Delirium and sleep in intensive care I – epidemiology, risk factors and outcomes
Authors:
M. Kovář 1,2,5; J. Bednařík 3,5; L. Bakošová 3,5; D. Kec 3,5; E. Klabusayová 1,2,5; T. Bönischová 1,2,5; J. Klučka 1,2,5; J. Maláska 1,2,4,5
Authors‘ workplace:
Klinika dětské anesteziologie a resuscitace FN Brno
1; Ústav simulační medicíny, LF MU Brno
2; Neurologická klinika FN Brno
3; II. Anesteziologicko-resuscitační oddělení, FN Brno
4; LF MU, Brno
5
Published in:
Cesk Slov Neurol N 2023; 86(5): 299-303
Category:
Review Article
doi:
https://doi.org/10.48095/cccsnn2023299
Overview
Poor quality of sleep and delirium are frequent complications of intensive care. The incidence of both complications is high, and evidence-based medicine has significantly demonstrated serious consequences in both cases. More data are available on delirium. While there is significant room for further research on sleep quality impairment, there are also technical limitations of monitoring and diagnosis. This article summarises known data on the epidemiology and risk factors of decreased quality of sleep and delirium in the intensive care setting.
Keywords:
intensive care – sleep – delirium – risk factors – critical care outcomes
Sources
1. Krewulak KD, Stelfox HT, Leigh JP et al. Incidence and prevalence of delirium subtypes in an adult ICU: a systematic review and meta-analysis. Crit Care Med 2018; 46 (12): 2029–2035. doi: 10.1097/CCM.0000000000003402.
2. Foreman B, Westwood AJ, Claassen J et al. Sleep in the neurological intensive care unit: feasibility of quantifying sleep after melatonin supplementation with environmental light and noise reduction. J Clin Neurophysiol 2015; 32 (1): 66–74. doi: 10.1097/WNP.0000000000000110.
3. Sinha S, Soneja M, Naik RD et al. Sleep quality and quantity in intensive care unit patients: a cross-sectional study. Indian J Crit Care Med 2018; 22 (6): 408–414. doi: 10.4103/ijccm.IJCCM_65_18.
4. Honarmand K, Rafay H, Le J et al. A systematic review of risk factors for sleep disruption in critically ill adults. Crit Care Med 2020; 48 (7): 1066–1074. doi: 10.1097/CCM.0000000000004405.
5. Salluh JIF, Wang H, Schneider EB et al. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ 2015; 350: h2538–h2538. doi: 10.1136/bmj.h2538.
6. Fiest KM, Soo A, Hee Lee C et al. Long-term outcomes in ICU patients with delirium: a population-based cohort study. Am J Respir Crit Care Med 2021; 204 (4): 412–420. doi: 10.1164/rccm.202002-0320OC7.
7. Hrežová L, Bednařík J. Management deliria v neurointenzivní péči v České republice – dotazníková studie. Cesk Slov Neurol N 2022; 85 (4): 325–329. doi: 10.48095/cccsnn2022325.
8. Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep 1996; 19 (4): 318–326. doi: 10.1093/sleep/19.4.318.
9. Kahn-Greene ET, Killgore DB, Kamimori GH et al. The effects of sleep deprivation on symptoms of psychopathology in healthy adults. Sleep Med 2007; 8 (3): 215–221. doi: 10.1016/j.sleep.2006.08.007.
10. Waters F, Chiu V, Atkinson A et al. Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake. Front Psychiatry 2018; 9: 303. doi: 10.3389/fpsyt.2018.00303.
11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association 2013. doi: 10.1176/appi.books.9780890425596.
12. Carskadon MA, Dement WC. Normal human sleep. In: Principles and practice of sleep medicine. Elsevier 2017; 15–24.e3. doi: 10.1016/B978-0-323-24288-2.00002-7.
13. Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: from physiological to pathological conditions. Sleep Sci 2015; 8 (3): 143–152. doi: 10.1016/j.slsci.2015.09.002.
14. Poza JJ, Pujol M, Ortega-Albás JJ et al. Melatonin in sleep disorders. Neurología (Engl Ed) 2022; 37 (7): 575–585. doi: 10.1016/j.nrleng.2018.08.004.
15. Pisani MA, D’Ambrosio C. Sleep and delirium in adults who are critically ill. Chest 2020; 157 (4): 977–984. doi: 10.1016/j.chest.2019.12.003.
16. Faraut B, Boudjeltia KZ, Vanhamme L et al. Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery. Sleep Med Rev 2012; 16 (2): 137–149. doi: 10.1016/j.smrv.2011.05.001.
17. Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999; 354 (9188): 1435–1439. doi: 10.1016/S0140-6736 (99) 01376-8.
18. Boudjeltia KZ, Faraut B, Stenuit P et al. Sleep restriction increases white blood cells, mainly neutrophil count, in young healthy men: a pilot study. Vasc Health Risk Manag 2008; 4 (6): 1467–1470. doi: 10.2147/vhrm.s3934.
19. Berry RB, Brooks R, Gamaldo CE al et. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Version 2.4. American Academy of Sleep Medicine 2017. doi: 10.5664/jcsm.6576.
20. Memar P, Faradji F. A novel multi-class EEG-based sleep stage classification system. IEEE Trans Neural Syst Rehabil Eng 2018; 26 (1): 84–95. doi: 10.1109/TNSRE. 2017.2776149.
21. Friese RS, Diaz-Arrastia R, McBride D et al. Quantity and quality of sleep in the surgical intensive care unit: are our patients sleeping? J Trauma Inj Infect Crit Care 2007; 63 (6): 1210–1214. doi: 10.1097/TA.0b013e31815b83d7.
22. Gazendam JAC, Van Dongen HPA, Grant DA et al. Altered circadian rhythmicity in patients in the ICU. Chest 2013; 144 (2): 483–489. doi: 10.1378/chest.12-2405.
23. Devlin JW, Skrobik Y, Gélinas C et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018; 46 (9): e825–e873. doi: 10.1097/CCM.00000 00000003299.
24. Trompeo AC, Vidi Y, Locane MD et al. Sleep disturbances in the critically ill patients: role of delirium and sedative agents. Minerva Anestesiol 2011; 77 (6): 604–612.
25. White DP, Douglas NJ, Pickett CK et al. Sleep deprivation and the control of ventilation. Am Rev Respir Dis 1983; 128 (6): 984–986. doi: 10.1164/arrd.1983.128.6.984.
26. Roche Campo F, Drouot X, Thille AW et al. Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure. Crit Care Med 2010; 38 (2): 477–485. doi: 10.1097/CCM.0b013e3181bc8243.
27. Watson PL, Pandharipande P, Gehlbach BK et al. Atypical sleep in ventilated patients: empirical electroencephalography findings and the path toward revised ICU sleep scoring criteria. Crit Care Med 2013; 41 (8): 1958–1967. doi: 10.1097/CCM.0b013e31828a3f75.
28. Berry RB, Brooks R, Gamaldo C et al. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med 2017; 13 (5): 665–666. doi: 10.5664/jcsm.6576.
29. Káňová M, Burda M, Povová J et al. Delirium u kriticky nemocných – prospektivní studie. Cesk Slov Neurol N 2015; 78/111 (6): 662–667.
30. Mitášová A, Mitáš L, Urbánek I et al. Incidence a rizikové faktory pooperačního deliria. Cesk Slov Neurol N 2012; 75 (108 (5): 574–580.
31. Mitasova A, Kostalova M, Bednarik J et al. Poststroke delirium incidence and outcomes: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 2012; 40 (2): 484–490. doi: 10.1097/CCM.0b013e318232da12.
32. Lobo-Valbuena B, Gordo F, Abella A et al. Risk factors associated with the development of delirium in general ICU patients. A prospective observational study. PLoS One 2021; 16 (9): e0255522. doi: 10.1371/journal.pone.0255522.
33. Zaal IJ, Devlin JW, Peelen LM et al. A systematic review of risk factors for delirium in the ICU. Crit Care Med 2015; 43 (1): 40–47. doi: 10.1097/CCM.0000000000000 625.
34. Kotfis K, Marra A, Ely EW. ICU delirium – a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther 2018; 50 (2): 160–167. doi: 10.5603/AIT.a2018.0011.
35. Pan Y, Yan J, Jiang Z et al. Incidence, risk factors, and cumulative risk of delirium among ICU patients: a case-control study. Int J Nurs Sci 2019; 6 (3): 247–251. doi: 10.1016/j.ijnss.2019.05.008.
36. Steinberg BE, Sundman E, Terrando N et al. Neural control of inflammation. Anesthesiology 2016; 124 (5): 1174–1189. doi: 10.1097/ALN.0000000000001 083.
37. Ormseth CH, LaHue SC, Oldham MA et al. Predisposing and precipitating factors associated with delirium: a systematic review. JAMA Netw Open 2023; 6 (1): e2249950. doi: 10.1001/jamanetworkopen.2022.49 950.
38. Knauert MP, Gilmore EJ, Murphy TE et al. Association between death and loss of stage N2 sleep features among critically ill patients with delirium. J Crit Care 2018; 48: 124–129. doi: 10.1016/j.jcrc.2018.08.028.
39. Tonna JE, Dalton A, Presson AP et al. The effect of a quality improvement intervention on sleep and delirium in critically ill patients in a surgical ICU. Chest 2021; 160 (3): 899–908. doi: 10.1016/j.chest.2021.03.030.
40. Altman MT, Knauert MP, Murphy TE et al. Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: an observational cohort study. Ann Intensive Care 2018; 8 (1): 63. doi: 10.1186/s13613-018-0408-4.
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
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