Friese Randall S, Diaz-Arrastia Ramon, McBride Dara, Frankel Heidi, Gentilello Larry M
Division of Burn, Trauma, Critical Care, Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Texas, USA.
J Trauma. 2007 Dec;63(6):1210-4. doi: 10.1097/TA.0b013e31815b83d7.
The lack of adequate sleep during intensive care unit (ICU) admission is a frequently overlooked complication. Disrupted sleep is associated with immune system dysfunction, impaired resistance to infection, as well as alterations in nitrogen balance and wound healing. The effects of surgical ICU admission on patients' sleep quality and architecture remain poorly defined. The purpose of this study was to describe the quantity and quality of sleep as well as sleep architecture, as defined by polysomnography (PSG), in patients cared for in the surgical ICU.
A prospective observational cohort study was performed at our urban Level I trauma center. A convenience sample of surgical or trauma ICU patients underwent continuous PSG for up to 24 hours to evaluate sleep patterns. A certified sleep technician performed, monitored, and scored all PSG recordings. A single neurologist trained in PSG interpretation reviewed all PSG recordings. chi goodness-of-fit analysis was performed to detect differences in the proportion of time spent in stages 1 and 2 (superficial stages), stages 3 and 4 (deep stages), or rapid eye movement (REM) sleep between study patients and healthy historical controls. All PSG recordings were performed greater than 24 hours after the administration of a general anesthetic. Patients with traumatic brain injury were excluded.
Sixteen patients were selected to undergo PSG recordings. Median age was 37.5 years (range, 20-83), 81.3% were male patients, 62.5% were injured, and 31.3% were mechanically ventilated. Total PSG recording time was 315 hours (mean, 19.7 hours per patient), total sleep time captured by PSG was 132 hours (mean, 8.28 hours per patient), and there were 6.2 awakenings per hour of sleep measured. ICU patients had an increase in the proportion of time spent in the superficial stages of sleep, and a decrease in the proportion of time spent in the deeper stages of sleep as well as a decrease in REM sleep compared with healthy controls (p < 0.001).
Patients do achieve measurable sleep while cared for in a surgical ICU setting. However, sleep is fragmented and the quality of sleep is markedly abnormal with significant reductions in stages 3 and 4 and REM, the deeper restorative stages of sleep. Further studies on the effects of a strategy to promote sleep during ICU care are warranted.
重症监护病房（ICU）住院期间缺乏充足睡眠是一种常被忽视的并发症。睡眠中断与免疫系统功能障碍、抗感染能力受损以及氮平衡和伤口愈合改变有关。外科ICU住院对患者睡眠质量和睡眠结构的影响仍不明确。本研究的目的是描述外科ICU中接受治疗患者的睡眠数量和质量以及多导睡眠图（PSG）所定义的睡眠结构。
在我们城市的一级创伤中心进行了一项前瞻性观察队列研究。选取外科或创伤ICU患者的便利样本，进行长达24小时的连续PSG监测以评估睡眠模式。由一名经过认证的睡眠技术人员进行、监测并对所有PSG记录进行评分。一名接受过PSG解读培训的神经科医生对所有PSG记录进行审核。采用卡方拟合优度分析来检测研究患者与健康历史对照在睡眠第1和第2阶段（浅睡眠阶段）、第3和第4阶段（深睡眠阶段）或快速眼动（REM）睡眠中所花费时间比例的差异。所有PSG记录均在全身麻醉给药24小时后进行。排除创伤性脑损伤患者。
选取16例患者进行PSG记录。中位年龄为37.5岁（范围20 - 83岁），81.3%为男性患者，62.5%为受伤患者，31.3%接受机械通气。PSG总记录时间为315小时（平均每位患者19.7小时），PSG记录的总睡眠时间为132小时（平均每位患者8.28小时），每小时睡眠时间的觉醒次数为6.2次。与健康对照相比，ICU患者在浅睡眠阶段所花费时间的比例增加，在深睡眠阶段所花费时间的比例减少，REM睡眠也减少（p < 0.001）。
患者在外科ICU环境中接受治疗时确实能获得可测量的睡眠。然而，睡眠是碎片化的，睡眠质量明显异常，睡眠的第3和第4阶段以及REM阶段（睡眠中更深层次的恢复阶段）显著减少。有必要进一步研究在ICU护理期间促进睡眠策略的效果。
