Sleep quality and circadian rhythm disruption in the intensive care unit: a review.
Sleep quality and circadian rhythm disruption in the intensive care unit: a review.
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DOI：
10.2147/nss.s151525
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发表时间：
2017
影响因子：
3.4
通讯作者：
Toft P
中科院分区：
文献类型：
--
作者：
Boyko Y;Jennum P;Toft P
据报道，危重病人的睡眠和昼夜节律严重异常。睡眠紊乱可导致谵妄的发展，因此，可能与在重症监护病房（ICU）的长时间停留和死亡率增加有关。多导睡眠图（polysomnography， PSG）是一种标准的睡眠评估方法，由于实践上的挑战和解释上的困难，在危重患者中应用起来很复杂。在ICU进行的多项PSG睡眠研究报告显示，许多危重患者缺乏正常的睡眠特征，使得标准的睡眠评分方法在该患者组中存在不足。Watson等人提出了危重患者睡眠评分的改进分类。这种分类尚未得到证实。重症监护病房的睡眠障碍是一个多因素问题。据报道，ICU环境、机械通气、药物治疗以及危重疾病本身都是重要的睡眠干扰因素。在危重患者中，表达昼夜节律的睡眠激素、褪黑素的分泌被发现被取消或延迟。在一些旨在改善ICU睡眠质量和昼夜节律的研究中，已经测试了各种干预措施。由于使用了除PSG以外的睡眠评估方法，或者缺乏可靠的睡眠评分工具来分析该患者群体的PSG结果，这些研究的结果尚无定论。建立有效的睡眠评分分类法对进一步开展危重患者睡眠研究至关重要。
Sleep and circadian rhythm are reported to be severely abnormal in critically ill patients. Disturbed sleep can lead to the development of delirium and, as a result, can be associated with prolonged stay in the intensive care unit (ICU) and increased mortality. The standard criterion method of sleep assessment, polysomnography (PSG), is complicated in critically ill patients due to the practical challenges and interpretation difficulties. Several PSG sleep studies in the ICU reported the absence of normal sleep characteristics in many critically ill patients, making the standard method of sleep scoring insufficient in this patient group. Watson et al proposed a modified classification for sleep scoring in critically ill patients. This classification has not yet been validated. Sleep disturbance in the ICU is a multifactorial problem. The ICU environment, mechanical ventilation, medication, as well as the critical illness itself have been reported as important sleep disturbing factors. Secretion of sleep hormone, melatonin, expressing circadian rhythmicity was found abolished or phase delayed in critically ill patients. Various interventions have been tested in several studies aiming to improve sleep quality and circadian rhythm in the ICU. The results of these studies were inconclusive due to using the sleep assessment methods other than PSG or the absence of a reliable sleep scoring tool for the analysis of the PSG findings in this patient population. Development of a valid sleep scoring classification is essential for further sleep research in critically ill patients.