Shilo L, Dagan Y, Smorjik Y, Weinberg U, Dolev S, Komptel B, Balaum H, Shenkman L
Department of Medicine C, Meir Hospital, Sapir Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, Israel.
Am J Med Sci. 1999 May;317(5):278-81. doi: 10.1097/00000441-199905000-00002.
Patients hospitalized in the intensive care unit (ICU) tend to become agitated and confused, and many even develop temporary psychoses (the ICU syndrome). We wondered whether the regulation of sleep and the secretion of melatonin is abnormal in ICU patients. Therefore, we studied the association of sleep-wake pattern in patients hospitalized in the ICU, their melatonin secretion rates, and profile compared with a control group of patients in general medical wards.
Sleep was assessed by actigraphy. Urine was collected every 3 hours for 24 hours. Melatonin secretion was assessed by measuring the melatonin metabolite 6-sulphatoxymelatonin by enzyme-linked immunosorbent assay.
Actigraphy suggested that the ICU patients lacked normal sleep behavior for the entire study period, except for occasional short naps. Compared with controls, the nocturnal peak of melatonin secretion was absent, except in two patients in the nonventilated group, and showed a flat curve.
Our results suggest that lack of sleep is indeed a severe problem in ICU patients and is accompanied by impairment of normal melatonin secretion. The possibility that melatonin administration may prove useful in improving sleep patterns in ICU patients deserves further study.
入住重症监护病房（ICU）的患者往往会变得烦躁不安、意识模糊，许多人甚至会出现短暂性精神病（ICU综合征）。我们想知道ICU患者的睡眠调节和褪黑素分泌是否异常。因此，我们研究了ICU住院患者的睡眠-觉醒模式、褪黑素分泌率及其特征，并与普通内科病房的对照组患者进行了比较。
通过活动记录仪评估睡眠情况。每3小时收集一次尿液，共收集24小时。通过酶联免疫吸附测定法测量褪黑素代谢物6-硫酸氧褪黑素，评估褪黑素分泌情况。
活动记录仪显示，除偶尔有短暂小睡外，ICU患者在整个研究期间缺乏正常的睡眠行为。与对照组相比，除未通气组的两名患者外，褪黑素分泌的夜间高峰缺失，且呈平缓曲线。
我们的结果表明，睡眠不足确实是ICU患者面临的一个严重问题，并且伴有正常褪黑素分泌受损。给予褪黑素可能有助于改善ICU患者睡眠模式，这一可能性值得进一步研究。
