Feasibility of Measuring Sleep in a Critical Care Environment

描述（由申请人提供）：睡眠是一项基本的生物功能，具有生理、行为和时间特征。它受体内平衡和昼夜节律过程的调节。在过去的几年里，人们对睡眠的重要性和睡眠不足的负面影响的认识呈指数级增长。尽管在美国，每年约有570万成年人在重症监护病房（ICU）接受治疗，尽管人们越来越意识到睡眠在ICU的潜在重要性，但关于睡眠的本质、睡眠中断的预测因素和后果以及促进睡眠干预对危重患者的效果等许多问题仍未得到解答。具体目标1：确定在医疗重症监护病房（MICU）患有呼吸衰竭需要机械通气的60岁及以上患者中获取24小时内高质量便携式多导睡眠图（PSG）数据的可行性。可行性将由三个部分组成：1。危重病人PSG的患者、家属及护理接受程度。2. 能够在MICU对机械通气患者进行24小时便携式PSG。3. 能够获得脑电图数据来检查睡眠潜伏期，睡眠阶段和睡眠持续时间。具体目标2：描述60岁及以上接受机械通气的呼吸衰竭患者24小时内睡眠中断的严重程度。为了产生假设，我们将跟踪可能导致睡眠中断的诱发因素和促成因素。具体目标3：描述60岁及以上接受机械通气的呼吸衰竭患者24小时内的睡眠结构和睡眠分布。睡眠中断已被证明对免疫功能、葡萄糖代谢和认知功能有重要影响，所有这些都可能导致危重疾病的不良预后。更重要的是，在重症监护病房，睡眠是一个潜在的可改变因素。一旦收集到准确的睡眠数据，我们就可以开始研究睡眠中断、睡眠阶段的变化和昼夜节律的改变是如何影响包括谵妄在内的重症监护结果的。在这项初步研究中获得的信息也将有助于设计研究，以检查危重疾病中睡眠中断的诱发和促成风险因素，以及使用镇静催眠药物对睡眠模式的影响。公共卫生相关性：美国每年有570万成年人住进重症监护病房（ICU），人们对ICU中睡眠的影响知之甚少。本研究的目的是探讨使用便携式多导睡眠图研究ICU收治的需要机械通气的老年患者睡眠的可行性。本研究的最终目标是更好地了解导致重症患者睡眠受损的因素，睡眠对ICU护理结果的重要性，并制定干预措施以促进重症护理环境中的睡眠。

DESCRIPTION (provided by applicant): Sleep is an essential biological function that has physiological, behavioral and temporal characteristics. It is regulated by homeostatic and circadian processes. The knowledge of the importance of sleep and the adverse effects of sleep deprivation has grown in an exponential manner over the last few years. Although approximately 5.7 million adults are cared for in an intensive care unit (ICU) annually in the U.S, and despite the growing awareness of the potential importance of sleep in the ICU, many questions about the nature of sleep, the predictors and consequences of sleep disruption and the efficacy of sleep promoting interventions in critically ill patients remain unanswered. This grant proposes the following Specific Aims: Specific Aim 1: Determine feasibility of acquiring high quality portable polysomnographic (PSG) data over a 24-hour period among patients age 60 and older in the medical intensive care unit (MICU) who have respiratory failure requiring mechanical ventilation. Feasibility will consist of three components: 1. Patient, family and nursing acceptance of PSG in critically ill patients. 2. Ability to perform a 24-hour portable PSG in mechanically ventilated patients in the MICU. 3. Ability to obtain EEG data to examine sleep latency, sleep stages, and sleep duration. Specific Aim 2: Describe the severity of sleep disruption over a 24-hour period among patients age 60 and older admitted with respiratory failure who are mechanically ventilated. For the purpose of hypothesis generation we will track both predisposing and precipitating factors which may contribute to sleep disruption. Specific Aim 3: Describe sleep architecture and the distribution of sleep over a 24-hour period among patients age 60 and older admitted with respiratory failure who are mechanically ventilated. Sleep disruption has been shown to have important effects on immune function, glucose metabolism and cognitive function, all of which may contribute to poor outcomes from critical illness. More importantly sleep is a potentially modifiable factor in the intensive care unit. Once accurate sleep data is collected we can begin to examine how sleep disruption, shifts in sleep stages, and alterations in circadian rhythms impact critical care outcomes including delirium. The information obtained in this pilot study will also be useful for designing studies that examine predisposing and precipitating risk factors for sleep disruption in critical illness and the effect of using sedative-hypnotic medications on sleep patterns. PUBLIC HEALTH RELEVANCE: There are 5.7 million adults admitted to intensive care units (ICU) each year in the U.S. Little is known about the impact of sleep in the ICU. The goal of the study is to examine the feasibility of using portable polysomnography to study sleep in older patients admitted to a medical ICU who require mechanical ventilation. The ultimate goal of this research is to better understand factors which lead to impaired sleep in critical illness, the importance of sleep on outcomes from ICU care and to develop interventions to promote sleep in a critical care environment.