Sleep assessment in critically ill patients the night before a spontaneous breathing trial: a feasibility and descriptive study.
CCCF ePoster library. Dres M. Nov 1, 2016; 150934; 54 Disclosure(s): none
Dr. Martin Dres
Dr. Martin Dres
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Abstract
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#54

Topic: Clinical Trial

Sleep assessment in critically ill patients the night before a spontaneous breathing trial: a feasibility and descriptive study.


Martin Dres1,2, Edmond Chau1,2, Tetyana Kendzerska3,4, Domenico Grieco1,2, Nuttapol Rittayamai1,2, Sangeeta Mehta5,7, Elizabeth Wilcox6,7, Richard Leung3,4, Laurent Brochard1,2,7
 
1Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
2Medical surgical Intensive Care Unit, St Michael’s Hospital, Toronto, Canada.
3Respirology and Sleep laboratory, St Michael’s, Toronto
4Institute for Clinical Evaluative Sciences, Toronto, Canada
5Intensive Care Unit, Mount Sinai Hospital, Toronto, Canada.
6Department of Critical Care, Toronto Western Hospital, Toronto
7Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.


Grant acknowledgements:
M.D. was supported by the French Intensive Care Society (bourse de mobilite´2015). The 2015 Short-Term Fellowship program of the European Respiratory Society. The2015 Bernhard Drager Award for advanced treatment of ARF of the European Society of Intensive Care Medicine, the Assistance Publique – Hoˆpitaux de Paris and the Fondation pour la Recherche Me´dicale (FDM 20150734498).N.R. was receiving a grant from his home institution in Thailand.

Abstract:
Introduction
Sleep disruption and poor sleep quality are common problems in critically ill patients, particularly during mechanical ventilation. The association between sleep disruption and weaning outcome has not been studied. Our study objective is to describe sleep patterns in critically ill patients the night before a spontaneous breathing trial (SBT). We describe the feasibility of our study approach and preliminary description of the sleep recordings.
 
Methods
The study took place in 3 Intensive Care Units of large urban hospitals in Toronto. Mechanically ventilated patients were enrolled if the clinical team planned to conduct an SBT the following day. Patients were excluded if they had central nervous system disease impairing consciousness with Glasgow Coma Scale ≤8, and if they were previously diagnosed with predominantly central sleep apnea. On the night prior to the planned SBT, sleep architecture was recorded from 5 pm to 8 am using an unattended portable sleep diagnostic device (Alice PDx, Philips, Murrysville, USA). Alice PDx includes six electrodes and two bands (thorax and abdomen) and records electroencephalography, electrooculography, electromyography, electrocardiography, and chest and abdominal effort. SBT was performed under continuous positive airway pressure set at 0 cmH2O.
 
Results
Preliminary results from the first 10 patients (66±14 years, 2 females, APACHE II score 16±6) were assessed. One of the 10 patients died before having a diagnostic sleep test.
At the time of the sleep test, patients had been ventilated for a median of 5 (3-6) days. Richmond Agitation Sedation Scale was 0 for the 9 patients. All patients were ventilated in pressure support mode. Overall, the total recording time per patient was 13.9 hours (median, IQR 12.3-14.4) and total sleep time was 11.1 hours (8.6-12.1); with sleep efficiency of 80% (75-85). Slow wave (Stage 3) represented 8% (1-13) and rapid eye movement (REM) stage represented 0% (0-2) of total sleep time. Arousal index was 31 (28-42) per hour. Tracings of abnormal wakefulness or abnormal sleep were observed. All 9 patients had an SBT the day after the sleep test; 6 patients passed the SBT (3 were extubated), and 3 failed. At this stage no comparison was made between patients who succeeded and failed the SBT.

Conclusion
Sleep patterns in critically ill patients the night before a spontaneous breathing trial was characterized by a fragmented sleep, decreased slow-wave (deep) and rapid eye movement sleep, an abnormal electroencephalographic pattern and disruption of the circadian sleep cycle. Further data are needed to explore the potential impact of sleep disruption on weaning outcome.
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