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

基本信息

批准号：
10191387
负责人：
Makayla Cordoza
金额：
$ 9.1万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
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/10191387
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 Wireless Technology 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

项目摘要

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.

项目概要重症监护病房 (ICU) 中超过三分之一的患者出现 ICU 谵妄，这是一种急性的、波动性的形式认知功能障碍与死亡率增加、ICU 住院时间和住院天数延长有关机械通气；并且不成比例地增加长期认知障碍的风险。 ICU 中的睡眠被认为会导致 ICU 谵妄的发生，然而，睡眠-谵妄尽管 ICU 患者每人保持充足的睡眠时间，但这种关系尚未得到严格研究。 24小时内，睡眠结构严重紊乱，即快速眼动明显减少。与健康成年人相比，快速眼动睡眠 (REM) 睡眠不足与神经退行性疾病有关。痴呆症等疾病的特征与 ICU 谵妄症相似，快速眼动睡眠时间较少。与没有 ICU 的谵妄患者相比，虽然暂时性尚不清楚，但目前还不清楚。研究调查了 ICU 谵妄发生前的睡眠情况，但没有研究能够客观解释我们提出了一种新方法，通过利用人群来解决这些关键差距。计划术后入住 ICU 的胸外科候选人，以进行基线睡眠评估。研究：K99 阶段研究将评估临床和人口预测因素的天数百分比回顾性电子健康记录中 ICU 急性期（第 1 至 14 天）的 ICU 谵妄或昏迷 (DoDC) 宾夕法尼亚大学医疗系统 (UPHS) 胸外科患者 (N=4,849) 的记录研究从 2015 年至今，由于 ICU 不定期评估睡眠，因此无法评估自 2015 年起的睡眠情况。因此，我们将首先确定 ICU 谵妄的非睡眠预测因素，然后才能进行评估。如果未来研究中测量的睡眠指数能够解释 ICU 谵妄的很大一部分差异，则不能 R00 阶段研究将评估平均分钟数的差异。在一项前瞻性观察队列研究中，有或没有 ICU 谵妄患者每晚的快速眼动睡眠 UPHS 的胸外科候选人 (N=148) 将使用无线技术对睡眠进行评估。基线时（ICU 前）和术后 ICU 各 3 天进行脑电图检查。在 R00 队列 (N=20) 中，将评估由于 ICU 环境而从睡眠中醒来的频率。这些研究的结果将用于为未来促进睡眠干预措施的开发提供信息。培训：为了实现总体职业目标，培训计划将建立在候选人的背景之上通过为她提供临床睡眠方面的深入培训，为健康人提供重症监护和睡眠和 ICU 人群，以及 ICU 谵妄机制的培训和预测模型的开发。培训还将包括提高她的科学传播技能以及技能发展成为科学界的领导者需要采取多种方法来实现这些目标。目标包括正式课程、实践培训和结构化的一对一指导。