Ambrogio Cristina, Koebnick Jeffrey, Quan Stuart F, Ranieri Marco, Parthasarathy Sairam
Section of Pulmonary, Critical Care, and Sleep Medicine, Southern Arizona VA Health Care System, Tucson, AZ 85723, USA.
Sleep. 2008 Nov;31(11):1559-68. doi: 10.1093/sleep/31.11.1559.
In critically ill patients, sleep derangements are reported to be severe using Rechtschaffen and Kales (R&K) methodology; however, whether such methodology can reliably assess sleep during critical illness is unknown. We set out to determine the reproducibility of 4 different sleep-assessment methods (3 manual and 1 computer-based) for ventilator-supported critically ill patients and also to quantify the extent to which the reproducibility of the manual methods for measuring sleep differed between critically ill and ambulatory (control) patients.
Observational methodologic study.
Academic center.
Critically ill patients receiving mechanical ventilation and age-matched controls underwent polysomnography.
None.
Reproducibility for the computer-based method (spectral analysis of electroencephalography [EEG]) was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern (P = 0.03). In critically ill patients, the proportion of misclassifications for measurements using spectral analysis, sleep-wakefulness organization pattern, and R&K methodology were 0%, 36%, and 53%, respectively (P < 0.0001). The EEG pattern of burst suppression was not observed. Interobserver and intraobserver reliability of the manual sleep-assessment methods for critically ill patients (kappa = 0.52 +/- 0.23) was worse than that for control patients (kappa = 0.89 +/- 0.13; P = 0.03). In critically ill patients, the overall reliability of the R&K methodology was relatively low for assessing sleep (kappa = 0.19), but detection of rapid eye movement sleep revealed good agreement (kappa = 0.70).
Reproducibility for spectral analysis of EEG was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern. For assessment of sleep in critically ill patients, the use of spectral analysis, sleep-wakefulness organization state, or rapid eye movement sleep alone may be preferred over the R&K methodology.
据报道，使用 Rechtschaffen 和 Kales（R&K）方法评估危重症患者的睡眠紊乱情况较为严重；然而，该方法能否可靠地评估危重症期间的睡眠尚不清楚。我们旨在确定 4 种不同睡眠评估方法（3 种手动方法和 1 种基于计算机的方法）对接受机械通气的危重症患者的可重复性，并量化危重症患者与非卧床（对照）患者在测量睡眠的手动方法可重复性方面的差异程度。
观察性方法学研究。
学术中心。
接受机械通气的危重症患者和年龄匹配的对照者接受了多导睡眠图检查。
无。
基于计算机的方法（脑电图[EEG]频谱分析）的可重复性优于手动方法：R&K 方法和睡眠-觉醒组织模式（P = 0.03）。在危重症患者中，使用频谱分析、睡眠-觉醒组织模式和 R&K 方法进行测量的错误分类比例分别为 0%、36%和 53%（P < 0.0001）。未观察到爆发抑制的 EEG 模式。危重症患者手动睡眠评估方法的观察者间和观察者内可靠性（kappa = 0.52 ± 0.23）低于对照患者（kappa = 0.89 ± 0.13；P = 0.03）。在危重症患者中，R&K 方法评估睡眠的总体可靠性相对较低（kappa = 0.19），但快速眼动睡眠的检测显示一致性良好（kappa = 0.70）。
EEG 频谱分析的可重复性优于手动方法：R&K 方法和睡眠-觉醒组织模式。对于评估危重症患者的睡眠，单独使用频谱分析、睡眠-觉醒组织状态或快速眼动睡眠可能比 R&K 方法更可取。
