Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology, and Intensive Care Medicine, Oulu University Hospital and Medical Research Center, Oulu, Finland.
Physiological Signal Analysis Team, Center for Machine Vision and Signal Analysis, University of Oulu and Medical Research Center, Oulu, Finland.
Acta Anaesthesiol Scand. 2022 Nov;66(10):1211-1218. doi: 10.1111/aas.14131. Epub 2022 Aug 23.
The disturbance of sleep has been associated with intensive care unit (ICU) delirium. Monitoring of EEG slow-wave activity (SWA) has potential in measuring sleep quality and quantity. We investigated the quantitative monitoring of nighttime SWA and its association with the clinical evaluation of sleep in patients with hyperactive ICU delirium treated with dexmedetomidine.
We performed overnight EEG recordings in 15 patients diagnosed with hyperactive delirium during moderate dexmedetomidine sedation. SWA was evaluated by offline calculation of the C-Trend Index, describing SWA in one parameter ranging 0 to 100 in values. Average and percentage of SWA values <50 were categorized as poor. The sleep quality and depth was clinically evaluated by the bedside nurse using the Richards-Campbell Sleep Questionnaire (RCSQ) with scores <70 categorized as poor.
Nighttime SWA revealed individual sleep structures and fundamental variation between patients. SWA was poor in 67%, sleep quality (RCSQ) in 67%, and sleep depth (RCSQ) in 60% of the patients. The category of SWA aligned with that of RCSQ-based sleep quality in 87% and RCSQ-based sleep depth in 67% of the patients.
Both, SWA and clinical evaluation suggested that the quality and depth of nighttime sleep were poor in most patients with hyperactive delirium despite dexmedetomidine infusion. Furthermore, the SWA and clinical evaluation classifications were not uniformly in agreement. An objective mode such as practical EEG-based solution for sleep evaluation and individual drug dosing in the ICU setting could offer potential in improving sleep for patients with delirium.
睡眠障碍与重症监护病房（ICU）谵妄有关。脑电图慢波活动（SWA）监测在测量睡眠质量和数量方面具有潜力。我们研究了夜间 SWA 的定量监测及其与接受右美托咪定治疗的活动型 ICU 谵妄患者的临床睡眠评估的关系。
我们对 15 名在中度右美托咪定镇静期间被诊断为活动型谵妄的患者进行了整夜脑电图记录。通过离线计算 C-Trend 指数评估 SWA，该指数以 0 到 100 的值描述 SWA 的一个参数。<50 的 SWA 值的平均值和百分比被归类为差。通过床边护士使用 Richards-Campbell 睡眠问卷（RCSQ）对睡眠质量和深度进行临床评估，评分<70 被归类为差。
夜间 SWA 揭示了患者之间的个体睡眠结构和基本变化。67%的患者 SWA 较差，67%的患者睡眠质量（RCSQ）较差，60%的患者睡眠深度（RCSQ）较差。在 87%的患者中，SWA 类别与基于 RCSQ 的睡眠质量类别一致，在 67%的患者中，SWA 类别与基于 RCSQ 的睡眠深度类别一致。
尽管给予右美托咪定输注，但 SWA 和临床评估均表明，大多数活动型谵妄患者的夜间睡眠质量和深度较差。此外，SWA 和临床评估分类并不完全一致。在 ICU 环境中，基于实际 EEG 的睡眠评估和个体化药物剂量的客观模式可能为改善谵妄患者的睡眠提供潜力。
