Sleep and delirium in unsedated patients in the intensive care unit

Research output: Contribution to journal › Journal article › Research › peer-review

Standard

Sleep and delirium in unsedated patients in the intensive care unit. / Boesen, H C; Andersen, J H; Bendtsen, A O; Jennum, P J.

In: Acta Anaesthesiologica Scandinavica, Vol. 60, No. 1, 01.2016, p. 59-68.

Research output: Contribution to journal › Journal article › Research › peer-review

Harvard

Boesen, HC, Andersen, JH, Bendtsen, AO & Jennum, PJ 2016, 'Sleep and delirium in unsedated patients in the intensive care unit', Acta Anaesthesiologica Scandinavica, vol. 60, no. 1, pp. 59-68. https://doi.org/10.1111/aas.12582

APA

Boesen, H. C., Andersen, J. H., Bendtsen, A. O., & Jennum, P. J. (2016). Sleep and delirium in unsedated patients in the intensive care unit. Acta Anaesthesiologica Scandinavica, 60(1), 59-68. https://doi.org/10.1111/aas.12582

Vancouver

Boesen HC, Andersen JH, Bendtsen AO, Jennum PJ. Sleep and delirium in unsedated patients in the intensive care unit. Acta Anaesthesiologica Scandinavica. 2016 Jan;60(1):59-68. https://doi.org/10.1111/aas.12582

Author

Boesen, H C ; Andersen, J H ; Bendtsen, A O ; Jennum, P J. / Sleep and delirium in unsedated patients in the intensive care unit. In: Acta Anaesthesiologica Scandinavica. 2016 ; Vol. 60, No. 1. pp. 59-68.

Bibtex

@article{27b64b1f07ca4706a856d45bdfe798db,

title = "Sleep and delirium in unsedated patients in the intensive care unit",

abstract = "BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients.METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients. Delirium assessment was done using the confusion assessment method for the intensive care unit (CAM-ICU).RESULTS: Of four patients who were delirium free, only one had identifiable sleep on PSG. Sleep was disrupted with loss of circadian rhythm, and diminished REM sleep. In the remaining three patients the PSGs were atypical, meaning that no sleep signs were found, and sleep could not be quantified from the PSGs. Clinical total sleep time (ClinTST) ranged from 2.0-13.1 h in patients without delirium. Six patients with delirium all had atypical PSGs, so sleep could not be quantified. Short periods of REM sleep were found. ClinTST was median 8.5 h (range 0.4-13.8 h). EEG reactivity and wakefulness was found in all but one PSG. Four patients were CAM-ICU {"}unassessable{"} (unresponsive to voice). PSGs were atypical without reactivity or wakefulness, even though clinical wakefulness was documented. ClinTST was median 18.3 h (range 3.7-19.8 h). Paroxystic EEG activity was found in this subgroup.CONCLUSIONS: The objective signs of sleep were absent in all but one PSG, so even though patients were not sedated, sleep could not be quantified. Even in patients without delirium, sleep could only be quantified in one of four patients. Paroxystic activity is frequent in unsedated patients, unresponsive to voice, but the implication is unknown.",

keywords = "Adult, Aged, Aged, 80 and over, Circadian Rhythm, Conscious Sedation, Critical Care, Delirium, Electroencephalography, Female, Humans, Intensive Care Units, Male, Middle Aged, Polysomnography, Prospective Studies, Psychomotor Agitation, Respiration, Artificial, Sleep Deprivation, Sleep, REM, Wakefulness, Journal Article, Observational Study, Research Support, Non-U.S. Gov't",

author = "Boesen, {H C} and Andersen, {J H} and Bendtsen, {A O} and Jennum, {P J}",

note = "{\textcopyright} 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2016",

month = jan,

doi = "10.1111/aas.12582",

language = "English",

volume = "60",

pages = "59--68",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Wiley-Blackwell",

number = "1",

}

RIS

TY - JOUR

T1 - Sleep and delirium in unsedated patients in the intensive care unit

AU - Boesen, H C

AU - Andersen, J H

AU - Bendtsen, A O

AU - Jennum, P J

PY - 2016/1

Y1 - 2016/1

N2 - BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients.METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients. Delirium assessment was done using the confusion assessment method for the intensive care unit (CAM-ICU).RESULTS: Of four patients who were delirium free, only one had identifiable sleep on PSG. Sleep was disrupted with loss of circadian rhythm, and diminished REM sleep. In the remaining three patients the PSGs were atypical, meaning that no sleep signs were found, and sleep could not be quantified from the PSGs. Clinical total sleep time (ClinTST) ranged from 2.0-13.1 h in patients without delirium. Six patients with delirium all had atypical PSGs, so sleep could not be quantified. Short periods of REM sleep were found. ClinTST was median 8.5 h (range 0.4-13.8 h). EEG reactivity and wakefulness was found in all but one PSG. Four patients were CAM-ICU "unassessable" (unresponsive to voice). PSGs were atypical without reactivity or wakefulness, even though clinical wakefulness was documented. ClinTST was median 18.3 h (range 3.7-19.8 h). Paroxystic EEG activity was found in this subgroup.CONCLUSIONS: The objective signs of sleep were absent in all but one PSG, so even though patients were not sedated, sleep could not be quantified. Even in patients without delirium, sleep could only be quantified in one of four patients. Paroxystic activity is frequent in unsedated patients, unresponsive to voice, but the implication is unknown.

AB - BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients.METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients. Delirium assessment was done using the confusion assessment method for the intensive care unit (CAM-ICU).RESULTS: Of four patients who were delirium free, only one had identifiable sleep on PSG. Sleep was disrupted with loss of circadian rhythm, and diminished REM sleep. In the remaining three patients the PSGs were atypical, meaning that no sleep signs were found, and sleep could not be quantified from the PSGs. Clinical total sleep time (ClinTST) ranged from 2.0-13.1 h in patients without delirium. Six patients with delirium all had atypical PSGs, so sleep could not be quantified. Short periods of REM sleep were found. ClinTST was median 8.5 h (range 0.4-13.8 h). EEG reactivity and wakefulness was found in all but one PSG. Four patients were CAM-ICU "unassessable" (unresponsive to voice). PSGs were atypical without reactivity or wakefulness, even though clinical wakefulness was documented. ClinTST was median 18.3 h (range 3.7-19.8 h). Paroxystic EEG activity was found in this subgroup.CONCLUSIONS: The objective signs of sleep were absent in all but one PSG, so even though patients were not sedated, sleep could not be quantified. Even in patients without delirium, sleep could only be quantified in one of four patients. Paroxystic activity is frequent in unsedated patients, unresponsive to voice, but the implication is unknown.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Circadian Rhythm

KW - Conscious Sedation

KW - Critical Care

KW - Delirium

KW - Electroencephalography

KW - Female

KW - Humans

KW - Intensive Care Units

KW - Male

KW - Middle Aged

KW - Polysomnography

KW - Prospective Studies

KW - Psychomotor Agitation

KW - Respiration, Artificial

KW - Sleep Deprivation

KW - Sleep, REM

KW - Wakefulness

KW - Journal Article

KW - Observational Study

KW - Research Support, Non-U.S. Gov't

U2 - 10.1111/aas.12582

DO - 10.1111/aas.12582

M3 - Journal article

C2 - 26190149

VL - 60

SP - 59

EP - 68

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 1

ER -

ID: 178858379