Evaluating the Role of Sleep in the Development of Intensive Care Unit Delirium

评估睡眠在重症监护病房谵妄发生中的作用

• 批准号: 10394899
• 负责人: Makayla Cordoza
• 金额: $ 9.51万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394899
• 关键词: APACHE II; Acute; Address; Admission activity; Adrenal Cortex Hormones; Adult; Age; Agitation; Alcohol abuse; American; Award; Benzodiazepines; Cardiac Surgery procedures; Characteristics; Clinical; Cohort Studies; Coma; Communities; Complex; Critical Care; Critical Illness; Data; Delirium; Dementia; Demographic Factors; Development; Disease; Disorientation; Electroencephalography; Electronic Health Record; Environment; Environmental Risk Factor; Evaluation; Event; Frequencies; Future; Goals; Health system; Heart-Lung Transplantation; Home; Hour; Hypertension; Hypotension; Impaired cognition; Incidence; Individual; Intensive Care Units; Intervention; Learning; Length of Stay; Lighting; Link; Measures; Mechanical ventilation; Medical Records; Memory impairment; Mentorship; Morbidity - disease rate; Neurocognitive; Neurodegenerative Disorders; Noise; Operative Surgical Procedures; Outcome; Patient Care; Patients; Pennsylvania; Phase; Physiological; Polysomnography; Population; Postoperative Period; Predictive Factor; Public Health; REM Sleep; Research; Research Personnel; Risk; Risk Factors; Role; Scientific Advances and Accomplishments; Sedation procedure; Sleep; Sleep Apnea Syndromes; Sleep Architecture; Sleep Deprivation; Sleep disturbances; Structure; Survivors; Symptoms; Testing; Thoracic Surgical Procedures; Time; Training; Universities; adequate sleep; career; clinical care; cognitive function; cohort; common symptom; confusion assessment method; experience; improved; inattention; indexing; modifiable risk; mortality; neurochemistry; novel strategies; patient oriented; predictive modeling; primary outcome; programs; prospective; skill acquisition; skills; sleep quality; wireless

PROJECT SUMMARY More than one third of patients in the intensive care unit (ICU) develop ICU delirium, an acute, fluctuating form of cognitive dysfunction that is associated with increased mortality, and longer ICU lengths of stay and days of mechanical ventilation; and disproportionately increases the risk for long-term cognitive impairment. Disrupted sleep in the ICU is thought to contribute to development of ICU delirium, however the sleep-delirium relationship has not been rigorously investigated. Although ICU patients maintain adequate sleep duration per 24 hours, sleep architecture is severely disrupted. Namely, there is a marked decrease in rapid eye movement (REM) sleep compared to healthy adults. Insufficient REM sleep has been associated with neurodegenerative disease such as dementia, which has similar characteristics to ICU delirium. Less REM sleep has been observed in patients with, compared to without ICU delirium, although the temporality is unclear. To date, few studies have investigated sleep prior to development of ICU delirium, and no studies account for objective baseline sleep. We propose a novel approach to address these critical gaps by leveraging a population of thoracic surgery candidates with a planned post-operative ICU admission to enable baseline sleep evaluation. Research: The K99 phase study will evaluate clinical and demographic predictors of percentage of days with ICU delirium or coma (DoDC) in the acute ICU phase (days 1 up to 14) in a retrospective electronic health record study of thoracic surgery patients (N=4,849) at the University of Pennsylvania Health System (UPHS) from 2015-present. As sleep is not routinely assessed in the ICU, it is not possible to evaluate sleep from medical records. Therefore, we will first identify non-sleep predictors of ICU delirium to then be able to evaluate if sleep indices measured in future studies explains a substantial percentage of the variance in ICU delirium not accounted for by non-sleep predictors. The R00 phase study will evaluate the difference in mean minutes of REM sleep per night for patients with and without ICU delirium in a prospective observational cohort study of thoracic surgery candidates from UPHS (N=148). Sleep will be assessed using wireless electroencephalography at baseline (pre-ICU), and post-operatively in the ICU for 3 days each. In a subset of the R00 cohort (N=20), frequency of awakenings from sleep due to the ICU environment will be assessed. Results from these studies will be used to inform development of future sleep-promoting interventions. Training: To achieve overall career goals, the training plan will build upon the candidate’s background in critical care and sleep in healthy individuals by affording her in-depth training in learning about sleep in clinical and ICU populations, and training in ICU delirium mechanisms and development of predictive models. This training will also include advancing her scientific dissemination skills, as well as development of the skills needed to become a leader in the scientific community. A variety of approaches will be used to achieve these goals including formal coursework, hands-on training, and structured one-on-one mentorship.

项目摘要 重症监护病房（ICU）中有超过三分之一的患者发展了ICU del妄，这是一种急性，波动的形式 与死亡率增加有关的认知功能障碍以及较长的ICU的住院时间和天数 机械通气；不成比例地增加了长期认知障碍的风险。破坏了 ICU中的睡眠被认为有助于ICU妄想的发展 关系尚未经过严格的研究。尽管ICU患者维持足够的睡眠时间 24小时，睡眠体系结构严重禁用。也就是说，快速眼动显着下降 （REM）睡眠与健康的成年人相比。 REM睡眠不足与神经退行性有关 诸如痴呆症之类的疾病，其特征与ICU del妄具有类似的特征。不再需要雷姆睡眠 尽管暂时性尚不清楚，但在没有ICU ir妄的患者中观察到。迄今为止，很少 研究在开发ICU del妄之前已经调查了睡眠，没有任何研究解释客观 基线睡眠。我们提出了一种新颖的方法来解决这些关键差距，通过利用 具有计划的术后ICU入院的胸外科手术候选者可以进行基线睡眠评估。 研究：K99阶段研究将评估临床和人口统计学预测因素 在回顾性电子健康中，急性ICU阶段（最多14天）中的ICU del妄或昏迷（DODC） 宾夕法尼亚大学卫生系统（UPHS）的胸外科手术患者（n = 4,849）的记录研究 从2015年至今。由于没有在ICU中进行常规评估睡眠，因此无法评估睡眠 病历。因此，我们将首先识别ICU del妄的非睡眠预测因子，然后能够评估 如果未来的研究中测量的睡眠指标解释了ICU deli妄差异的很大一部分 由非睡眠预测变量计算。 R00阶段研究将评估平均分钟的差异 在一项前瞻性观察队列研究中，有或没有ICU del妄的患者的REM睡眠每晚。 来自UPHS的胸手术候选者（n = 148）。睡眠将使用无线评估 基线（ICU前）的脑电图，并在ICU进行后3天。在一个子集中 R00队列（n = 20），将评估由于ICU环境而导致的睡眠觉醒频率。 这些研究的结果将用于告知未来促进睡眠干预措施的发展。 培训：为了实现整体职业目标，培训计划将以候选人的背景为基础 健康个体的重症监护和睡眠，通过为学习睡眠学习临床的深入培训。 ICU种群以及ICU ir妄机制的培训和预测模型的发展。这 培训还将包括提高她的科学传播技巧以及发展技能 需要成为科学界的领导者。将使用各种方法来实现这些 目标包括正式课程，动手培训和结构化的一对一思想。

项目成果

Acceptability of the Cognition Test Battery in Astronaut and Astronaut-Surrogate Populations.

• DOI: 10.1016/j.actaastro.2021.09.035
• 发表时间: 2022-01
• 期刊: Acta astronautica
• 影响因子: 3.5
• 作者: Casario K;Howard K;Cordoza M;Hermosillo E;Ibrahim L;Larson O;Nasrini J;Basner M
• 通讯作者: Basner M

Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations: A Secondary Analysis of the iCOMPARE Trial.

与普通医学轮换相比，重症监护实习生的睡眠和警觉性：iCOMPARE 试验的二次分析。

• DOI: 10.4300/jgme-d-21-00045.1
• 发表时间: 2021
• 期刊: Journal of graduate medical education
• 作者: Cordoza,Makayla;Basner,Mathias;Asch,DavidA;Shea,JudyA;Bellini,LisaM;Carlin,Michele;Ecker,AdrianJ;Malone,SusanK;Desai,SanjayV;Katz,JoelT;Bates,DavidW;Small,DylanS;Volpp,KevinG;Mott,ChristopherG;Coats,Sara;Mollicone,
• 通讯作者: Mollicone,