Bench-to-bedside review: Delirium in ICU patients - importance of sleep deprivation

Abstract

Delirium occurs frequently in critically ill patients and has been associated with both short-term and long-term consequences. Efforts to decrease delirium prevalence have been directed at identifying and modifying its risk factors. One potentially modifiable risk factor is sleep deprivation. Critically ill patients are known to experience poor sleep quality with severe sleep fragmentation and disruption of sleep architecture. Poor sleep while in the intensive care unit is one of the most common complaints of patients who survive critical illness. The relationship between delirium and sleep deprivation remains controversial. However, studies have demonstrated many similarities between the clinical and physiologic profiles of patients with delirium and sleep deprivation. This article aims to review the literature, the clinical and neurobiologic consequences of sleep deprivation, and the potential relationship between sleep deprivation and delirium in intensive care unit patients. Sleep deprivation may prove to be a modifiable risk factor for the development of delirium with important implications for the acute and long-term outcome of critically ill patients.

Examination of Patterns in Intubation by an Emergency Airway Team at a Large Academic Center: Higher Frequency During Daytime Hours

“…6 An alternative possibility would be diurnal variations in the extent of attention and therapeutic interventions delivered to patients, perhaps as a calculated tradeoff to improve sleep quality and quan- tity. 13,14 This phenomenon has been witnessed when studying calls to medical emergency teams 15 and might imply that intubations that should have been performed overnight are instead delayed until daybreak. Additional study is warranted to determine whether a significant number of early-morning airway consults are performed for patients with more severe respiratory distress or whether this cohort of patients suffer worse clinical outcomes.…”

Effect of Ventilatory Variability on Occurrence of Central Apneas

“…8,34,35 Even if it is well documented that sleep abnormalities may impair psychological and physiological well-being, with effects such as increased protein catabolism, decreased immune function, and altered respiratory mechanics, which could affect weaning from mechanical ventilation, 36 the impact of sleep disturbances on morbidity and mortality remains unknown 37 ; however, it could worsen the quality of life after discharge. 38,39 Quantitative and qualitative deficiencies have been characterized, including decreased total sleep time, fragmented sleep, as well as altered circadian patterns. The etiology of sleep disruption in the ICU is multifactorial, including the inherent nature of environment (exposure to noise and light), medications, mechanical ventilation, and particularly, patient-ventilator interaction and acute illness.…”

Incidence and risk factors for delirium development in ICU patients - a prospective observational study

“…Early recognition and prevention of modifiable factors allow us to ameliorate their impact on patient outcomes. Moreover, the current approach to delirium in critically ill patients has been shifted from treatment to prevention 16,[20][21][22][23][24][25][26][27][28][29][30] and early mobilization 31,32 . The primary aim of this prospective, observational study was to evaluate the incidence of delirium among surgical, trauma and medical patients in one of the six-bed Intensive Care Units of the University Hospital Ostrava.…”