Nagatomo Kanae, Masuyama Tomoyuki, Iizuka Yusuke, Makino Jun, Shiotsuka Junji, Sanui Masamitsu
1Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan.
2Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503 Japan.
J Intensive Care. 2020 Feb 11;8:16. doi: 10.1186/s40560-020-0433-x. eCollection 2020.
Considering the adverse effects of sleep disturbance in critical care settings, accurate assessment could aid therapy; however, methodological inadequacies mean that no viable option is currently available. Research in healthy population has recently shown that a non-wearable sleep measurement device placed under the mattress of the bed could be beneficial in intensive care settings. Therefore, we aimed to validate this device compared with polysomnography (PSG) and to assess how it related to subjective sleep evaluations.
This observational study measured the sleep of critically ill adult patients. The primary goal was to validate the Nemuri SCAN (NSCAN; Paramount Bed Co., Ltd., Tokyo, Japan) against the reference standard PSG for 24 h. The secondary goal was to evaluate the association between the objective parameters obtained from NSCAN and PSG and the subjective report data obtained using the Richards-Campbell Sleep Questionnaire (RCSQ) for the nighttime.
Eleven participants were evaluated. The median of the total sleep time scored by PSG was 456.0 (353.0-517.5) min during the nighttime and 305.0 (186.2-542.5) min during the daytime. PSG over 24 h revealed significant decreases in restorative sleep, with excessive daytime sleep, but with a normal quantity of nighttime sleep. The agreement, sensitivity, and specificity rates (with 95% confidence intervals) for the NSCAN compared with PSG were 68.4% (67.9-69.0%), 90.1% (89.7-90.6%), and 38.7% (37.9-39.7%), respectively. The median RCSQ value when subjectively evaluating nighttime sleep was 68.0 (26.3-83.5); this showed no correlation with the NSCAN sleep parameters, despite a positive correlation with the ratio of the stage N2 isolated or combined with restorative sleep in the PSG assessment.
NSCAN had moderate agreement, high sensitivity, and poor specificity in intensive care settings, which is most likely due to its inability to identify immobile wakefulness often observed in critically ill patients or sleep depth. This remains a barrier to its use in the assessment of subjective sleep quality.
This investigation was part of an interventional trial registered with the University Hospital Medical Information Network Individual Clinical Trials Registry (UMIN000026350, http://www.umin.ac.jp/icdr/index-j.html) on March 1, 2017.
考虑到重症监护环境中睡眠障碍的不良影响，准确评估有助于治疗；然而，方法上的不足意味着目前没有可行的选择。最近在健康人群中的研究表明，放置在床垫下的非穿戴式睡眠测量设备在重症监护环境中可能有益。因此，我们旨在将该设备与多导睡眠图（PSG）进行比较以验证其有效性，并评估其与主观睡眠评估的关系。
这项观察性研究测量了成年重症患者的睡眠情况。主要目标是针对24小时的情况，将Nemuri SCAN（NSCAN；日本东京Paramount Bed有限公司）与参考标准PSG进行验证。次要目标是评估从NSCAN和PSG获得的客观参数与使用理查兹 - 坎贝尔睡眠问卷（RCSQ）获得的夜间主观报告数据之间的关联。
对11名参与者进行了评估。PSG记录的夜间总睡眠时间中位数为456.0（353.0 - 517.5）分钟，白天为305.0（186.2 - 542.5）分钟。24小时的PSG显示恢复性睡眠显著减少，白天睡眠过多，但夜间睡眠量正常。与PSG相比，NSCAN的一致性、敏感性和特异性率（95%置信区间）分别为68.4%（67.9 - 69.0%）、90.1%（89.7 - 90.6%）和38.7%（37.9 - 39.7%）。主观评估夜间睡眠时RCSQ值的中位数为68.0（26.3 - 83.5）；这与NSCAN睡眠参数无相关性，尽管与PSG评估中分离或合并恢复性睡眠的N2期比例呈正相关。
在重症监护环境中，NSCAN具有中等一致性、高敏感性和低特异性，这很可能是由于其无法识别重症患者中常见的静止性觉醒或睡眠深度。这仍然是其用于评估主观睡眠质量的障碍。
本研究是一项干预性试验的一部分，该试验于2017年3月1日在大学医院医学信息网络个体临床试验注册中心（UMIN000026350，http://www.umin.ac.jp/icdr/index - j.html）注册。
