Altered Circadian Rhythmicity in Patients in the ICU

Gazendam, Joost A. C.; Dongen, Hans P A Van; Grant, Devon A.; Freedman, Neil; Zwaveling, JH; Schwab, Richard J.

doi:10.1378/chest.12-2405

Cited by 83 publications

(89 citation statements)

References 56 publications

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“…Recent data support the use of core body temperature or 6-sulfatoxymelatonin as phase markers in critically ill patients. Fever, organ dysfunction, and medications may, however, render these measurements unreliable (13,25).…”

Section: Circadian Rhythm Alterations In Critically Ill Patientsmentioning

confidence: 99%

Sleep in the Intensive Care Unit

Pisani

Friese

Gehlbach

et al. 2015

Am J Respir Crit Care Med

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300

253

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Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.

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Section: Circadian Rhythm Alterations In Critically Ill Patientsmentioning

confidence: 99%

Sleep in the Intensive Care Unit

Pisani

Friese

Gehlbach

et al. 2015

Am J Respir Crit Care Med

Self Cite

300

253

View full text Add to dashboard Cite

show abstract

“…45 In a recent study, Gazendam and colleagues 46 found that acrophases were shifted (advanced or delayed) in 81% of patients, but that this shift was stable across days in each individual. In contrast, in a large cohort of 137 patients investigated after thoracic or vascular surgery, core body temperature showed no circadian rhythmicity in most patients during the first 3 postoperative days.…”

Section: Circadian Rhythms and Melatonin In Intensive Care Unit Patientsmentioning

confidence: 99%

Sleep Neurobiology and Critical Care Illness

Drouot

Quentin

2016

Sleep Medicine Clinics

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“…38,39 Therefore, although suppression of biological rhythms is an energy-preserving mechanism that is beneficial under stress, 40 the effects of long-term disruption of rhythms are pathologic, 41 leading to worse outcomes and delayed recovery. 42 Recent evidence supported the potential of using circadian systems as a therapeutic target. 43 …”

Section: Ra and Circadian Rhythmsmentioning

confidence: 99%

The Potential of Circadian Realignment in Rheumatoid Arthritis

Rao

Pierre

Schlesinger

et al. 2016

Crit Rev Biomed Eng

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In this short review, we discuss evidence supporting the modulation of peripheral circadian systems as a therapeutic strategy for rheumatoid arthritis (RA). We first review the role of proinflammatory cytokines and oxidative stress, two of the primary mediators of chronic inflammation in RA, and their regulation by circadian clock machinery. We further highlight the role of environmental and metabolic signals in regulating the central and peripheral circadian clocks, with an emphasis on seasonal variations in photoperiod and rhythmic metabolic input, respectively. Finally, we hypothesize that the entrainment and realignment of peripheral clock rhythms have the ability to modulate these mediators, improving clinical outcomes in RA patients. Our discussion emphasizes the use of light therapy and time-restricted feeding for entraining peripheral clocks either via the entrainment of the central circadian clock in suprachiasmatic nuclei (SCN) or directly by uncoupling the peripheral circadian clocks from SCN. In doing so, we highlight the use of nonpharmacologic interventions as a potential strategy for improving clinical outcomes in chronic inflammatory conditions such as RA.

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Altered Circadian Rhythmicity in Patients in the ICU

Abstract: The findings indicate that circadian rhythms are present but altered in patients in the ICU, with the degree of circadian abnormality correlating with severity of illness.

Cited by 83 publications

References 56 publications

Sleep in the Intensive Care Unit

Sleep in the Intensive Care Unit

Sleep Neurobiology and Critical Care Illness

The Potential of Circadian Realignment in Rheumatoid Arthritis

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