Sleep and delirium in unsedated patients in the intensive care unit

H C Boesen; J H Andersen; A O Bendtsen; P J Jennum

doi:10.1111/aas.12582

Sleep and delirium in unsedated patients in the intensive care unit

H C Boesen, J H Andersen, A O Bendtsen, P J Jennum

19 Citations (Scopus)

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.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	60
Issue number	1
Pages (from-to)	59-68
Number of pages	10
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.12582
Publication status	Published - 1 Jan 2016

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

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10.1111/aas.12582

Cite this

@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,

day = "1",

doi = "10.1111/aas.12582",

language = "English",

volume = "60",

pages = "59--68",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Wiley-Blackwell",

number = "1",

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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 - 2016/1/1

Y1 - 2016/1/1

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

SN - 0001-5172

VL - 60

SP - 59

EP - 68

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 1

ER -

Sleep and delirium in unsedated patients in the intensive care unit

Abstract

Keywords

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