Assessment of sleep in ventilator-supported critically ill patients

Cristina Ambrogio, Jeffrey Koebnick, Stuart F Quan, V. Marco Ranieri, Sairam Parthasarathy

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objectives: In critically ill patients, sleep derangements are reported to be severe using Rechtschaffen and Kales (R&K) methodology; however, whether such methodology can reliably assess sleep during critical illness is unknown. We set out to determine the reproducibility of 4 different sleep-assessment methods (3 manual and 1 computer-based) for ventilator-supported critically ill patients and also to quantify the extent to which the reproducibility of the manual methods for measuring sleep differed between critically ill and ambulatory (control) patients. Design: Observational methodologic study. Setting: Academic center. Patients: Critically ill patients receiving mechanical ventilation and age-matched controls underwent polysomnography. Interventions: None. Measurements and Results: Reproducibility for the computer-based method (spectral analysis of electroencephalography [EEG]) was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern (P = 0.03). In critically ill patients, the proportion of misclassifications for measurements using spectral analysis, sleep-wakefulness organization pattern, and R&K methodology were 0%, 36%, and 53%, respectively (P < 0.0001). The EEG pattern of burst suppression was not observed. Interobserver and intraobserver reliability of the manual sleep-assessment methods for critically ill patients (K = 0.52 ± 0.23) was worse than that for control patients (K = 0.89 ± 0.13; P = 0.03). In critically ill patients, the overall reliability of the R&K methodology was relatively low for assessing sleep (K = 0.19), but detection of rapid eye movement sleep revealed good agreement (K = 0.70). Conclusions: Reproducibility for spectral analysis of EEG was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern. For assessment of sleep in critically ill patients, the use of spectral analysis, sleep-wakefulness organization state, or rapid eye movement sleep alone may be preferred over the R&K methodology.

Original languageEnglish (US)
Pages (from-to)1559-1568
Number of pages10
JournalSleep
Volume31
Issue number11
StatePublished - Nov 1 2008

Fingerprint

Mechanical Ventilators
Critical Illness
Sleep
Wakefulness
Electroencephalography
REM Sleep
Polysomnography
Brassica
Artificial Respiration
Reproducibility of Results
Observational Studies

Keywords

  • Artificial respiration
  • Critical illness
  • Physiologic monitoring
  • Polysomnography
  • Reproducibility of results

ASJC Scopus subject areas

  • Physiology (medical)
  • Clinical Neurology

Cite this

Ambrogio, C., Koebnick, J., Quan, S. F., Ranieri, V. M., & Parthasarathy, S. (2008). Assessment of sleep in ventilator-supported critically ill patients. Sleep, 31(11), 1559-1568.

Assessment of sleep in ventilator-supported critically ill patients. / Ambrogio, Cristina; Koebnick, Jeffrey; Quan, Stuart F; Ranieri, V. Marco; Parthasarathy, Sairam.

In: Sleep, Vol. 31, No. 11, 01.11.2008, p. 1559-1568.

Research output: Contribution to journalArticle

Ambrogio, C, Koebnick, J, Quan, SF, Ranieri, VM & Parthasarathy, S 2008, 'Assessment of sleep in ventilator-supported critically ill patients', Sleep, vol. 31, no. 11, pp. 1559-1568.
Ambrogio C, Koebnick J, Quan SF, Ranieri VM, Parthasarathy S. Assessment of sleep in ventilator-supported critically ill patients. Sleep. 2008 Nov 1;31(11):1559-1568.
Ambrogio, Cristina ; Koebnick, Jeffrey ; Quan, Stuart F ; Ranieri, V. Marco ; Parthasarathy, Sairam. / Assessment of sleep in ventilator-supported critically ill patients. In: Sleep. 2008 ; Vol. 31, No. 11. pp. 1559-1568.
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abstract = "Objectives: In critically ill patients, sleep derangements are reported to be severe using Rechtschaffen and Kales (R&K) methodology; however, whether such methodology can reliably assess sleep during critical illness is unknown. We set out to determine the reproducibility of 4 different sleep-assessment methods (3 manual and 1 computer-based) for ventilator-supported critically ill patients and also to quantify the extent to which the reproducibility of the manual methods for measuring sleep differed between critically ill and ambulatory (control) patients. Design: Observational methodologic study. Setting: Academic center. Patients: Critically ill patients receiving mechanical ventilation and age-matched controls underwent polysomnography. Interventions: None. Measurements and Results: Reproducibility for the computer-based method (spectral analysis of electroencephalography [EEG]) was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern (P = 0.03). In critically ill patients, the proportion of misclassifications for measurements using spectral analysis, sleep-wakefulness organization pattern, and R&K methodology were 0{\%}, 36{\%}, and 53{\%}, respectively (P < 0.0001). The EEG pattern of burst suppression was not observed. Interobserver and intraobserver reliability of the manual sleep-assessment methods for critically ill patients (K = 0.52 ± 0.23) was worse than that for control patients (K = 0.89 ± 0.13; P = 0.03). In critically ill patients, the overall reliability of the R&K methodology was relatively low for assessing sleep (K = 0.19), but detection of rapid eye movement sleep revealed good agreement (K = 0.70). Conclusions: Reproducibility for spectral analysis of EEG was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern. For assessment of sleep in critically ill patients, the use of spectral analysis, sleep-wakefulness organization state, or rapid eye movement sleep alone may be preferred over the R&K methodology.",
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AB - Objectives: In critically ill patients, sleep derangements are reported to be severe using Rechtschaffen and Kales (R&K) methodology; however, whether such methodology can reliably assess sleep during critical illness is unknown. We set out to determine the reproducibility of 4 different sleep-assessment methods (3 manual and 1 computer-based) for ventilator-supported critically ill patients and also to quantify the extent to which the reproducibility of the manual methods for measuring sleep differed between critically ill and ambulatory (control) patients. Design: Observational methodologic study. Setting: Academic center. Patients: Critically ill patients receiving mechanical ventilation and age-matched controls underwent polysomnography. Interventions: None. Measurements and Results: Reproducibility for the computer-based method (spectral analysis of electroencephalography [EEG]) was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern (P = 0.03). In critically ill patients, the proportion of misclassifications for measurements using spectral analysis, sleep-wakefulness organization pattern, and R&K methodology were 0%, 36%, and 53%, respectively (P < 0.0001). The EEG pattern of burst suppression was not observed. Interobserver and intraobserver reliability of the manual sleep-assessment methods for critically ill patients (K = 0.52 ± 0.23) was worse than that for control patients (K = 0.89 ± 0.13; P = 0.03). In critically ill patients, the overall reliability of the R&K methodology was relatively low for assessing sleep (K = 0.19), but detection of rapid eye movement sleep revealed good agreement (K = 0.70). Conclusions: Reproducibility for spectral analysis of EEG was better than that for the manual methods: R&K methodology and sleep-wakefulness organization pattern. For assessment of sleep in critically ill patients, the use of spectral analysis, sleep-wakefulness organization state, or rapid eye movement sleep alone may be preferred over the R&K methodology.

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