Evaluating the Role of Sleep in the Development of Intensive Care Unit Delirium

项目摘要 超过三分之一的重症监护室（ICU）患者发生ICU谵妄，一种急性波动形式 认知功能障碍与死亡率增加、ICU住院时间延长和 机械通气;并且不成比例地增加长期认知障碍的风险。打乱 ICU中的睡眠被认为有助于ICU谵妄的发展，然而， 这种关系没有得到严格的调查。尽管ICU患者保持充足的睡眠时间， 24小时，睡眠结构被严重破坏。也就是说，快速眼动明显减少， (REM)与健康成年人相比，快速眼动睡眠不足与神经退行性疾病有关。 例如痴呆症，其具有与ICU谵妄相似的特征。快速眼动睡眠减少 在有ICU谵妄的患者中观察到，与没有ICU谵妄的患者相比，尽管时间性尚不清楚。迄今为止， 已有研究调查了ICU谵妄发生前的睡眠情况，但没有研究说明客观的 基线睡眠我们提出了一种新的方法来解决这些关键的差距，利用人口 胸外科候选人，计划术后入住ICU，以进行基线睡眠评估。 研究：K99阶段研究将评估临床和人口统计学预测因素， 回顾性电子健康研究中急性ICU阶段（第1天至第14天）的ICU谵妄或昏迷（DoDC） 宾夕法尼亚大学卫生系统（UPHS）胸外科患者（N= 4，849）的记录研究 2015年至今。由于ICU中没有对睡眠进行常规评估，因此不可能从 医疗记录因此，我们将首先确定ICU谵妄的非睡眠预测因子，然后能够评估 如果在未来的研究中测量的睡眠指数解释了ICU谵妄的很大一部分变异， 非睡眠预测因素。R 00阶段研究将评价 在一项前瞻性观察性队列研究中，有和无ICU谵妄的患者每晚的REM睡眠 来自UPHS的胸外科候选人（N=148）。睡眠将通过无线网络进行评估。 基线（ICU前）和术后ICU各3天的脑电图。的子集中 在R 00队列（N=20）中，将评估ICU环境导致的睡眠觉醒频率。 这些研究的结果将用于为未来的睡眠促进干预措施提供信息。 培训：为了实现总体职业目标，培训计划将建立在候选人的背景上， 重症监护和睡眠在健康的人，通过提供她在学习睡眠的临床深入培训， 和ICU人群，以及ICU谵妄机制的培训和预测模型的开发。这 培训还将包括提高她的科学传播技能，以及技能的发展， 需要成为科学界的领导者将使用各种方法来实现这些目标 目标包括正式的课程，动手训练，和结构化的一对一的指导。

PROJECT SUMMARY More than one third of patients in the intensive care unit (ICU) develop ICU delirium, an acute, fluctuating form of cognitive dysfunction that is associated with increased mortality, and longer ICU lengths of stay and days of mechanical ventilation; and disproportionately increases the risk for long-term cognitive impairment. Disrupted sleep in the ICU is thought to contribute to development of ICU delirium, however the sleep-delirium relationship has not been rigorously investigated. Although ICU patients maintain adequate sleep duration per 24 hours, sleep architecture is severely disrupted. Namely, there is a marked decrease in rapid eye movement (REM) sleep compared to healthy adults. Insufficient REM sleep has been associated with neurodegenerative disease such as dementia, which has similar characteristics to ICU delirium. Less REM sleep has been observed in patients with, compared to without ICU delirium, although the temporality is unclear. To date, few studies have investigated sleep prior to development of ICU delirium, and no studies account for objective baseline sleep. We propose a novel approach to address these critical gaps by leveraging a population of thoracic surgery candidates with a planned post-operative ICU admission to enable baseline sleep evaluation. Research: The K99 phase study will evaluate clinical and demographic predictors of percentage of days with ICU delirium or coma (DoDC) in the acute ICU phase (days 1 up to 14) in a retrospective electronic health record study of thoracic surgery patients (N=4,849) at the University of Pennsylvania Health System (UPHS) from 2015-present. As sleep is not routinely assessed in the ICU, it is not possible to evaluate sleep from medical records. Therefore, we will first identify non-sleep predictors of ICU delirium to then be able to evaluate if sleep indices measured in future studies explains a substantial percentage of the variance in ICU delirium not accounted for by non-sleep predictors. The R00 phase study will evaluate the difference in mean minutes of REM sleep per night for patients with and without ICU delirium in a prospective observational cohort study of thoracic surgery candidates from UPHS (N=148). Sleep will be assessed using wireless electroencephalography at baseline (pre-ICU), and post-operatively in the ICU for 3 days each. In a subset of the R00 cohort (N=20), frequency of awakenings from sleep due to the ICU environment will be assessed. Results from these studies will be used to inform development of future sleep-promoting interventions. Training: To achieve overall career goals, the training plan will build upon the candidate’s background in critical care and sleep in healthy individuals by affording her in-depth training in learning about sleep in clinical and ICU populations, and training in ICU delirium mechanisms and development of predictive models. This training will also include advancing her scientific dissemination skills, as well as development of the skills needed to become a leader in the scientific community. A variety of approaches will be used to achieve these goals including formal coursework, hands-on training, and structured one-on-one mentorship.