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

评估睡眠在重症监护病房谵妄发生中的作用

• 批准号: 10843392
• 负责人: Makayla Cordoza
• 金额: $ 24.9万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10843392
• 关键词: APACHE II; Acute; Address; Admission activity; Adrenal Cortex Hormones; Adult; Age; Agitation; Alcohol abuse; American; Award; Benzodiazepines; Cardiac Surgery procedures; Characteristics; Clinical; Coma; Communities; Complex; Critical Care; Critical Illness; Data; Delirium; Dementia; Demographic Factors; Development; Disease; Disorientation; Electroencephalography; Electronic Health Record; Environment; Environmental Risk Factor; Evaluation; Event; Frequencies; Future; Goals; Health system; Heart; Home; Hour; Hypertension; Hypotension; Impaired cognition; Incidence; Individual; Intensive Care Units; Intervention; Learning; Length of Stay; Lighting; Link; Lung Transplantation; Measures; Mechanical ventilation; Medical Records; Memory impairment; Mentorship; Morbidity - disease rate; Neurocognitive; Neurodegenerative Disorders; Noise; Operative Surgical Procedures; Outcome; Patient Care; Patients; Pennsylvania; Phase; Physiological; Polysomnography; Population; Postoperative Period; Predictive Factor; Public Health; REM Sleep; Research; Research Personnel; Risk; Risk Factors; Role; Scientific Advances and Accomplishments; Sedation procedure; Sleep; Sleep Apnea Syndromes; Sleep Architecture; Sleep Deprivation; Sleep disturbances; Structure; Survivors; Symptoms; Testing; Thoracic Surgical Procedures; Time; Training; Universities; adequate sleep; career; clinical care; cognitive function; cohort; common symptom; confusion assessment method; experience; human old age (65+); improved; improvement on sleep; inattention; indexing; modifiable risk; mortality; neurochemistry; novel strategies; observational cohort study; patient oriented; predictive modeling; primary outcome; programs; prospective; skill acquisition; skills; sleep quality; wireless

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.

项目概要 重症监护病房 (ICU) 中超过三分之一的患者出现 ICU 谵妄，这是一种急性的、波动性的形式 认知功能障碍与死亡率增加、ICU 住院时间和住院天数延长有关 机械通气；并且不成比例地增加长期认知障碍的风险。被破坏 ICU 中的睡眠被认为会导致 ICU 谵妄的发生，然而，睡眠-谵妄 关系尚未经过严格调查。尽管 ICU 患者每天都能保持充足的睡眠时间 24小时，睡眠结构被严重扰乱。即，快速眼球运动明显减少 与健康成年人相比，快速眼动睡眠 (REM) 睡眠。快速眼动睡眠不足与神经退行性疾病有关 痴呆症等疾病，与 ICU 谵妄症具有相似的特征。快速眼动睡眠时间减少 与没有 ICU 的谵妄患者相比，在患有谵妄的患者中观察到这一现象，尽管暂时性尚不清楚。迄今为止，很少有 研究调查了 ICU 谵妄发生前的睡眠情况，但没有研究能够客观解释 基线睡眠。我们提出了一种新方法，通过利用人口来解决这些关键差距 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预测因素的天数百分比 回顾性电子健康记录中 ICU 急性期（第 1 至 14 天）的 ICU 谵妄或昏迷 (DoDC) 宾夕法尼亚大学医疗系统 (UPHS) 的胸外科患者 (N=4,849) 的记录研究 从2015年至今。由于 ICU 中不定期评估睡眠，因此无法评估睡眠 医疗记录。因此，我们将首先确定 ICU 谵妄的非睡眠预测因素，然后才能评估 如果未来研究中测量的睡眠指数能够解释 ICU 谵妄的很大一部分差异，则不能 由非睡眠预测因子来解释。 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，有或没有 ICU 谵妄患者每晚的快速眼动睡眠 来自 UPHS 的胸外科候选人 (N=148)。将使用无线评估睡眠 基线时（ICU 前）和术后 ICU 各进行 3 天脑电图检查。在一个子集中 在 R00 队列 (N=20) 中，将评估由于 ICU 环境而从睡眠中醒来的频率。 这些研究的结果将用于为未来促进睡眠干预措施的开发提供信息。 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之上 通过为她提供临床睡眠方面的深入培训，为健康人提供重症监护和睡眠 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发展 需要成为科学界的领导者。将采用多种方法来实现这些目标 目标包括正式课程、实践培训和结构化的一对一指导。