Georgopoulos Dimitris, Kondili Eumorfia, Alexopoulou Christina, Younes Magdy
Department of Intensive Care Medicine, University Hospital of Heraklion, Heraklion, Greece.
Sleep Disorders Centre, University of Manitoba, Winnipeg, MB, Canada.
Crit Care Explor. 2021 Aug 10;3(8):e0503. doi: 10.1097/CCE.0000000000000503. eCollection 2021 Aug.
Evaluation of sleep quality in critically ill patients is difficult using conventional scoring criteria. The aim of this study was to examine sleep in critically ill patients with and without light sedation using the odds ratio product, a validated continuous metric of sleep depth (0 = deep sleep; 2.5 = full wakefulness) that does not rely on the features needed for conventional staging.
Retrospective study.
A 16-bed medical-surgical ICU.
Twenty-three mechanically ventilated patients who had previously undergone two nocturnal sleep studies, one without and one with sedation (propofol, = 12; dexmedetomidine, = 11).
None.
Sleep architecture was evaluated with odds ratio product analysis by the distribution of 30-second epochs with different odds ratio product values. Electroencephalogram spectral patterns and frequency of wake intrusions (3-s odds ratio product > 1.75) were measured at different odds ratio product levels. Thirty-seven normal sleepers were used as controls. Compared with normal sleepers, unsedated critically ill patients spent little time in stable sleep (percent odds ratio product < 1.0: 31% vs 63%; < 0.001), whereas most of the time were either in stage wake (odds ratio product > 1.75) or in a transitional state (odds ratio product 1.0-1.75), characterized by frequent wake intrusions. Propofol and dexmedetomidine had comparable effects on sleep. Sedation resulted in significant shift in odds ratio product distribution toward normal; percent odds ratio product less than 1.0 increased by 54% ( = 0.006), and percent odds ratio product greater than 1.75 decreased by 48% ( = 0.013). In six patients (26%), sedation failed to improve sleep.
In stable critically ill unsedated patients, sleep quality is poor with frequent wake intrusions and little stable sleep. Light sedation with propofol or dexmedetomidine resulted in a shift in sleep architecture toward normal in most, but not all, patients.
使用传统评分标准评估重症患者的睡眠质量很困难。本研究的目的是使用优势比乘积来检查接受或未接受轻度镇静的重症患者的睡眠情况，优势比乘积是一种经过验证的连续睡眠深度指标（0 = 深度睡眠；2.5 = 完全清醒），不依赖于传统分期所需的特征。
回顾性研究。
一个拥有16张床位的内科-外科重症监护病房。
23名机械通气患者，他们之前进行过两次夜间睡眠研究，一次未使用镇静剂，一次使用镇静剂（丙泊酚，n = 12；右美托咪定，n = 11）。
无。
通过不同优势比乘积值的30秒时段分布，用优势比乘积分析评估睡眠结构。在不同优势比乘积水平下测量脑电图频谱模式和觉醒侵入频率（3秒优势比乘积>1.75）。37名正常睡眠者作为对照。与正常睡眠者相比，未使用镇静剂的重症患者在稳定睡眠中的时间很少（优势比乘积百分比<1.0：31%对63%；P<0.001），而大部分时间要么处于觉醒阶段（优势比乘积>1.75），要么处于过渡状态（优势比乘积1.0 - 1.75），其特征是频繁的觉醒侵入。丙泊酚和右美托咪定对睡眠的影响相当。镇静导致优势比乘积分布显著向正常转移；优势比乘积百分比小于1.0增加了54%（P = 0.006），优势比乘积百分比大于1.75减少了48%（P = 0.013）。在6名患者（26%）中，镇静未能改善睡眠。
在病情稳定的未使用镇静剂的重症患者中，睡眠质量差，觉醒侵入频繁，稳定睡眠少。使用丙泊酚或右美托咪定进行轻度镇静可使大多数但并非所有患者的睡眠结构向正常转变。
