU stay, patients required mechanical ventilation through the tracheostomy tube. Five themes were identified from the interview as factors disturbing sleep: fear, noise, light, medical staff, and at home best. (4) Conclusions: chronic anxiety appears to contribute to sleep disturbances in the ICUs, psychological support, and individualized approach to the hospitalized patient seem necessary. By raising the awareness of the essence of sleep among medical staff, environmental factors can be reduced as disturbing sleep. Based on the participants’ comments, it is possible that repeated actions could also increase the patients’ sense of security.
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Luo M, Song B, Zhu J. Sleep Disturbances After General Anesthesia: Current Perspectives. Front Neurol 2020; 11:629. [PMID: 32733363 PMCID: PMC7360680 DOI: 10.3389/fneur.2020.00629] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
The purpose of this article is to review (1) sleep mechanism under general anesthesia, harmful effects of postoperative sleep disturbances; (2) risk factors associated with postoperative sleep disturbances; (3) measures to prevent and improve postoperative sleep disturbances. General anesthesia changes the postoperative sleep structure especially in elderly patients after major surgery and results in a high incidence rate of sleep disturbances. Sleep disturbances produce harmful effects on postoperative patients and lead to a higher risk of delirium, more cardiovascular events, and poorer recovery. Some researchers do propose non-pharmacological treatments such as attention to environmental and psychological factors, application of electroacupuncture (EA) technology and pharmacological treatments are helpful, but larger high-quality clinical trials with longer following-up are needed to further investigate the efficacy and safety.
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Affiliation(s)
- Man Luo
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.,Department of Anesthesiology, Friendship Hospital of Capital Medical University, Beijing, China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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Sleep and Intensive Care Unit–Acquired Weakness in Critically Ill Older Adults. Dimens Crit Care Nurs 2019; 38:20-28. [DOI: 10.1097/dcc.0000000000000335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Effect of Intravenous Oxycodone in Combination With Different Doses of Dexmedetomdine on Sleep Quality and Visceral Pain in Patients After Abdominal Surgery. Clin J Pain 2018; 34:1126-1132. [DOI: 10.1097/ajp.0000000000000645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Purpose of review We reviewed evidences regarding occurrence, risk factors, harmful effects, prevention, and management of sleep disturbances in patients after surgery. Recent findings Normal sleep is important to maintain physical and mental health. Sleep disturbances frequently occur in patients after surgery. Factors associated with the development of postoperative sleep disturbances include old age, preoperative comorbidity, type of anesthesia, severity of surgical trauma, postoperative pain, environment stress, as well as other factors leading to discomfort of patients. Development of sleep disturbances produces harmful effects on postoperative patients, that is, leading to higher risk of delirium, increased sensitivity to pain, more cardiovascular events, and poorer recovery. Both nonpharmacological and pharmacological measures (such as zolpidem, melatonin, and dexmedetomidine) can be used to improve postoperative sleep. Recent evidences show that sleep promotion may improve patients’ outcome, but requires further evidences. Summary Sleep disturbances are common in patients after surgery and produce harmful effects on postoperative recovery. Sleep-promotion therapy may be helpful to improve postoperative recovery, but long-term effects deserve further study.
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Gulia KK, Kumar VM. Sleep disorders in the elderly: a growing challenge. Psychogeriatrics 2018; 18:155-165. [PMID: 29878472 DOI: 10.1111/psyg.12319] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/27/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022]
Abstract
In contrast to newborns, who spend 16-20 h in sleep each day, adults need only about sleep daily. However, many elderly may struggle to obtain those 8 h in one block. In addition to changes in sleep duration, sleep patterns change as age progresses. Like the physical changes that occur during old age, an alteration in sleep pattern is also a part of the normal ageing process. As people age, they tend to have a harder time falling asleep and more trouble staying asleep. Older people spend more time in the lighter stages of sleep than in deep sleep. As the circadian mechanism in older people becomes less efficient, their sleep schedule is shifted forward. Even when they manage to obtain 7 or 8 h sleep, they wake up early, as they have gone to sleep quite early. The prevalence of sleep disorders is higher among older adults. Loud snoring, which is more common in the elderly, can be a symptom of obstructive sleep apnoea, which puts a person at risk for cardiovascular diseases, headaches, memory loss, and depression. Restless legs syndrome and periodic limb movement disorder that disrupt sleep are more prevalent in older persons. Other common medical problems of old age such as hypertension diabetes mellitus, renal failure, respiratory diseases such as asthma, immune disorders, gastroesophageal reflux disease, physical disability, dementia, pain, depression, and anxiety are all associated with sleep disturbances.
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Affiliation(s)
- Kamalesh K Gulia
- Division of Sleep Research, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Velayudhan Mohan Kumar
- Division of Sleep Research, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Machado ADS, Pires-Neto RC, Carvalho MTX, Soares JC, Cardoso DM, Albuquerque IMD. Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial. J Bras Pneumol 2017; 43:134-139. [PMID: 28538781 PMCID: PMC5474377 DOI: 10.1590/s1806-37562016000000170] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/18/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients. (ClinicalTrials.gov Identifier: NCT01769846 [http://www.clinicaltrials.gov/]).
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Affiliation(s)
- Aline Dos Santos Machado
- . Curso de Especialização em Reabilitação Físico-Motora, Programa de Pós-Graduação em Gerontologia, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS) Brasil
| | - Ruy Camargo Pires-Neto
- . Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Maurício Tatsch Ximenes Carvalho
- . Programa de Pós-Graduação em Reabilitação Funcional, Departamento de Fisioterapia e Reabilitação, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS) Brasil
| | - Janice Cristina Soares
- . Unidade de Terapia Intensiva Adulto, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS) Brasil.,. Universidade Luterana do Brasil - ULBRA -Santa Maria (RS) Brasil
| | - Dannuey Machado Cardoso
- . Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Isabella Martins de Albuquerque
- . Programa de Pós-Graduação em Reabilitação Funcional, Departamento de Fisioterapia e Reabilitação, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS) Brasil
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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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Dick-Smith F. 'Sorry, were you sleeping? Nurses' role in the promotion of sleep for critically ill patients. Contemp Nurse 2016; 53:121-125. [PMID: 27848277 DOI: 10.1080/10376178.2016.1261632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND During critical illness sleep is important for immune function and restorative processes. Despite theoretical evidence and scientific understanding of the effects of sleep deprivation in the critically ill, research is yet to be entirely translated into institutional practices and department cultural norms. OBJECTIVES This article was adapted from an undergraduate essay that considered the nurse's role in addressing fragmented sleep in critical care patients'. METHOD The databases, PubMed, CINAHL and Science Direct were searched using the keywords sleep, critical care and nurs* resulting in the inclusion of 15 journal articles. Also utilised were nursing prescribed texts and professional websites. RESULTS Sleep deprivation has a multitude of intrinsic and extrinsic factors, however the healthcare environment has been established as the most common cause of sleep fragmentation. CONCLUSIONS A paradigm shift in nursing and institutional culture is required to implement sleep promotion research and strategies to minimise adverse outcomes for patients.
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Affiliation(s)
- Felicity Dick-Smith
- a Faculty of Health , University of Technology Sydney , PO Box 123, Broadway, Ultimo , NSW 2007 Australia
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Abstract
Sleep disturbances are common in the intensive care unit setting. This article describes the causal factors associated with alterations in sleep in the intensive care setting, effects of sleep disturbances for patients, and strategies to mitigate sleep disturbances. A review of normal sleep architecture is provided, as is a discussion of the methods of measuring sleep in the critical care setting.
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Affiliation(s)
- Roberta Kaplow
- Emory University Hospital, 2184 Briarwood Bluff NE, Atlanta, GA 30319, USA.
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Matthews EE, Tanner JM, Dumont NA. Sleep Disturbances in Acutely Ill Patients with Cancer. Crit Care Nurs Clin North Am 2016; 28:253-68. [PMID: 27215362 DOI: 10.1016/j.cnc.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options.
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Affiliation(s)
- Ellyn E Matthews
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA.
| | - J Mark Tanner
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA
| | - Natalie A Dumont
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA
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Leigh L, Hudson IL, Byles JE. Sleep Difficulty and Disease in a Cohort of Very Old Women. J Aging Health 2016; 28:1090-104. [PMID: 26801231 DOI: 10.1177/0898264315624907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the association between chronic diseases and sleep difficulty in older women. METHOD A total of 10,721 women from The Australian Longitudinal Study on Women's Health, aged 70 to 75 years at baseline (1996), who answered sleep questionnaire data over 15 years follow-up, were surveyed. Longitudinal sleep difficulty class was regressed on baseline diseases. RESULTS Arthritis and heart disease were the strongest predictors of sleep difficulty; odds ratios for belonging to the greatest sleep difficulty class were 2.27 (95% confidence interval [CI] = [1.98, 2.61]) and 1.8 (95% CI [1.5, 2.16], respectively. Bronchitis/emphysema, osteoporosis, asthma, diabetes, and hypertension also predicted greater sleep difficulty. CONCLUSION Older women diagnosed with the aforementioned significant diseases may also be at greater risk of sleep difficulty. These women may need counseling or treatment for their sleep difficulty, to prevent depression, cognitive function decline, falls, frailty, and increased mortality, as well as greater risk of nursing home placement, well known to be reinforced by sleep trouble, and the associated health care costs and societal impacts poor sleep quality has for older adults.
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Affiliation(s)
- Lucy Leigh
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Australia
| | - Irene L Hudson
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Australia School of Mathematical and Physical Sciences, Faculty of Science and Information Technology, University of Newcastle, Callaghan, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Australia
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Reversal of a Suspected Paradoxical Reaction to Zopiclone with Flumazenil. Case Rep Crit Care 2016; 2016:3185873. [PMID: 27672456 PMCID: PMC5031812 DOI: 10.1155/2016/3185873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
We describe the care for an elderly woman who was admitted to the intensive care unit (ICU) to receive noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease. After administration of the sleeping pill zopiclone, a nonbenzodiazepine receptor agonist (NBRA), the patient became agitated and was confused, a possible paradoxical reaction to benzodiazepines. These symptoms were immediately resolved after treatment with flumazenil, usually used to reverse the adverse effects of benzodiazepines or NBRAs and to reverse paradoxical reactions to benzodiazepines. This case indicates that zopiclone induced behavioral changes resembling a paradoxical reaction to benzodiazepines and these symptoms may be treated with flumazenil.
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Zeng A, Song X, Dong J, Mitnitski A, Liu J, Guo Z, Rockwood K. Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit. J Gerontol A Biol Sci Med Sci 2015; 70:1586-94. [PMID: 26400736 PMCID: PMC4631107 DOI: 10.1093/gerona/glv084] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 05/18/2015] [Indexed: 02/06/2023] Open
Abstract
Background. In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival. Methods. Older patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July–December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores. Results. The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score—APACHE II and APACHE IV (r2 = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%–15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days. Conclusion. ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults.
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Affiliation(s)
- An Zeng
- School of Computers, Guangdong University of Technology, Guangzhou, China
| | - Xiaowei Song
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Centre for Healthcare of the Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jiahui Dong
- Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China
| | - Arnold Mitnitski
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Departments of Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jian Liu
- Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China
| | - Zhenhui Guo
- Department of Medical Intensive Care Unit, General Hospital of Guangzhou Military Command; Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support and Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou, China. Department of Medicine, Southern Medical University, Guangzhou, China.
| | - Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Centre for Healthcare of the Elderly, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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Leigh L, Hudson IL, Byles JE. Sleeping difficulty, disease and mortality in older women: a latent class analysis and distal survival analysis. J Sleep Res 2015; 24:648-57. [DOI: 10.1111/jsr.12324] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/05/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Lucy Leigh
- Research Centre for Gender, Health and Ageing; Faculty of Health and Medicine; The University of Newcastle; Callaghan NSW Australia
| | - Irene L. Hudson
- Research Centre for Gender, Health and Ageing; Faculty of Health and Medicine; The University of Newcastle; Callaghan NSW Australia
- School of Mathematical and Physical Sciences; Faculty of Science and Information Technology; University of Newcastle; Callaghan NSW Australia
| | - Julie E. Byles
- Research Centre for Gender, Health and Ageing; Faculty of Health and Medicine; The University of Newcastle; Callaghan NSW Australia
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Babaii A, Adib-Hajbaghery M, Hajibagheri A. The Effect of Aromatherapy with Damask Rose and Blindfold on Sleep Quality of Patients Admitted to Cardiac Critical Care Units. ACTA ACUST UNITED AC 2015. [DOI: 10.29252/ijn.28.93.94.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
For an organism to be successful in an evolutionary sense, it and its offspring must survive. Such survival depends on satisfying a number of needs that are driven by motivated behaviors, such as eating, sleeping, and mating. An individual can usually only pursue one motivated behavior at a time. The circadian system provides temporal structure to the organism's 24 hour day, partitioning specific behaviors to particular times of the day. The circadian system also allows anticipation of opportunities to engage in motivated behaviors that occur at predictable times of the day. Such anticipation enhances fitness by ensuring that the organism is physiologically ready to make use of a time-limited resource as soon as it becomes available. This could include activation of the sympathetic nervous system to transition from sleep to wake, or to engage in mating, or to activate of the parasympathetic nervous system to facilitate transitions to sleep, or to prepare the body to digest a meal. In addition to enabling temporal partitioning of motivated behaviors, the circadian system may also regulate the amplitude of the drive state motivating the behavior. For example, the circadian clock modulates not only when it is time to eat, but also how hungry we are. In this chapter we explore the physiology of our circadian clock and its involvement in a number of motivated behaviors such as sleeping, eating, exercise, sexual behavior, and maternal behavior. We also examine ways in which dysfunction of circadian timing can contribute to disease states, particularly in psychiatric conditions that include adherent motivational states.
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