Assessment of Sleep in Ventilator-Supported Critically III Patients
Assessment of Sleep in Ventilator-Supported Critically III Patients
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DOI：
10.1093/sleep/31.11.1559
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发表时间：
2008-11-01
期刊：
影响因子：
5.6
通讯作者：
Parthasarathy, Sairam
中科院分区：
文献类型：
--
作者：
Ambrogio, Cristina;Koebnick, Jeffrey;Parthasarathy, Sairam
目的：在危重患者中，使用Rechtschaffen和Kales （R&K）方法报道了严重的睡眠紊乱；然而，这种方法是否可以可靠地评估危重疾病期间的睡眠是未知的。我们着手确定4种不同睡眠评估方法（3种手动方法和1种基于计算机的方法）对呼吸机支持的危重患者的可重复性，并量化用于测量危重患者和门诊（对照）患者睡眠的手动方法的可重复性的差异程度。设计：观察性方法学研究。环境：学术中心。患者：接受机械通气的危重患者和年龄匹配的对照组接受多导睡眠描记术。干预措施:没有。测量与结果：基于计算机的方法（脑电图谱分析[EEG]）的重现性优于手工方法（R&K方法和睡眠-觉醒组织模式）（P = 0.03）。在危重患者中，使用频谱分析、睡眠-觉醒组织模式和R&K方法测量的错误分类比例分别为0%、36%和53% （P < 0.0001）。未观察到爆发抑制的脑电图模式。危重患者手工睡眠评估方法的观察者间和观察者内信度（kappa = 0.52 +/- 0.23）均低于对照组（kappa = 0.89 +/- 0.13; P = 0.03）。在危重患者中，R&K方法评估睡眠的总体可靠性相对较低（kappa = 0.19），但快速眼动睡眠的检测显示出良好的一致性（kappa = 0.70）。结论：脑电图频谱分析的再现性优于手工方法：R&K方法和睡眠-觉醒组织模式，对于危重患者的睡眠评估，使用频谱分析、睡眠-觉醒组织状态或单独使用快速眼动睡眠可能优于R&K方法。
Objectives: In critically ill patients, sleep derangements are reported to be severe using Rechtschaffen and Kales (R&K) methodology; however, whether such methodology can reliably assess sleep during critical illness is unknown. We set out to determine the reproducibility of 4 different sleep-assessment methods (3 manual and 1 computer-based) for ventilator-supported critically ill patients and also to quantify the extent to which the reproducibility of the manual methods for measuring sleep differed between critically ill and ambulatory (control) patients.Design: Observational methodologic study.Setting: Academic center.Patients: Critically ill patients receiving mechanical ventilation and age-matched controls underwent polysomnography.Interventions: None.Measurements and Results: Reproducibility for the computer-based method (spectral analysis of electroencephalography [EEG]) was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern (P = 0.03). In critically ill patients, the proportion of misclassifications for measurements using spectral analysis, sleep-wakefulness organization pattern, and R&K methodology were 0%, 36%, and 53%, respectively (P < 0.0001). The EEG pattern of burst suppression was not observed. Interobserver and intraobserver reliability of the manual sleep-assessment methods for critically ill patients (kappa = 0.52 +/- 0.23) was worse than that for control patients (kappa = 0.89 +/- 0.13; P = 0.03). In critically ill patients, the overall reliability of the R&K methodology was relatively low for assessing sleep (kappa = 0.19), but detection of rapid eye movement sleep revealed good agreement (kappa = 0.70).Conclusions: Reproducibility for spectral analysis of EEG was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern, For assessment of sleep in critically ill patients, the use of spectral analysis, sleep-wakefulness organization state, or rapid eye movement sleep alone may be preferred over the R&K methodology.