Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels.
Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels.
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DOI：
10.1186/s13613-017-0248-7
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发表时间：
2017-12
影响因子：
8.1
通讯作者：
Mira JP
中科院分区：
文献类型：
--
作者：
Elbaz M;Léger D;Sauvet F;Champigneulle B;Rio S;Strauss M;Chennaoui M;Guilleminault C;Mira JP
众所周知，重症监护病房（ICU）患者的睡眠受到严重干扰，这可能会损害他们的康复潜力。然而，客观地评估睡眠的数量和质量仍然很困难，睡眠障碍的决定因素也不清楚。因此，本研究的目的是仔细评估ICU声强度水平及其来源对ICU患者24小时睡眠的影响。记录11例符合标准的ICU插管患者的睡眠和声音水平。使用小型多通道动态记录设备记录睡眠。用Nox-T3监测仪记录声强级及其声源。对30 s的睡眠阶段和声音数据进行逐历分析。使用多项和二项逻辑回归将睡眠阶段、觉醒和睡眠-觉醒转换与声音水平及其来源联系起来。受试者的平均睡眠时间为502.2[283.2-718.9]分钟/ 24小时；夜间（22.00-08.00）356.9[188.6-590.9]分钟，白天（上午8点-晚上10点）168.5[142.5-243.3]分钟。夜间中位声强为70.2 [65.1-80.3]dBC。导致睡眠紊乱的声音阈值在白天为63 dBC，在夜间为59 dBC。当水平高于77 dBC时，觉醒发生率（OR 3.9, 95% CI 3.0-5.0）和睡眠-觉醒转换发生率（OR 7.6, 95% CI 4.1-14）增加。最令人不安的噪声源是监测器报警（OR 4.5, 95% CI 3.5-5.6）和通风机报警（OR 4.2, 95% CI 2.9-6.1）。我们在一组11例非重症ICU患者中表明，声级强度是影响睡眠连续性的主要干扰因素，应严格控制在24小时范围内。
It is well recognized that sleep is severely disturbed in patients in intensive care units (ICU) and that this can compromise their rehabilitation potential. However, it is still difficult to objectively assess sleep quantity and quality and the determinants of sleep disturbance remain unclear. The aim of this study was therefore to evaluate carefully the impact of ICU sound intensity levels and their sources on ICU patients’ sleep over a 24-h period. Sleep and sound levels were recorded in 11 ICU intubated patients who met the criteria. Sleep was recorded using a miniaturized multi-channel ambulatory recording device. Sound intensity levels and their sources were recorded with the Nox-T3 monitor. A 30-s epoch-by-epoch analysis of sleep stages and sound data was carried out. Multinomial and binomial logistic regressions were used to associate sleep stages, wakefulness and sleep–wake transitions with sound levels and their sources. The subjects slept a median of 502.2 [283.2–718.9] min per 24 h; 356.9 [188.6–590.9] min at night (22.00–08.00) and 168.5 [142.5–243.3] during daytime (8 am–10 pm). Median sound intensity level reached 70.2 [65.1–80.3] dBC at night. Sound thresholds leading to disturbed sleep were 63 dBC during the day and 59 dBC during the night. With levels above 77 dBC, the incidence of arousals (OR 3.9, 95% CI 3.0–5.0) and sleep-to-wake transitions (OR 7.6, 95% CI 4.1–14) increased. The most disturbing noises sources were monitor alarms (OR 4.5, 95% CI 3.5–5.6) and ventilator alarms (OR 4.2, 95% CI 2.9–6.1). We have shown, in a small group of 11 non-severe ICU patients, that sound level intensity, a major disturbance factor of sleep continuity, should be strictly controlled on a 24-h profile.