Abnormal Sleep, Circadian Rhythm Disruption, and Delirium in the ICU: Are They Related?
Abnormal Sleep, Circadian Rhythm Disruption, and Delirium in the ICU: Are They Related?
复制标题
DOI：
10.3389/fneur.2020.549908
复制
发表时间：
2020
影响因子：
3.4
通讯作者：
Wilcox ME
中科院分区：
文献类型：
--
作者：
Daou M;Telias I;Younes M;Brochard L;Wilcox ME
谵妄是一种以急性脑衰竭为特征的综合征，其导致影响注意力、意识和认知的神经认知障碍。它在重症患者中非常普遍，并与发病率和死亡率增加有关。谵妄的一个核心领域是睡眠-觉醒周期中的行为障碍，可能与昼夜节律紊乱有关。睡眠、昼夜节律和重症监护病房（ICU）获得性谵妄之间的关系是复杂的，可能是双向的。在这篇综述中，我们探讨了睡眠中断和昼夜节律紊乱的病理生理机制，作为ICU中过渡到谵妄的可能因素，并强调了一些最相关的注意事项，以了解这些复杂现象之间的关系。具体而言，我们将（1）回顾睡眠质量和效率差的生理后果;（2）探索在谵妄中生物钟功能的神经基质如何被破坏;（3）讨论镇静药物作为谵妄和时间中断的贡献者的作用;（4）描述异常睡眠病理性觉醒，昼夜节律紊乱，谵妄和危重病之间的关联。改善睡眠和重新调整昼夜节律以重新调整生物钟的机会可能作为ICU中谵妄预防和治疗的治疗目标。需要进一步的研究来更好地定义这些条件，并了解潜在的生理关系，以制定有效的预防和治疗策略。
Delirium is a syndrome characterized by acute brain failure resulting in neurocognitive disturbances affecting attention, awareness, and cognition. It is highly prevalent among critically ill patients and is associated with increased morbidity and mortality. A core domain of delirium is represented by behavioral disturbances in sleep-wake cycle probably related to circadian rhythm disruption. The relationship between sleep, circadian rhythm and intensive care unit (ICU)-acquired delirium is complex and likely bidirectional. In this review, we explore the proposed pathophysiological mechanisms of sleep disruption and circadian dysrhythmia as possible contributing factors in transitioning to delirium in the ICU and highlight some of the most relevant caveats for understanding the relationship between these complex phenomena. Specifically, we will (1) review the physiological consequences of poor sleep quality and efficiency; (2) explore how the neural substrate underlying the circadian clock functions may be disrupted in delirium; (3) discuss the role of sedative drugs as contributors to delirium and chrono-disruption; and, (4) describe the association between abnormal sleep-pathological wakefulness, circadian dysrhythmia, delirium and critical illness. Opportunities to improve sleep and readjust circadian rhythmicity to realign the circadian clock may exist as therapeutic targets in both the prevention and treatment of delirium in the ICU. Further research is required to better define these conditions and understand the underlying physiologic relationship to develop effective prevention and therapeutic strategies.
登录
查看更多内容
影响因子：
--
作者：
Nguyen DN;Huyghens L;Zhang H;Schiettecatte J;Smitz J;Vincent JL
通讯作者：
Vincent JL
影响因子：
9.3
作者：
European Delirium Association;American Delirium Society
通讯作者：
American Delirium Society
影响因子：
2.9
作者：
Burry, Lisa;Scales, Damon;Rose, Louise
通讯作者：
Rose, Louise
影响因子：
39.2
作者：
Ely, EW;Evans, GW;Haponik, EF
通讯作者：
Haponik, EF
影响因子：
8.8
作者：
Devlin, John W.;Skrobik, Yoanna;Alhazzani, Waleed
通讯作者：
Alhazzani, Waleed