A meta-analysis of sleep-promoting interventions during critical illness.
A meta-analysis of sleep-promoting interventions during critical illness.
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对促进睡眠的干预措施的荟萃分析。
DOI：
10.1016/j.amjmed.2015.05.026
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发表时间：
2015-10
期刊：
影响因子：
--
通讯作者：
Parthasarathy S
中科院分区：
文献类型：
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作者：
Poongkunran C;John SG;Kannan AS;Shetty S;Bime C;Parthasarathy S
接受机械通气的重症患者的睡眠质量和数量严重降低，可能会产生不良后果。我们的目的是综合随机对照试验（RCT），衡量睡眠促进干预措施对危重患者睡眠质量和数量的有效性。我们纳入了通过脑电图或其衍生物客观测量睡眠的RCT，排除了观察性研究和通过主观报告测量睡眠的研究。该研究根据PRISMA指南进行。在确定的6，022项研究中，13项研究符合资格标准，涉及296名危重患者。8项试验将不同模式的机械通气作为睡眠干预措施，其余5项涉及药物，非药物或环境干预。研究的荟萃分析显示，促进睡眠的干预措施通过减少睡眠碎片（SMD-0.31; 95%CI-0.60，-0.01; P= 0.04）改善了睡眠量（合并标准化差异均值[SMD] 0.37，95%CI：0.05，0.69; P= 0.02）和睡眠质量。亚组分析显示，与自主通气模式相比，定时通气模式改善了睡眠质量（SMD 0.45，95%CI 0.10，0.81; P=0.01）。非机械通气干预倾向于改善睡眠质量（SMD 0.65; 95%CI; −0.03，1.33; P=0.06），并倾向于减少睡眠碎片（SMD −0.29; 95%CI −0.61，0.03; P=0.07）。综合证据表明，机械通气和非机械通气为基础的治疗都可以改善危重患者的睡眠数量和质量，但临床意义尚不清楚。在未来，有足够的动力多中心随机对照试验，涉及药物干预，以促进重症患者的睡眠是必要的。
Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients. We included RCTs that objectively measured sleep with electroencephalography or its derivatives and excluded observational studies and those that measured sleep by subjective reports. The research was performed according to PRISMA guidelines. Of 6,022 studies identified, 13 studies met eligibility criteria involving 296 critically-ill patients. Eight trials looked at different modes of mechanical ventilation as sleep interventions, and the remaining five involved pharmacological, non-pharmacological, or environmental interventions. Meta-analysis of the studies revealed that sleep-promoting interventions improved sleep quantity (pooled standardized mean of differences [SMD] 0.37, 95%CI: 0.05, 0.69; P=0.02) and sleep quality through reduction in sleep fragmentation (SMD −0.31; 95%CI −0.60, −0.01; P=0.04). Subgroup analysis revealed that timed-modes of ventilation improved sleep quantity when compared to spontaneous-modes of ventilation (SMD 0.45, 95%CI 0.10, 0.81; P=0.01). Non-mechanical ventilation interventions tended to improve sleep quantity (SMD 0.65; 95%CI; −0.03, 1.33; P=0.06) and tended to reduce sleep fragmentation (SMD −0.29; 95% CI −0.61, 0.03; P=0.07). The synthesized evidence suggests that both mechanical ventilation and non-mechanical ventilation-based therapies improve sleep quantity and quality in critically ill patients but the clinical significance is unclear. In the future, adequately-powered multi-center RCTs involving pharmacological interventions to promote sleep in critically ill patients are warranted.