Dutta Rebecca, West Leslie C, Sampat Ajay, Wilson Machelle, Palchik Guillermo, Yee Alan H
University of California Davis.
UCSF Medical Center.
Res Sq. 2025 Jul 14:rs.3.rs-6977598. doi: 10.21203/rs.3.rs-6977598/v1.
Examine the association between sleep and clinical outcome in patients with acute brain injury and critical illness.
Retrospective analysis of critically ill patients who underwent continuous electroencephalography monitoring in an academic medical center from 2018-2020. Patients admitted with primary neurologic, medical, and surgical conditions were included. Clinical outcome was determined by the modified Rankin Scale (mRS < 3 represented favorable outcome). Statistical modeling of outcome included predictor variables controlling for anesthetic concentration, diagnosis, and sex.
262 patients were included of which 57% were male with a mean age of 58 years (range 18-91). Twenty-one percent of the total population achieved sleep (56/262). Of those achieving any sleep, 43% had good outcomes compared to only 26% who did not (χ =10.99, p = 0.0009), controlling for diagnosis, sex, anesthetic level, and Acute Physiology and Chronic Health Evaluation score. Neurological patients attained sleep more often (27%) compared to those with other primary diagnoses (14%). In multivariable analysis, the effect of level of centrally acting anesthetics did not account for sleep differences between neurologic and non-neurological patients (χ =3.5, p = 0.95).
Neurocritical patients slept more often, and obtaining any sleep was associated with better functional outcome when controlling disease severity. Further studies are needed to determine whether sleep augmentation and anesthetic use in critically ill patients impact functional outcomes.
研究急性脑损伤和危重症患者睡眠与临床结局之间的关联。
对2018年至2020年在一所学术医疗中心接受连续脑电图监测的危重症患者进行回顾性分析。纳入因原发性神经、内科和外科疾病入院的患者。临床结局由改良Rankin量表确定（mRS<3表示预后良好）。结局的统计建模包括控制麻醉浓度、诊断和性别的预测变量。
纳入262例患者，其中57%为男性，平均年龄58岁（范围18 - 91岁）。总人群中有21%实现了睡眠（56/262）。在实现任何睡眠的患者中，43%预后良好，而未实现睡眠的患者中这一比例仅为26%（χ =10.99，p = 0.0009），同时控制了诊断、性别、麻醉水平和急性生理与慢性健康状况评估得分。与其他原发性诊断的患者（14%）相比，神经科患者更常实现睡眠（27%）。在多变量分析中，中枢作用麻醉剂水平的影响并不能解释神经科和非神经科患者之间的睡眠差异（χ =3.5，p = 0.95）。
神经危重症患者睡眠更频繁，在控制疾病严重程度时，实现任何睡眠都与更好的功能结局相关。需要进一步研究以确定危重症患者的睡眠增强和麻醉使用是否会影响功能结局。
