Schlaf in der Intensivmedizin

Kernaussagen

• Schlafstörungen treten beim kritisch kranken Patienten häufig auf und können mit einer schlechteren Prognose vergesellschaftet sein. Tiefe, erholsame Schlafstadien fehlen häufig komplett.

• Exogene Faktoren, wie Licht, Lärm und Interventionen am Patienten sollten nachts möglichst auf ein Minimum reduziert werden.

• Die Analgosedierung stört die Schlafarchitektur und sollte so bald wie möglich beendet werden.

• Bei beatmeten Patienten muss auf eine Synchronität zwischen Beatmungsgerät und Patient geachtet werden. Vor allem bei kardial erkrankten Patienten sollte man aus schlafmedizinischer Sicht nachts eine Beatmungsform mit einer Backup-Atemfrequenz einsetzen.

• Literatur

• 1 Weinhouse GL, Schwab RJ, Watson PL et al. Bench-to-bedside review: delirium in ICU patients – importance of sleep deprivation. Crit Care 2009; 13: 234
• 2 Ely EW, Shintani A, Truman B et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291: 1753-1762
• 3 Stuck BA, Maurer JT, Schredl M et al. Praxis der Schlafmedizin – Schlafstörungen bei Erwachsenen und Kindern Diagnostik, Differenzialdiagnostik und Therapie. Berlin, Heidelberg: Springer; 2013
• 4 Nieuwenhuijs D, Coleman EL, Douglas NJ et al. Bispectral index values and spectral edge frequency at different stages of physiologic sleep. Anesthesia and Analgesia 2002; 94: 125-129
• 5 Tilmanne J, Urbain J, Kothare MV et al. Algorithms for sleep-wake identification using actigraphy: a comparative study and new results. Journal of Sleep Research 2009; 18: 85-98
• 6 Randerath W. Sleep-related breathing disorders. In: Bassetti C, Dogas Z, Peigneux P, eds. European Sleep Medicine Textbook. European Sleep Research Society (EERS). 2014
• 7 Randerath WJ, Hein H, Arzt M et al. Konsensuspapier zur Diagnostik und Therapie schlafbezogener Atmungsstorungen bei Erwachsenen. Somnologie 2014; 18: 34-52
• 8 Esche B, Geiseler J, Karg O. Pneumologie. Lehrbuch für Atmungstherapeuten. Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V.; 2016
• 9 Elliott R, McKinley S, Cistulli P. The quality and duration of sleep in the intensive care setting: an integrative review. International Journal of Nursing Studies 2011; 48: 384-400
• 10 Palmblad J, Petrini B, Wasserman J et al. Lymphocyte and granulocyte reactions during sleep deprivation. Psychosomatic Medicine 1979; 41: 273-278
• 11 Salas RE, Gamaldo CE. Adverse effects of sleep deprivation in the ICU. Critical Care Clinics 2008; 24: 461-476
• 12 Aurell J, Elmqvist D. Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care. BMJ 1985; 290: 1029-1032
• 13 Cooper AB, Thornley KS, Young GB et al. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000; 117: 809-818
• 14 Freedman NS, Gazendam J, Levan L et al. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J of Respiratory and Crit Care Med 2001; 163: 451-457
• 15 Hardin KA, Seyal M, Stewart T et al. Sleep in critically ill chemically paralyzed patients requiring mechanical ventilation. Chest 2006; 129: 1468-1477
• 16 Hilton BA. Quantity and quality of patients' sleep and sleep-disturbing factors in a respiratory intensive care unit. Journal of Advanced Nursing 1976; 1: 453-468
• 17 Aaron JN, Carlisle CC, Carskadon MA et al. Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep 1996; 19: 707-710
• 18 Scotto CJ, McClusky C, Spillan S et al. Earplugs improve patients' subjective experience of sleep in critical care. Nursing in Critical Care 2009; 14: 180-184
• 19 Richardson A, Allsop M, Coghill E et al. Earplugs and eye masks: do they improve critical care patientsʼ sleep?. Nursing in Critical Care 2007; 12: 278-286
• 20 Huang HW, Zheng BL, Jiang L et al. Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation?. Critical Care 2015; 19: 124
• 21 Wallace CJ, Robins J, Alvord LS et al. The effect of earplugs on sleep measures during exposure to simulated intensive care unit noise. Am J Crit Care 1999; 8: 210-219
• 22 Stanchina ML, Abu-Hijleh M, Chaudhry BK et al. The influence of white noise on sleep in subjects exposed to ICU noise. Sleep Medicine 2005; 6: 423-428
• 23 Williamson JW. The effects of ocean sounds on sleep after coronary artery bypass graft surgery. Am J Crit Care 1992; 1: 91-97
• 24 Tamburri LM, DiBrienza R, Zozula R et al. Nocturnal care interactions with patients in critical care units. Am J Crit Care 2004; 13: 102-112 quiz 114-105
• 25 Gabor JY, Cooper AB, Crombach SA et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003; 167: 708-715
• 26 Fanfulla F, Ceriana P, DʼArtavilla Lupo N et al. Sleep disturbances in patients admitted to a step-down unit after ICU discharge: the role of mechanical ventilation. Sleep 2011; 34: 355-362
• 27 Cabello B, Thille AW, Drouot X et al. Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes. Crit Care Med 2008; 36: 1749-1755
• 28 Delisle S, Ouellet P, Bellemare P et al. Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes. Annals of Intensive Care 2011; 1: 42
• 29 Bosma K, Ferreyra G, Ambrogio C et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med 2007; 35: 1048-1054
• 30 Fanfulla F, Delmastro M, Berardinelli A et al. Effects of different ventilator settings on sleep and inspiratory effort in patients with neuromuscular disease. Am J Respir Crit Care Med 2005; 172: 619-624
• 31 Parthasarathy S, Tobin MJ. Effect of ventilator mode on sleep quality in critically ill patients. Am J Respir Crit Care Med 2002; 166: 1423-1429
• 32 Toublanc B, Rose D, Glerant JC et al. Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in intubated ICU patients. Intensive Care Med 2007; 33: 1148-1154
• 33 MacFarlane JG, Cleghorn JM, Brown GM et al. The effects of exogenous melatonin on the total sleep time and daytime alertness of chronic insomniacs: a preliminary study. Biological Psychiatry 1991; 30: 371-376
• 34 Bourne RS, Mills GH. Melatonin: possible implications for the postoperative and critically ill patient. Intensive Care Med 2006; 32: 371-379
• 35 Shilo L, Dagan Y, Smorjik Y et al. Patients in the intensive care unit suffer from severe lack of sleep associated with loss of normal melatonin secretion pattern. Am J Med Sciences 1999; 317: 278-281
• 36 Olofsson K, Alling C, Lundberg D et al. Abolished circadian rhythm of melatonin secretion in sedated and artificially ventilated intensive care patients. Acta Anaesthesiologica Scandinavica 2004; 48: 679-684
• 37 Mundigler G, Delle-Karth G, Koreny M et al. Impaired circadian rhythm of melatonin secretion in sedated critically ill patients with severe sepsis. Crit Care Med 2002; 30: 536-540
• 38 Al-Aama T, Brymer C, Gutmanis I et al. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. International Journal of Geriatric Psychiatry 2011; 26: 687-694
• 39 Shilo L, Dagan Y, Smorjik Y et al. Effect of melatonin on sleep quality of COPD intensive care patients: a pilot study. Chronobiology International 2000; 17: 71-76
• 40 Pandharipande P, Ely EW. Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. Critical Care Clinics 2006; 22: 313-327
• 41 Bourne RS, Mills GH. Sleep disruption in critically ill patients – pharmacological considerations. Anesthesia 2004; 59: 374-384
• 42 Trompeo AC, Vidi Y, Locane MD et al. Sleep disturbances in the critically ill patients: role of delirium and sedative agents. Minerva Anestesiologica 2011; 77: 604-612
• 43 Kamdar BB, Niessen T, Colantuoni E et al. Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors. Crit Care Med 2015; 43: 135-141
• 44 Oto J, Yamamoto K, Koike S et al. Sleep quality of mechanically ventilated patients sedated with dexmedetomidine. Intensive Care Med 2012; 38: 1982-1989