Investigation of Sleep in the Intensive Care Unit (ICU-SLEEP)

重症监护病房睡眠调查（ICU-SLEEP）

• 批准号: 10372017
• 负责人: Michael Brandon Westover
• 金额: $ 27.03万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10372017
• 关键词: Acute; Adrenergic Receptor; Affect; Agonist; Anesthesiology; Antipsychotic Agents; Attention; Base of the Brain; Benzodiazepines; Biomimetics; Bolus Infusion; Brain; Caring; Cerebrovascular Circulation; Cessation of life; Clinical Trials; Clinical Trials Cooperative Group; Clinical Trials Unit; Cognitive; Confusion; Continuous Infusion; Critical Illness; Data; Delirium; Development; Dexmedetomidine; Dose; Electroencephalogram; Encephalopathies; GABA Agents; GABA Agonists; Hospitalization; Hour; Impaired cognition; Impairment; Incidence; Infusion procedures; Intensive Care Units; Intervention; Investigation; Knowledge; Light; Link; Longitudinal Studies; Mediating; Mediation; Memory; Monitor; Morbidity - disease rate; Neuropsychology; Operative Surgical Procedures; Outcome; Outcome Measure; Patient Care; Patients; Pattern; Pharmaceutical Preparations; Phase; Phase III Clinical Trials; Placebo Control; Placebos; Positioning Attribute; Propofol; Randomized; Reaction Time; Risk; Risk Factors; Sleep; Sleep Architecture; Sleep Deprivation; Sleep Disorders; Sleep Fragmentations; Sleep Stages; Sleep disturbances; Slow-Wave Sleep; Subclinical Seizures; Surgical Intensive Care; Survivors; Testing; Therapeutic; alpha 2 agonist; arm; brain health; cognitive disability; cognitive function; cognitive testing; cost; design; experience; improved; insight; modifiable risk; mortality; neuropsychiatry; noise pollution; older patient; patient population; personalized approach; preservation; prevent; prophylactic; sedative; sleep physiology; sleep quality; treatment as usual; zolpidem

PROJECT SUMMARY / ABSTRACT: Investigation of Sleep in the Intensive Care Unit (ICU-SLEEP) Sleep deprivation is among the most common complaints about the ICU experience. ICU sleep tends to be light and non-restorative (as opposed to deep / restorative sleep), severely fragmented, and distributed throughout the day and night rather than consolidated into nighttime hours. Sleep deprived patients suffer from sleep debt, a condition of impaired attention and memory, and cognitive slowing. Sleep disturbances in the ICU arise not only from light and noise pollution, but also from drugs that interfere with brain activity involved in restorative sleep. Sleep deprivation has also been suggested as a major modifiable risk factors for acute encephalopathy, also known as delirium. Delirium is an acute state of confusion that affects up to 80% of ICU patients, and is one of six leading causes of preventable morbidity and mortality in hospitalized elderly patients. Many patients who survive delirium experience long-term cognitive impairment and loss of independence. Current medications used in the ICU to treat sleep problems (e.g. benzodiazepines, antipsychotics) do not induce natural sleep and do not prevent delirium. In contrast, we have found that the α2-adrenoceptor agonist dexmedetomidine can induce biomimetic sleep, a brain state whose pattern of electroencephalogram (EEG) activity, cerebral blood flow, and functional connectivity approximates restorative sleep. Moreover, a recent large clinical trial in post-surgical patients suggests that low-dose dexmedetomidine given overnight substantially reduces the risk of delirium. It is unknown whether this benefit is linked to improved sleep, or whether patients with better sleep while in the ICU have better long-term cognitive outcomes. Our central hypothesis is that sleep deprivation substantially mediates both the short- and long-term cognitive impairments associated with delirium in critical illness. To test this hypothesis, our specific aims are designed to systematically determine 1) the impact of prophylactic dexmedetomidine on sleep quality, 2) the optimal way to give dexmedetomidine (all night vs at the beginning of the night only), 2) the impact of sleep deprivation on short-term cognitive function and delirium, and 3) the contribution of sleep deprivation to long-term neuropsychiatric outcome following critical illness. At the conclusion of these studies, we will have expanded our knowledge of sleep physiology in critical illness and relationship of sleep with delirium; evaluated a new preemptive therapeutic strategy to promote sleep and prevent delirium, and developed an understanding of how sleep impacts neuropsychological outcomes after critical illness. Our studies will thus will provide crucial guidance for individualized approaches to preserving long-term brain health in this vulnerable patient population.

项目摘要/摘要：重症监护病房 (ICU-SLEEP) 睡眠调查 睡眠不足是 ICU 睡眠趋势中最常见的抱怨之一。 浅度睡眠和非恢复性睡眠（与深度/恢复性睡眠相反）、严重碎片化和分布式 整个白天和晚上，而不是集中在夜间，患者都会遭受睡眠不足的困扰。 睡眠债、注意力和记忆力受损以及重症监护病房中的认知减慢。 不仅来自光和噪音污染，还来自干扰大脑活动的药物 恢复性睡眠也被认为是急性发作的主要可改变危险因素。 脑病，也称为谵妄，是一种急性精神错乱状态，影响 80% 的 ICU 患者。 患者，并且是住院老年患者可预防的发病率和死亡率的六大主要原因之一。 许多在谵妄中幸存下来的患者都会经历长期的认知障碍和丧失独立性。 目前 ICU 中用于治疗睡眠问题的药物（例如苯二氮卓类药物、抗精神病药物）并不有效。 相比之下，我们发现α2-肾上腺素受体激动剂可以诱导自然睡眠，但不能预防谵妄。 右美托咪定可以诱导仿生睡眠，这是一种脑电图（EEG）模式的大脑状态 活动、脑血流量和功能连接接近于恢复性睡眠。 针对术后患者的大型临床试验表明，隔夜给予低剂量右美托咪定 显着降低谵妄的风险尚不清楚这种益处是否与改善睡眠有关。 在 ICU 期间睡眠质量更好的患者是否有更好的长期认知结果。 假设认为睡眠不足会显着介导短期和长期认知障碍 与危重疾病中的谵妄有关 为了检验这一假设，我们的具体目标旨在 仔细确定 1) 预防性右美托咪定对睡眠质量的影响，2) 最佳方法 给予右美托咪定（整夜与仅在夜间开始），2) 睡眠剥夺对 短期认知功能和谵妄，以及 3) 睡眠剥夺对长期认知功能的影响 在这些研究结束时，我们将扩大危重病后的神经精神结局。 我们对危重疾病的睡眠生理学知识以及睡眠与谵妄的关系进行了新的评估； 促进睡眠和预防谵妄的先发性治疗策略，并了解 因此，我们的研究将提供至关重要的睡眠如何影响危重疾病后的神经心理结果。 为该弱势患者提供维持长期大脑健康的个体化方法指导 人口。