Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands.
PLoS One. 2022 Jul 7;17(7):e0268065. doi: 10.1371/journal.pone.0268065. eCollection 2022.
Vital signs follow circadian patterns in both healthy volunteers and critically ill patients, which seem to be influenced by disease severity in the latter. In this study we explored the existence of circadian patterns in heart rate, respiratory rate and skin temperature of hospitalized COVID-19 patients, and aimed to explore differences in circadian rhythm amplitude during patient deterioration.
We performed a retrospective study of COVID-19 patients admitted to the general ward of a tertiary hospital between April 2020 and March 2021. Patients were continuously monitored using a wireless sensor and fingertip pulse oximeter. Data was divided into three cohorts: patients who recovered, patients who developed respiratory insufficiency and patients who died. For each cohort, a population mean cosinor model was fitted to detect rhythmicity. To assess changes in amplitude, a mixed-effect cosinor model was fitted.
A total of 429 patients were monitored. Rhythmicity was observed in heartrate for the recovery cohort (p<0.001), respiratory insufficiency cohort (p<0.001 and mortality cohort (p = 0.002). Respiratory rate showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.18 and p = 0.51). Skin temperature also showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.22 and p = 0.12). For respiratory insufficiency, only the amplitude of heart rate circadian pattern increased slightly the day before (1.2 (99%CI 0.16-2.2, p = 0.002)). In the mortality cohort, the amplitude of heart rate decreased (-1.5 (99%CI -2.6- -0.42, p<0.001)) and respiratory rate amplitude increased (0.72 (99%CI 0.27-1.3, p = 0.002) the days before death.
A circadian rhythm is present in heart rate of COVID-19 patients admitted to the general ward. For respiratory rate and skin temperature, rhythmicity was only found in patients who recover, but not in patients developing respiratory insufficiency or death. We found no consistent changes in circadian rhythm amplitude accompanying patient deterioration.
生命体征在健康志愿者和危重症患者中都存在昼夜节律模式，而后者的节律模式似乎受到疾病严重程度的影响。在这项研究中，我们探讨了住院 COVID-19 患者的心率、呼吸频率和皮肤温度是否存在昼夜节律，并旨在探讨患者病情恶化过程中昼夜节律振幅的差异。
我们对 2020 年 4 月至 2021 年 3 月期间入住一家三级医院普通病房的 COVID-19 患者进行了回顾性研究。患者使用无线传感器和指尖脉搏血氧仪进行连续监测。数据分为三组：康复组、发生呼吸功能不全组和死亡组。对于每个队列，拟合群体平均余弦模型以检测节律性。为了评估振幅的变化，拟合了混合效应余弦模型。
共监测了 429 名患者。在康复队列（p<0.001）、呼吸功能不全队列（p<0.001）和死亡队列（p = 0.002）中观察到心率的节律性。呼吸率在康复队列中表现出节律性（p<0.001），但在其他队列中没有（p = 0.18 和 p = 0.51）。皮肤温度在康复队列中也表现出节律性（p<0.001），但在其他队列中没有（p = 0.22 和 p = 0.12）。对于呼吸功能不全，只有心率昼夜节律模式的振幅在前一天略有增加（1.2（99%CI 0.16-2.2，p = 0.002））。在死亡队列中，心率振幅降低（-1.5（99%CI -2.6- -0.42，p<0.001）），呼吸率振幅增加（0.72（99%CI 0.27-1.3，p = 0.002））在死亡前几天。
住院的 COVID-19 患者的心率存在昼夜节律。对于呼吸频率和皮肤温度，节律性仅在康复患者中发现，而在发生呼吸功能不全或死亡的患者中未发现。我们没有发现昼夜节律振幅随患者病情恶化而发生一致变化。
