School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia.
Medicine and Health Sciences, Australian National University, Canberra, ACT, Australia.
Crit Care. 2021 Jan 29;25(1):42. doi: 10.1186/s13054-020-03447-8.
Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring.
Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time.
We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated.
Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).
重症监护病房患者的睡眠减少且高度碎片化，这可能对康复产生不利影响。目前，重症监护临床医生面临的挑战是确定可行且准确的睡眠评估方法，以便广泛应用。本研究旨在调查一种微创睡眠监测技术与金标准多导睡眠图相比用于睡眠监测的可行性和可靠性。
采用前瞻性观察研究，对入住重症监护病房的成年患者进行自身对照设计。在 24 小时内对轻度镇静患者同时进行多导睡眠图和活动监测，以评估两种方法（总睡眠时间和清醒时间）之间的一致性。
我们共招募了 80 名在重症监护病房中接受机械通气（24%）和非机械通气（76%）的患者。研究发现，睡眠高度碎片化，由多个睡眠阶段组成，并表现出异常的睡眠结构。在逐个时段的分析中，活动监测在识别睡眠和清醒状态方面与多导睡眠图具有中度的总体一致性（69.4%；K=0.386，p<0.05），具有中度的敏感性（65.5%）和特异性（76.1%）。在非机械通气患者中，活动监测的监测准确性提高（特异性 83.7%；敏感性 56.7%）。活动监测与多导睡眠图报告的总睡眠时间（r=0.359，p<0.05）和清醒时间（r=0.371，p<0.05）具有中度相关性。Bland-Altman 图表明，活动监测低估了睡眠，高估了清醒状态。
活动监测易于使用且安全，在区分睡眠和清醒状态方面与多导睡眠图具有中度一致性，可能是测量重症监护患者睡眠的合理替代方法。临床试验注册号 ACTRN12615000945527（2015 年 9 月 9 日注册）。
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