背景：睡眠異常在ICU中很常見，并與譫妄和死亡率增加有關(guān)。如果需要鎮(zhèn)靜，通常使用GABA(γ-氨基丁酸)激動劑，如丙泊酚或咪達(dá)唑侖，這導(dǎo)致患者缺乏快速動眼睡眠。我們的目的是評估右美托咪定對睡眠質(zhì)量和時(shí)長的影響。

方法：本研究是一項(xiàng)雙盲、隨機(jī)、安慰劑對照試驗(yàn)，共納入30名患者，分為兩個組：20名患者接受右美托咪啶治療，10名患者接受安慰劑治療。每個患者連續(xù)兩個晚上進(jìn)行兩次16小時(shí)的多導(dǎo)睡眠監(jiān)測。在第一次記錄后，患者被隨機(jī)分為右美托咪定或安慰劑組，從而為所有患者提供了對照數(shù)據(jù)。在第二次監(jiān)測期間(下午6點(diǎn)-早上6點(diǎn))注射右美托咪定。目的：比較右美托咪定與安慰劑對睡眠質(zhì)量和時(shí)長的影響。主要結(jié)果：睡眠質(zhì)量、總睡眠時(shí)間(TST)、睡眠效率(SE)和由PSG確定的REM睡眠次要結(jié)果：由CAMICU(重癥監(jiān)護(hù)病房的混亂評估方法)和體力活動測定的譫妄和日間功能。由RASS(Richmond躁動-鎮(zhèn)靜評分)評估的警覺性和清醒程度。

Sleep quality and quantity determined by polysomnography in mechanically ventilated critically ill patients randomized to dexmedetomidine or placebo

Background: Abnormal sleep is commonly observed in the ICU and is associated with delirium and increased mortality. If sedation is necessary, it is often performed with GABA (gamma-aminobutyric acid) agonists such as propofol or midazolam leading to an absence of restorative sleep. We aim to evaluate the effect of dexmedetomidine on sleep quality and quantity.

Methods：Thirty consecutive patients were included. The study was conducted as a double-blinded, randomized, placebo-controlled trial with two parallel groups: 20 patients were treated with dexmedetomidine, and 10 with placebo. Two 16 hours of polysomnography recordings were done for each patient on two consecutive nights. Patients were randomized to dexmedetomidine or placebo after the first recording, thus providing a control recording for all patients. Dexmedetomidine was administered during the second recording (6 pm. – 6 am.). Objective: To compare the effect of dexmedetomidine vs. placebo on sleep - quality and quantity. Primary outcome: Sleep quality, total sleep time (TST), Sleep efficiency (SE), and REM sleep determined by PSG Secondary outcome: Delirium and daytime function determined by CAM ICU (Confusion Assessment Method of the Intensive Care Unit) and physical activity. Alertness and wakefulness determined by RASS (Richmond Agitation and Sedation Scale).

Results: SE were increased in the dexmedetomidine group by; 37.6% (29.7;45.6 95% CI) vs. 3.7% (-11.4;18.8 95% CI) (p<0.001) and TST were prolonged by 271 min. (210;324 95% CI) vs. 27 min. (-82;135 95% CI), (p<0.001). No significant difference in REM sleep, delirium physical activity or RASS score was found except RASS night two.

Conclusion: Total sleep time and sleep efficiency were significantly increased, without elimination of REM sleep, in mechanically ventilated ICU patients randomized to dexmedetomidine, when compared to a control PSG recording performed during non-sedation/standard care.