Delirium: is sleep important?
Delirium: is sleep important?
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DOI：
10.1016/j.bpa.2012.08.005
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发表时间：
2012-09
期刊：
影响因子：
--
通讯作者：
Fanfulla F
中科院分区：
文献类型：
--
作者：
Watson PL;Ceriana P;Fanfulla F
谵妄和睡眠质量差在住院患者中很常见，并且经常同时存在。已经假设这些疾病之间存在联系，但这种联系是因果关系还是仅仅是由共享机制产生的关联尚待确定。潜在的共同机制包括：神经递质异常、组织缺血、炎症和镇静剂暴露。镇静剂虽然可以缩短睡眠潜伏期，但通常会导致慢波睡眠和快速眼动睡眠阶段减少，因此可能无法提供与自然睡眠相同的恢复特性。机械通气是 ICU 患者睡眠中断的一个重要原因，不仅可能因气管插管的不适而导致睡眠中断，而且如果没有根据患者的生理需求进行适当调整，还可能因无效的呼吸努力以及诱发中枢性呼吸暂停事件而导致睡眠中断。如果可能，应努力优化患者与呼吸机的相互作用，以尽量减少睡眠中断。
Delirium and poor sleep quality are common and often co-exist in hospitalized patients. A link between these disorders has been hypothesized but whether this link is a cause and effect relationship or simply an association resulting from shared mechanisms is yet to be determined. Potential shared mechanisms include: abnormalities of neurotransmitters, tissue ischemia, inflammation, and sedative exposure. Sedatives, while decreasing sleep latency, often cause a decrease in slow wave sleep and stage REM sleep and therefore may not provide the same restorative properties as natural sleep. Mechanical ventilation, an important cause of sleep disruption in ICU patients, may lead to sleep disruption not only from the discomfort of the endotracheal tube but also as a result of ineffective respiratory efforts and by inducing central apnea events if not properly adjusted for the patient’s physiologic needs. When possible, efforts should be made to optimize the patient-ventilator interaction to minimize sleep disruptions.