Is there an association between subjective sleep quality and daily delirium occurrence in critically ill adults? A post hoc analysis of a randomised controlled trial.
Is there an association between subjective sleep quality and daily delirium occurrence in critically ill adults? A post hoc analysis of a randomised controlled trial.
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危重成人的主观睡眠质量与每日谵妄发生率之间是否存在关联？
DOI：
10.1136/bmjresp-2020-000576
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发表时间：
2020
影响因子：
4.1
通讯作者：
Skrobik,Yoanna
中科院分区：
文献类型：
--
作者：
Duprey,MatthewS;Devlin,JohnW;Skrobik,Yoanna
目的重症监护病房（ICU）中谵妄和睡眠质量是否以及如何联系尚不清楚。最近的一项随机试验报告夜间低剂量右美托咪定（DEX）可显著降低ICU谵妄事件。干预组（DEX; n=50）和对照组（安慰剂（PLA）; n = 50）的利兹睡眠评估问卷（LSEQ）评分相似。我们测量了早晨LSEQ和之前24小时内谵妄发生率之间的关系（回顾性分析）以及早晨LSEQ与随后24小时内谵妄发生率之间的相关性随机对照试验数据的设计事后分析。使用重症监护谵妄筛查检查表（ICDSC），对100名ICU成人患者进行谵妄筛查，每天两次如果里士满躁动镇静量表（RASS）≥−3，如果RASS ≥− 1，则每天09：00用LSEQ进行患者报告的睡眠质量评估。结果分析包括所有24小时研究期间的LSEQ记录和无昏迷患者的匹配谵妄筛查。单独的logistic回归模型控制年龄，基线急性生理学和慢性健康评估II评分和DEX/PLA分配评估之间的关联早晨LSEQ和谵妄发生的回顾性和预测性analysis.ResultsThe 100例患者花了1115 24小时期间在ICU。昏迷130例（11.7%），谵妄114例（10.2%），无谵妄871例（78.1%）。在回顾性分析中，当LSEQ结果之前是ICDSC结果时（439/985（44.6%）24小时周期），41/439（9.3%）周期内发生谵妄。在回归分析中，LSEQ评分与既往谵妄发生无关（OR（每1分平均LSEQ变化）0.97，95% CI 0.72 - 1.31）。对于预测性分析，在LSEQ结果之后是ICDSC结果的387/985（39.1%）个24小时期间，56/387（14.5%）个期间发生谵妄。在回归分析中，LSEQ评分不能预测随后的谵妄发生（OR（每1点LSEQ变化）1.02，95%CI 0.99至1.05）。
ObjectivesWhether and how delirium and sleep quality in the intensive care unit (ICU) are linked remains unclear. A recent randomised trial reported nocturnal low-dose dexmedetomidine (DEX) significantly reduces incident ICU delirium. Leeds Sleep Evaluation Questionnaire (LSEQ) scores were similar between intervention (DEX; n=50) and control (placebo (PLA); n=50) groups. We measured the association between morning LSEQ and delirium occurrence in the prior 24 hours (retrospective analysis) and the association between morning LSEQ and delirium occurrence in the following 24 hours (predictive analysis).DesignPost hoc analysis of randomised controlled trial data.ParticipantsAdult ICU patients (n=100) underwent delirium screening twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) if Richmond Agitation Sedation Scale (RASS) was ≥−3 and patient-reported sleep quality evaluations at 09:00 daily with the LSEQ if RASS was ≥−1.OutcomesThe analysis included all 24-hour study periods with LSEQ documentation and matched delirium screening in coma-free patients. Separate logistic regression models controlling for age, baseline Acute Physiology and Chronic Health Evaluation II score and DEX/PLA allocation evaluated the association between morning LSEQ and delirium occurrence for both retrospective and predictive analyses.ResultsThe 100 patients spent 1115 24-hour periods in the ICU. Coma, delirium and no delirium occurred in 130 (11.7%), 114 (10.2%) and 871 (78.1%), respectively. In the retrospective analysis, when an LSEQ result was preceded by an ICDSC result (439/985 (44.6%) 24-hour periods), delirium occurred during 41/439 (9.3%) periods. On regression analysis, the LSEQ score had no relationship to prior delirium occurrence (OR (per every 1 point average LSEQ change) 0.97, 95% CI 0.72 to 1.31). For the predictive analysis, among the 387/985 (39.1%) 24-hour periods where an LSEQ result was followed by an ICDSC result, delirium occurred during 56/387 (14.5%) periods. On regression analysis, the LSEQ score did not predict subsequent delirium occurrence (OR (per 1 point LSEQ change) 1.02, 95% CI 0.99 to 1.05).ConclusionsThe sleep quality ICU patients perceive neither affects nor predicts delirium occurrence.Trial registration numberNCT01791296