Circadian rest-activity misalignment in critically ill medical intensive care unit patients.
Circadian rest-activity misalignment in critically ill medical intensive care unit patients.
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DOI：
10.1111/jsr.13587
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发表时间：
2022-10
影响因子：
4.4
通讯作者：
Kamdar BB
中科院分区：
文献类型：
--
作者：
Gupta P;Martin JL;Malhotra A;Bergstrom J;Grandner MA;Kamdar BB
静息-活动节律的昼夜调整是一个重要的生物学过程，在危重患者中可能容易发生失调。我们评估了危重患者的昼夜休息-活动节律及其与基线的相关性（例如，年龄）和临床（例如，机械通气状态）变量，沿着ICU明暗周期。使用腕关节活动记录仪，我们收集了三级医疗ICU（MICU）重症患者的48小时活动和光照数据。我们使用COSINOR和非参数昼夜节律分析（NPCRA）模型评估了昼夜休息-活动节律，并将这些数据在基线和临床变量中分层。我们使用线性回归来评估昼夜休息活动和光暗暴露节律的关联。在COSINOR和NPCRA分析中，完成48小时体动记录的34名MICU患者表现出平均MESOR（拟合曲线的平均活动水平）和幅度为0.50±0.32和0.20±0.19次运动/30秒，具有较高的日间变异性。年龄较大、机械通气、镇静、限制和器官衰竭评分较高的患者倾向于表现出更大的昼夜休息-活动失调，34例患者中有3例（9%）没有昼夜节律。还观察到昼夜光暗暴露不对准，并且与休息-活动不对准相关（p = 0.03）。我们的MICU中的危重患者经历了严重的昼夜休息-活动失调，大多数节律微弱或缺失，沿着昼夜光暗暴露失调。导致休息-活动不一致的潜在可修改因素（即，机械通风系统、安全带、日间光线不足等问题，都是未来改善工作的重点。
Circadian alignment of rest-activity rhythms is an essential biological process that may be vulnerable to misalignment in critically ill patients. We evaluated circadian rest-activity rhythms in critically ill patients and their association with baseline (e.g., age) and clinical (e.g., mechanical ventilation status) variables, along with ICU light-dark cycles. Using wrist actigraphy, we collected 48-hour activity and light exposure data from critically ill patients in a tertiary care medical ICU (MICU). We evaluated circadian rest-activity rhythms using COSINOR and non-parametric circadian rhythm analysis (NPCRA) models and stratified these data across baseline and clinical variables. We used linear regression to evaluate the association of circadian rest-activity and light-dark exposure rhythms. In COSINOR and NPCRA analyses, the 34 MICU patients completing 48-hour actigraphy recordings exhibited mean MESOR (mean activity levels of a fitted curve) and amplitudes of 0.50±0.32 and 0.20±0.19 movements per 30-second epoch, with high interdaily variability. Patients who were older, mechanically ventilated, sedated, restrained and with higher organ failure scores tended to exhibit greater circadian rest-activity misalignment, with three of 34 (9%) patients exhibiting no circadian rhythmicity. Circadian light-dark exposure misalignment was observed as well and was associated with rest-activity misalignment (p = 0.03). Critically ill patients in our MICU experienced profound circadian rest-activity misalignment, with mostly weak or absent rhythms, along with circadian light-dark exposure misalignment. Potentially modifiable factors contributing to rest-activity misalignment (i.e., mechanical ventilation, restraints, low daytime light levels) highlight possible targets for future improvement efforts.
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DOI：
10.4037/ajcc2017660
发表时间：
2017-07
期刊：
American journal of critical care : an official publication, American Association of Critical-Care Nurses
影响因子：
--
作者：
Kamdar BB;Kadden DJ;Vangala S;Elashoff DA;Ong MK;Martin JL;Needham DM
通讯作者：
Needham DM
影响因子：
2.8
作者：
Mitchell JA;Quante M;Godbole S;James P;Hipp JA;Marinac CR;Mariani S;Cespedes Feliciano EM;Glanz K;Laden F;Wang R;Weng J;Redline S;Kerr J
通讯作者：
Kerr J
DOI：
10.1186/cc10000
发表时间：
2011-03-22
期刊：
Critical care (London, England)
影响因子：
--
作者：
Castro R;Angus DC;Rosengart MR
通讯作者：
Rosengart MR
影响因子：
4.1
作者：
Figueiro, Mariana G.;Steverson, Bryan;Rea, Mark S.
通讯作者：
Rea, Mark S.
影响因子：
2.8
作者：
Gupta, Prerna;Martin, Jennifer L.;Kamdar, Biren B.
通讯作者：
Kamdar, Biren B.