Whitcomb John J, Morgan Michelle, Irvin Tameka, Spencer Kathleen, Boynton Lauren, Turman Sarah, Rhodes Christopher
Clemson University School of Nursing, Clemson, SC 29634, USA.
Dimens Crit Care Nurs. 2013 Sep-Oct;32(5):266-70. doi: 10.1097/DCC.0b013e3182a077cd.
Delirium continues to be a major issue in intensive care units (ICUs). Sedation and lack of rapid eye movement (REM) sleep could be important factors in the development of delirium. Improper sedation may interfere with a patient's sleep pattern, specifically time spent in REM sleep, and could be a contributor to the development of delirium. The research team has discovered through this pilot study that there is a possible correlation between sedation, disruptions, and sleep. The goal of our research was to determine the relationship between these variables using a sleep monitor to capture actual sleep activity compared with patient characteristics and real-time activity in the ICU environment.
This was a pilot study of 7 new patients, aged 65 years or older, who were intubated and sedated. Data on patient sleep cycles were collected using a wireless sleep monitor. A time sheet was placed outside each room to record time and type of interruption during nighttime hours (9 PM-6 AM). The patients were observed for 1 to 7 nights dependent on their length of stay in the ICU.
Preliminary results demonstrated that, on average, between 9 PM and 6 AM, 48% remained awake (range, 8%-88%), 30% were in light sleep (range, 2%-50%), 18.5% were in REM (range, 2%-60%), and 3.4% were in a deep sleep (range, 0%-9%). Subject 1 remained awake 52% to 88% of the time during the entire admission of 7 days, had an Intensive Care Delirium Screening Checklist score of 5, and had a self-extubation; sedation ordered was Versed as needed. Subject 5 had no interventions done between 12 midnight and 4:50 AM, with the exception of turning once, and had an REM recorded of 60% on 1 night, which equals to 4 hours 49 minutes of rest. All patients with the exception of 1 were on fentanyl and Versed drips with varying dose adjustments throughout their admission.
Preliminary results show that there is a relationship between lack of REM sleep and delirium. The pilot study was a useful model to demonstrate the need for further investigation in a larger population.
谵妄仍然是重症监护病房（ICU）中的一个主要问题。镇静和快速眼动（REM）睡眠不足可能是谵妄发生的重要因素。不当的镇静可能会干扰患者的睡眠模式，特别是在REM睡眠中所花费的时间，并且可能是导致谵妄发生的一个因素。研究团队通过这项初步研究发现，镇静、干扰和睡眠之间可能存在关联。我们研究的目的是使用睡眠监测器来记录实际睡眠活动，并将其与患者特征及ICU环境中的实时活动进行比较，以确定这些变量之间的关系。
这是一项针对7名65岁及以上接受插管和镇静治疗的新患者的初步研究。使用无线睡眠监测器收集患者睡眠周期的数据。在每个病房外放置一张时间表，以记录夜间（晚上9点至早上6点）的中断时间和类型。根据患者在ICU的住院时间，对他们进行1至7晚的观察。
初步结果表明，平均而言，在晚上9点至早上6点之间，48%的患者保持清醒（范围为8% - 88%），30%处于浅睡眠（范围为2% - 50%），18.5%处于REM睡眠（范围为2% - 60%），3.4%处于深睡眠（范围为0% - 9%）。患者1在7天的整个住院期间有52%至88%的时间保持清醒，重症监护谵妄筛查清单评分为5分，并且发生了自行拔管；按需使用的镇静药物为咪达唑仑。患者5在午夜12点至凌晨4点50分之间除了翻身一次外没有接受任何干预，并且有一晚记录到REM睡眠占60%，相当于4小时49分钟的休息时间。除1名患者外，所有患者在住院期间均接受了不同剂量调整的芬太尼和咪达唑仑静脉滴注。
初步结果表明，REM睡眠不足与谵妄之间存在关联。这项初步研究是一个有用的模型，证明了在更大规模人群中进行进一步研究的必要性。
