Sleep in ICU. Yuliya Boyko, Poul Jennum, Helle Oerding, Palle Toft
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1 Sleep in ICU Yuliya Boyko, Poul Jennum, Helle Oerding, Palle Toft
2 Background: Why is sleep is important? Modulation of the immune system Regenerative processes Neurophysiological organisation Memory consolidation Cognitive function
3 Sleep in ICU Abnormal circadian rhythm Fragmentation Lack of restorative sleep (REM, SWS) Absence of normal sleep patterns 1.Cooper NA et al. Sleep in critically ill patients requiring mechanical ventilation. Chest Elliott R et al. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care Watson PL et al. Atypical sleep in ventilated patients: empirical electroencephalography findings and the path toward revised ICU sleep scoring criteria. Crit Care Med 2013
4 Sleep disturbing factors in ICU Environment (noise, light, procedures) Mechanical ventilation Medication Critical illness
5 Sleep disturbances in ICU may lead to: Delirium Prolonged ICU stay Increased mortality 1.Weinhouse GL et al. Bench-to bedside review: delirium in ICU patients importance of sleep deprivation. Crit Care Ely EW et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004
6 Project 1: the role of environment Objective: Improved ICU environment be er sleep quality
7 Patients and Methods Randomized crossover study Inclusion criteria mechanical ventilation able to give consent Night intervention 'Quiet routine
8 Activities at Usual routine and Quiet routine nights
9 Sleep monitoring: polysomnography EEG EOG EMG ECG Respiration
10 Sleep analysis AASM classification (standard): insufficient Watson classification: + atypical sleep 1-6 Watson PL et al. Atypical sleep in ventilated patients: empirical electroencephalography findings and the path toward revised ICU sleep scoring criteria. Crit Care Med 2013
11 Results 19 pts included (2 excluded) Mean sound levels (p=0.3): intervention 46.9dB(A) control 47.6dB(A) Overnight PSGs: atypical patterns in ~70% of the patients
12 Sleep stage distribution
13 Conclusions so far: Normal sleep absent in many of the sleep EEGs Watson s sleep scoring classification useful Relatively low sound levels found. Unable to further reduce noise levels under Quiet routine nights No association between the intervention and the presence of normal sleep characteristics in sleep EEGs Boyko Y et al. Sleep in intensive care unit: The role of environment. J Crit Care 2016
14 Melatonin secretion pattern in critically ill patients 8 pts Melatonin: every 4 th hour - 48 hours (ELISA) Remifentanil 43% of participation time: remifentanil melatonin secre on? remifentanil sleep pa ern?
15 Results Melatonin secretion: diurnal phase-delayed pattern Remifentanil no effect on melatonin secretion
16 Results: remifentanil sleep Risk of atypical sleep compared with normal sleep lower (p<0.001) under remifentanil REM-sleep was only observed during the nonsedation
17 Project 2: sleep patterns in patients with sepsis and COPD Objective: Patterns in sleep-eegs in homogeneous groups of ICU pts? Sepsis COPD
18 Patients and methods Descriptive study Inclusion criteria: Group 1: sepsis Group 2: COPD mechanical ventilation nonsedation able to give consent Sleep monitoring:
19 Status: Inclusion completed: 16 pts sepsis group 17 pts COPD group Analysis ongoing
20 Project 1 patients: AASM/Watson-sleep Percent survival Kaplan-Meier survival estimates analysis time, days AASM sleep Watson sleep
21 Perspectives Sleep/micro sleep fenomena outcome Sutter R et al. Electroencephalographic sleep elements and outcome in acute encephalopathic patients: a 4-year cohort study. Eur J Neurol 2014
22 Acknowledgements ICU staff, Vejle Hospital + OUH Danish Center for Sleep Medicine, RH, Glostrup Funding: Southern Danish University the Region of Southern Denmark, Department of Anaesthesia and Intensive Care, Vejle Hospital Department of Anaesthesia and Intensive Care, OUH DASAIM The Research Foundation at Vejle Hospital Aage and Viola Holm-Madsens Research Foundation, A.P. Moellers foundation Networking foundation, OUH/RH
23 Thank you
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