多导睡眠图测定危重患者机械通气期间随机使用右美托咪定或安慰剂后的睡眠质量和时长

多导睡眠图测定危重患者机械通气期间随机使用右美托咪定或安慰剂后的睡眠质量和时长

贵州医科大学     麻醉与心脏电生理课题组

翻译：马艳燕  编辑：张中伟  审核：曹莹

罂 粟 摘 要 

背景：睡眠异常在ICU中很常见，并与谵妄和死亡率增加有关。如果需要镇静，通常使用GABA(γ-氨基丁酸)激动剂，如丙泊酚或咪达唑仑，这导致患者缺乏快速动眼睡眠。我们的目的是评估右美托咪定对睡眠质量和时长的影响。

方法：本研究是一项双盲、随机、安慰剂对照试验，共纳入30名患者，分为两个组：20名患者接受右美托咪啶治疗，10名患者接受安慰剂治疗。每个患者连续两个晚上进行两次16小时的多导睡眠监测。在第一次记录后，患者被随机分为右美托咪定或安慰剂组，从而为所有患者提供了对照数据。在第二次监测期间(下午6点-早上6点)注射右美托咪定。目的：比较右美托咪定与安慰剂对睡眠质量和时长的影响。主要结果：睡眠质量、总睡眠时间(TST)、睡眠效率(SE)和由PSG确定的REM睡眠次要结果：由CAMICU(重症监护病房的混乱评估方法)和体力活动测定的谵妄和日间功能。由RASS(Richmond躁动-镇静评分)评估的警觉性和清醒程度。

结果：右美托咪定组SE增加[37.6%(29.7；45.6，95%CI)比3.7%(-11.4；18.8，95%CI)(P<0.001)]，TST延长[271min(210；324 95%CI)比27min(-82；135 95%CI)，(p<0.001)]。除第2夜RASS外，两组在REM睡眠、谵妄、日间功能及RASS评分方面均无显著差异。

结论：在没有消除REM睡眠的情况下，与非镇静/标准护理期间进行的PSG监测相比，随机服用右美托咪啶的机械通气ICU患者的总睡眠时间和睡眠效率显著增加。

原始文献来源：Oxlund J, Knudsen T, Sörberg M, Strøm T, Toft P, Jennum PJ. Sleep quality and quantity determined by polysomnography in mechanically ventilated critically ill patients randomized to dexmedetomidine or placebo. Acta Anaesthesiol Scand. 2022 Oct 4. 

英文原文 

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.

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