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

项目总结 重症监护病房(ICU)中超过三分之一的患者出现ICU妄想，这是一种急性、波动的形式。 认知功能障碍与死亡率增加以及ICU住院时间和天数的延长有关 机械通风；并不成比例地增加长期认知障碍的风险。被扰乱 在ICU中的睡眠被认为是导致ICU精神错乱的原因，然而睡眠中的精神错乱 这种关系还没有得到严格的调查。尽管ICU患者每天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，快速眼球运动明显减少。 (REM)睡眠与健康成年人相比。快速眼动睡眠不足与神经退行性变有关 痴呆症等疾病，具有与ICU精神错乱相似的特征。较少的快速眼动睡眠 在有昏迷的患者中观察到，与没有ICU的患者相比，虽然暂时性尚不清楚。到目前为止，几乎没有人 已有研究调查了ICU神志不清发生前的睡眠情况，但没有一项研究能解释客观原因。 基线睡眠。我们提出了一种新的方法来解决这些关键差距，通过利用 胸外科候选人，术后有ICU入院计划，以便进行基线睡眠评估。 研究：K99阶段研究将评估临床和人口学预测因素 电子健康回顾中急性ICU阶段(1至14天)的ICU精神错乱或昏迷(DoDC) 宾夕法尼亚大学卫生系统(UPHS)胸科手术患者(N=4849)的记录研究 从2015年到现在。由于在ICU中不进行常规的睡眠评估，因此不可能从 医疗记录。因此，我们将首先确定ICU精神错乱的非睡眠预测因素，然后才能评估 如果在未来的研究中测量的睡眠指数可以解释ICU精神错乱的大部分差异，而不是 这是由非睡眠预测者解释的。R00阶段研究将评估平均分钟数的差异 在一项前瞻性观察队列研究中，有无ICU妄想的患者的每晚快速眼动睡眠 来自UPHS的胸外科候选人(N=148)。睡眠将通过无线方式进行评估 分别于术前(ICU前)和术后(ICU)行脑电检查，每次3天。在一个子集中 R00队列(N=20)，将评估由于ICU环境而从睡眠中唤醒的频率。 这些研究的结果将被用于为未来促进睡眠的干预措施的发展提供信息。 培训：为了实现总体职业目标，培训计划将建立在候选人的 通过为她提供深入的临床睡眠知识培训，为健康人提供危重护理和睡眠 和ICU人群，以及关于ICU精神错乱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，以及发展这些技能 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作业、实践培训和结构化的一对一指导。

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.