Pustjens Tobias, Schoutens Antonius Mc, Janssen Loes, Heesen Wilfred F
Department of Cardiology, Division of Cardiology, Viecuri Medical Centre, Venlo, the Netherlands.
Flux Plus, Tilburg, the Netherlands.
J Geriatr Cardiol. 2018 Sep 28;15(9):567-573. doi: 10.11909/j.issn.1671-5411.2018.09.006.
Disturbed circadian rhythm is a potential cause of delirium and is linked to disorganisation of the circadian rhythmicity. Dynamic light (DL) could reset the circadian rhythm by activation of the suprachiasmatic nucleus to prevent delirium. Evidence regarding the effects of light therapy is predominantly focused on psychiatric disorders and circadian rhythm sleep disorders. In this study, we investigated the effect of DL on the total hospital length of stay (LOS) and occurrence of delirium in patients admitted to the Coronary Care Unit (CCU).
This was a retrospective cohort study. Patients older than 18 years, who were hospitalized longer than 12 h at the CCU and had a total hospital LOS for at least 24 h, were included. Patients were assigned to a room with DL ( = 369) or regular lighting conditions ( = 379). DL was administered at the CCU by two ceiling-mounted light panels delivering light with a colour temperature between 2700 and 6500 degrees Kelvin. Reported outcome data were: total hospital LOS, delirium incidence, consultation of a geriatrician and the amount of prescripted antipsychotics.
Between May 2015 and May 2016, data from 748 patients were collected. Baseline characteristics, including risk factors provoking delirium, were equal in both groups. Median total hospital LOS in the DL group was 100.5 (70.8-186.0) and 101.0 (73.0-176.4) h in the control group ( = 0.935). The incidence of delirium in the DL and control group was 5.4% (20/369) and 5.0% (19/379), respectively ( = 0.802). No significant differences between the DL and control group were observed in secondary endpoints. Subgroup analysis based on age and CCU LOS also showed no differences.
Our study suggests exposure to DL as an early single approach does not result in a reduction of total hospital LOS or reduced incidence of delirium. When delirium was diagnosed, it was associated with poor hospital outcome.
昼夜节律紊乱是谵妄的一个潜在原因，且与昼夜节律的紊乱有关。动态光照（DL）可通过激活视交叉上核来重置昼夜节律，以预防谵妄。关于光照疗法效果的证据主要集中在精神疾病和昼夜节律性睡眠障碍方面。在本研究中，我们调查了动态光照对冠心病监护病房（CCU）住院患者的总住院时长（LOS）和谵妄发生率的影响。
这是一项回顾性队列研究。纳入年龄大于18岁、在CCU住院时间超过12小时且总住院时长至少24小时的患者。患者被分配到配备动态光照的房间（n = 369）或常规光照条件的房间（n = 379）。在CCU，通过两个天花板安装的光面板给予动态光照，其发出的光色温在2700至6500开尔文之间。报告的结局数据包括：总住院时长、谵妄发生率、老年科医生会诊情况以及处方抗精神病药物的用量。
在2015年5月至2016年5月期间，收集了748例患者的数据。两组的基线特征，包括引发谵妄的危险因素，均无差异。动态光照组的总住院时长中位数为100.5（70.8 - 186.0）小时，对照组为101.0（73.0 - 176.4）小时（P = 0.935）。动态光照组和对照组的谵妄发生率分别为5.4%（20/369）和5.0%（19/379）（P = 0.802）。在次要终点方面，动态光照组和对照组未观察到显著差异。基于年龄和CCU住院时长的亚组分析也未显示出差异。
我们的研究表明，作为一种早期单一方法，暴露于动态光照并不会导致总住院时长缩短或谵妄发生率降低。当诊断出谵妄时，它与不良的住院结局相关。
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