scholarly journals SLEEP DISORDER IN CHILDREN IN INTENSIVE CARE UNIT: CURRENT STATE OF PROBLEM AND PROSPECTS FOR FUTURE RESEARCH

2021 ◽  
Vol 21 (3) ◽  
pp. 37-41
Author(s):  
S.M. Tsvirenko ◽  
N.M. Adamchuk ◽  
V.M. Malakhova ◽  
O.I. Melashchenko ◽  
L.A. Zhuk
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Sleep Disturbances ◽  
Sleep Time ◽  
Future Research ◽  
Close Monitoring ◽  
Monitoring Method ◽  
Video Assisted

Insomnia is one of the most common clinical syndromes of somnological disorders, including any sleep disorders under sufficient time and appropriate sleeping conditions. Significant sleep disturbances are common in children who enter the intensive care unit. Between 18 and 65 per cent of children aged between 2 and 18 hospitalized in the intensive care unit have a clinical condition of acute confusion, better known as delirium. Sleep fragmentation, reduction of total sleep time, lack of slow, deep sleep and rapid sleep, and shift of sleep time are changes that can also act as insomnia triggers. Their presence worsens the course of the disease in the patient, prolongs the hospital stay, and increases the risk of complications and lethality. Circadian sleep disorder is a condition that requires close monitoring. Although insomnia therapy approaches are not yet reliable, early diagnosis of insomnia can reduce the duration of the delirium. Sleep assessment includes questionnaires and diaries. However, it was recognized that, despite the difficulties in implementing and interpreting polysomnography, it was still a gold standard for more accurate detection of changes in sleep phases and the difference between normal and abnormal sleep. In the absence of a polysomnograph, it is permissible to use a prolonged video assisted EEG. The inventive multimodal video-assisted monitoring method makes it possible to diagnose sleep disorders, pain syndrome and differential diagnosis of apnoea with cardiac and conductivity disorders or abnormal brain activity, including the presence of sub-clinical convulsions in patients of high-risk groups using a safe and non-invasive method for analyzing trends in the total bioelectric activity of different biological structures of a child. The validation of questionnaires according to the age of the child is also an important step in the timely diagnosis of sleep disorders in older children.

scholarly journals Sleep deprivation in Intensive Care Unit – systematic review

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 384-393 ◽  
Author(s):  
Wioletta Medrzycka-Dabrowska ◽  
Katarzyna Lewandowska ◽  
Katarzyna Kwiecień-Jaguś ◽  
Katarzyna Czyż-Szypenbajl
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sleep Disorders ◽  
Nursing Care ◽  
Sleep Disturbances ◽  
Web Of Science ◽  
Night Shift ◽  
Noise Levels ◽  
Therapeutic Procedures ◽  
Changing Noise

AbstractBackgroundSleep disturbances in intensive care unit (ICU) patients have been studied worldwide for over 30 years. Factors contributing to sleep disturbances are still being identified, and therapeutic procedures aimed at the mitigation of such ailments are consequently being developed.ObjectivesThe aim of this study was to review the literature on sleep disturbances in intensive care unit patients.Material and MethodsMEDLINE PubMed, OVID, Web of Science, and EBSCO databases have been searched using adequate keywords.ResultsSleep disorders in ICUs were common among all of the analysed articles. Noise plays a significant role in sleep interruption (11.5 - 17% of awakenings). It was noted that the introduction of “white noise” into the ICU environment proved unsuccessful in reducing the magnitude of changing noise levels. Nursing care activities significantly disturb nocturnal rest, and 42.7 such procedures per every 12-hour night shift were registered. Aggregating nursing care interventions was suggested in order to reduce the number of stimuli experienced by the patient.ConclusionChanges in sleep structure developing during an ICU stay may significantly contribute to sleep disorders once the hospitalisation is over.

scholarly journals Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians

2011 ◽  
Vol 39 (6) ◽  
pp. 1071-1075 ◽  
Author(s):  
G. Ok ◽  
H. Yilmaz ◽  
D. Tok ◽  
K. Erbüyün ◽  
S. Çoban ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Shift Work ◽  
Pittsburgh Sleep Quality Index ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Total Activity ◽  
Sleep Time ◽  
Sleep Parameters ◽  
Icu Physicians

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

scholarly journals The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
L. J. Delaney ◽  
E. Litton ◽  
K. L. Melehan ◽  
H.-C. C. Huang ◽  
V. Lopez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Moderate Level ◽  
Sleep Monitoring ◽  
Clinical Trial Registration ◽  
Wake Time ◽  
Intensive Care Patients

Abstract Background 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. Methods 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. Results 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. Conclusions 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).

scholarly journals Intraperitoneal Microdialysis as a Monitoring Method in the Intensive Care Unit

2014 ◽  
Vol 99 (6) ◽  
pp. 729-733 ◽  
Author(s):  
Tasiopoulos Konstantinos ◽  
Komnos Apostolos ◽  
Paraforos Georgios ◽  
Tepetes Konstantinos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glucose Concentration ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Monitoring Method ◽  
P Values ◽  
Repeated Measures Analysis ◽  
Low Glucose ◽  
Surgical Condition

Abstract Studies on surgical patients provide some evidence of prompt detection of enteric ischemia with microdialysis. The purpose of the study was to measure intraperitoneal microdialysis values (glucose, glycerol, pyruvate, and lactate) in patients hospitalized in an intensive care unit (ICU) with an underlying abdominal surgical condition and to correlate these values with patients' outcomes. Twenty-one patients, 10 female, were enrolled in the study. The intraperitoneal metabolite values were measured for 3 consecutive days, starting from the first day of ICU hospitalization. Descriptive and inferential statistics were performed. The t-test, repeated measures analysis, Holm's test, and a logistic regression model were applied. Level of statistical significance was set at P = 0.05. Mean age of participants was 68.10 ± 8.02 years old. Survivors exhibited statistically significantly higher glucose values on day 3 (6.61 ± 2.01 against 3.67 ± 1.62; P = 0.002). Mean lactate/ pyruvate (L/P) values were above 20 (35.35 ± 27.11). All non-survivors had a mean three day L/P values greater than 25.94. Low L/P values were related to increased survival possibilities. High microdialysis glucose concentration, high L/P ratio and low glucose concentration were the major findings during the first three ICU hospitalization days in non-survivors. Intraperitoneal microdialysis may serve as a useful tool in understanding enteric ischemia pathophysiology.

scholarly journals The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Jeff A. Dennis ◽  
Ahmad Alazzeh ◽  
Ann Marie Kumfer ◽  
Rebecca McDonald-Thomas ◽  
Alan N. Peiris
Keyword(s):  
Sleep Apnea ◽  
Sleep Disturbance ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Inflammatory Markers ◽  
Sleep Disturbances ◽  
Laboratory Data ◽  
Poor Sleep ◽  
Distribution Width ◽  
Inflammatory Status

Background/Objective. Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. Methods. Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. Results. Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. Conclusion. Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.

scholarly journals Implementation of a Continuous Glucose Monitoring Program at a Safety Net Hospital During Covid 19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A345-A346
Author(s):  
Erin E Finn ◽  
Lindsay Schlichting ◽  
Rocio Ines Pereira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Monitoring Program ◽  
Glucose Monitoring ◽  
Safety Net ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Background: COVID 19 disproportionately impacts individuals with diabetes leading to increased morbidity and mortality. Hyperglycemia is common in hospitalized patients with COVID requiring intensive monitoring and management. Close monitoring of glucoses requires increased use of personal protective equipment (PPE), which has been in limited supply since the beginning of the pandemic. The FDA granted conditional allowance for use of continuous glucose monitors (CGM) in hospital settings during the COVID pandemic to allow for preservation of PPE. We present the process of implementing a continuous glucose monitoring program in an urban safety net hospital. Methods: The program was implemented at a county urban safety net hospital. Patients were eligible to be started on Dexcom G6 CGM if they had hyperglycemia requiring multiple insulin injections daily, were in contact isolation, and were located in 1 of 3 units of the hospital (medical intensive care unit [MICU], surgical intensive care unit, COVID 19 floor unit). Initial program was started in the MICU and subsequently expanded. Nurses and staff underwent training using videos, in-person demonstrations, and written guides. Informational Technology modified the electronic medical system to allow for ordering and documentation of CGM values by nurses. Supplies were stored both on unit and in central supply allowing for primary team to initiate monitoring independent of diabetes team. Records of patients participating in program were maintained by the diabetes team. Amount of PPE saved was estimated to be 10 instances/day while on insulin drip and 3/day when using subcutaneous insulin. Results: A total of 69 patients used a CGM during their hospital course. Average age was 56 years old, 69 % were male, average BMI 31, and 84% had known diabetes prior to admission. The majority of patients were critically ill with 68% intubated, 48% on vasopressors, 6% requiring dialysis, 38% on insulin drip, 46% were on tube feeds, and 74% received steroids. The racial demographics of the patients were 72% White, 3% Black, 4% Native American, 4% Asian, and 14% other. For ethnicity, 73% identified as Hispanic and half spoke Spanish as their primary language. An estimated 2600 instances of PPE were saved. Challenges that were faced in implementing the program included consistent training of large numbers of staff, maintaining supplies in stock, troubleshooting discordant values, and restricting use of CGM to patients who met qualifications. Conclusion: Overall, the implementation of CGM was successful and received a positive response. Staff in the primary units quickly became comfortable with the application of the technology. Potential challenges in the future include ongoing training, improving troubleshooting of technology, validating the accuracy of the devices, and developing funding for CGM equipment and interpretation.

scholarly journals Effect of Sleep Disorder on Delirium in Post-Cardiac Surgery Patients

2020 ◽  
Vol 47 (5) ◽  
pp. 627-633 ◽  
Author(s):  
Hongbai Wang ◽  
Liang Zhang ◽  
Qipeng Luo ◽  
Yinan Li ◽  
Fuxia Yan
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Sleep Quality ◽  
Sleep Disorder ◽  
Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Post Cardiac Surgery

ABSTRACT:Background:Post-cardiac surgery patients exhibit a higher incidence of postoperative delirium (PD) compared to non-cardiac surgery patients. Patients with various cardiac diseases suffer from preoperative sleep disorder (SPD) induced by anxiety, depression, breathing disorder, or other factors.Objective:To examine the effect of sleep disorder on delirium in post-cardiac surgery patients.Methods:We prospectively selected 186 patients undergoing selective cardiac valve surgery. Preoperative sleep quality and cognitive function of all eligible participants were assessed through the Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment, respectively. The Confusion Assessment Method for Intensive Care Unit was used to assess PD from the first to seventh day postoperatively. Patients were divided into two groups according to the PD diagnosis: (1) No PD group and (2) the PD group.Results:Of 186 eligible patients, 29 (15.6%) were diagnosed with PD. A univariate analysis showed that gender (p = 0.040), age (p = 0.009), SPD (p = 0.008), intraoperative infusion volume (p = 0.034), postoperative intubation time (p = 0.001), and intensive care unit stay time (p = 0.009) were associated with PD. A multivariate logistic regression analysis demonstrated that age (odds ratio (OR): 1.106; p = 0.001) and SPD (OR: 3.223; p = 0.047) were independently associated with PD. A receiver operating characteristic curve demonstrated that preoperative PSQI was predictive of PD (area under curve: 0.706; 95% confidence interval: 0.595–0.816). A binomial logistic regression analysis showed that there was a significant association between preoperative 6 and 21 PSQI scores and PD incidence (p = 0.009).Conclusions:Preoperative SPD was significantly associated with PD and a main predictor of PD.

Drug Use in a Surgical Intensive Care Unit

1986 ◽  
Vol 20 (10) ◽  
pp. 752-756 ◽  
Author(s):  
Joseph F. Dasta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Use ◽  
Patient Characteristics ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Surgical Intensive Care ◽  
Drug Usage ◽  
Time Period ◽  
Short Time

A retrospective review of drug usage in 180 patients admitted to a surgical intensive care unit was conducted. The average stay was three days and the total and daily number of drugs averaged 7.6 and 5.6, respectively. The most common drug class used was antibiotics, with cefazolin being the most commonly used antibiotic. Other commonly used drugs include analgesics, diuretics, H2-antagonists, vasoactive drugs and inotropes, antacids, and antiarrhythmics. This study indicates that patients admitted to a surgical intensive care unit are exposed to a variety of potent drugs, often given in combination over a short time period. Although further studies are needed to delineate specific aspects of drug use and patient characteristics, this study suggests that there is a need for close monitoring of drug therapy in these patients with special attention to reduction of drug costs.

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

2019 ◽  
Vol 40 (05) ◽  
pp. 571-579
Author(s):  
Mayanka Tickoo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Glycemic Control ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Physiological Stress ◽  
Close Monitoring ◽  
Physiological Stress Response ◽  
Downstream Effects ◽  
Personalized Approach

AbstractIn the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.

Sleep and Sleep Disorders in Tourette Syndrome: What is Known and What is Still Unknown

2020 ◽  
Vol 15 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Arie Oksenberg
Keyword(s):  
Sleep Disorders ◽  
Sleep Disorder ◽  
Tourette Syndrome ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Life Quality ◽  
Sleep Stages ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Impaired Sleep

Background: Most of the patients with Tourette Syndrome (TS) present additional comorbidities. Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD) are the most common. Sleep Disorder has been suggested also as common comorbidity. Objective: To review the literature on sleep characteristics and sleep disorder in patients with Tourette Syndrome (TS), with emphasis on the contribution of specific co-morbidities to the severity of impaired sleep and life quality of the patients. Results: In general, sleep problems are not frequent at the age when tics appear which are estimated to affect about 10 % of these children. In severe cases, tics appear in all sleep stages. In a large study, the prevalence of sleep problems was 17.8% but was 12 % in “TS-only” (9.4% in children and 7.5 in adults) compared to 22% in children and 18% in adults with TS+ADHD. Unfortunately, in most of the studies, the characteristics of these “sleep problems” are not defined. In spite of the scarcity of data, the two main sleep disorders in TS patients are insomnia and parasomnias. Although much more data is needed, many TS subjects are sleep deprived (which exacerbate the tics) and may suffer from excessive daytime sleepiness, which negatively affects normal functioning. Conclusions: Although the literature is not conclusive, children and adolescents with TS appear to suffer more from sleep disturbances and sleep disorders than age-matched controls. Not all patients have tics during sleep, but in severe cases, tics may appear in all sleep stages. It is clear that when patients present both TS and ADHD, (a very common condition), the sleep difficulties are related mainly to ADHD. Much more research is warranted in all aspects of sleep and sleep disorders in TS.

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