Sleep in critically ill patients requiring mechanical ventilation
Sleep in critically ill patients requiring mechanical ventilation
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DOI：
10.1378/chest.117.3.809
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发表时间：
2000-03-01
期刊：
影响因子：
9.6
通讯作者：
Hanly, PJ
中科院分区：
文献类型：
--
作者：
Cooper, AB;Thornley, KS;Hanly, PJ
研究目的：客观地测量需要机械通气的危重患者的睡眠，并为今后研究这一人群的睡眠连续性确定选择标准。设计：前瞻性队列分析。单位：大学教学医院内科-外科ICU。患者：20例危重患者（APACHE II[急性生理和慢性健康评估II]急性生理储存[APS]， 10 +/- 5），机械通气成人（男性12人，女性8人，年龄62 +/- 15岁），轻至中度急性肺损伤（肺损伤评分1.8 +/- 0.9），入住ICU后10 +/- 7天。测量和结果：根据24小时多导睡眠图（PSG）结果将患者分为三组。没有患者表现出正常的睡眠。在“睡眠中断”组（n = 8）中，确定了电生理睡眠，并将其分布在白天（6:00 AM至10:00 PM； 4.0 +/- 2.9 h）和夜间(10:00 PM至6:00 AM；夜间睡眠效率严重降低（38 +/- 24%），第1阶段NREM睡眠比例增加（40 +/- 28%总睡眠时间[TST]），快速眼动睡眠比例减少（10 +/- 14% TST），严重的睡眠碎片化表现为高频率的唤醒（20 +/- 17/h）和觉醒（22 +/- 25/h）。在其余患者的PSG记录中未发现电生理睡眠。这些人要么被归类为“非典型睡眠”（n = 5），其特征是从第一阶段非快速眼动睡眠过渡到慢波睡眠，实际上没有第二阶段非快速眼动睡眠和减少的快速眼动睡眠阶段；要么被归类为“昏迷”（n = 7），其特征是有（n = 5）和没有（n = 2）脑电图自发激活或响应深度疼痛刺激的证据。与睡眠中断组相比，非典型睡眠和昏迷联合组APS （13 +/- 4 vs 6 +/- 4）和镇静药物剂量更高。结论：睡眠，正如传统测量的那样，只在需要机械通气的危重患者亚组中被确定，并且严重中断。我们提出了特定的标准来选择患者进行未来的研究，以评估这种情况下睡眠中断的潜在原因；人口。
Study objectives: To objectively measure sleep in critically ill patients requiring mechanical ventilation and to define selection criteria for future studies of sleep continuity in this population.Design: Prospective cohort analysis.Setting: University teaching hospital medical-surgical ICU.Patients: Twenty critically ill (APACHE II [acute physiology and chronic health evaluation II] acute physiology store [APS], 10 +/- 5), mechanically, ventilated adults (male 12, female 8, age 62 +/- 15 years) with mild to moderate acute lung injury (lung injury score, 1.8 +/- 0.9) 10 +/- 7 days after admission to the ICU.Measurements and results: Patients were divided into three groups based on 24-h polysomnography (PSG) findings. No patient demonstrated normal sleep. In the "disrupted sleep" group (n = 8), electrophysiologic sleep was identified and was distributed throughout the day (6:00 AM to 10:00 PM; 4.0 +/- 2.9 h) and night (10:00 PM to 6:00 AM; 3.0 +/- 1.9 h) with equivalent proportions of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, Nocturnal sleep efficiency was severely reduced (38 +/- 24%) with an increased proportion of stage 1 NREM sleep (40 +/- 28% total sleep time [TST]) and a reduced proportion of REM sleep (10 +/- 14% TST), Severe sleep fragmentation was reflected by a high frequency of arousals (20 +/- 17/h) and awakenings (22 +/- 25/h), Electrophysiologic sleep was not identifiable in the PSG recordings of the remaining patients. These were classified either as "atypical sleep" (n = 5), characterized bu transitions from stage 1 NREM to slow wave sleep with a virtual absence of stage 2 NREM and reduced stage REM sleep, or "coma" (n = 7), characterized by > 50% delta or theta EEG activity with (n = 5) and without (n = 2) evidence of EEG activation either spontaneously or in response to deep painful stimuli, The combined atypical sleep and coma groups had a higher APS (13 +/- 4 vs 6 +/- 4) and higher doses of sedative medications than the disrupted sleep group.Conclusion: Sleep, as it is conventionally measured, was identified only in a subgroup of critically ill patients requiring mechanical ventilation and was severely disrupted. We have proposed specific criteria to select patients for future studies to evaluate potential causes of sleep disruption in this; population.