Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria

Paula L WATSON; Pratik PANDHARIPANDE; Brian K GEHLBACH; Jennifer L THOMPSON; Ayumi K SHINTANI; Bob S DITTUS; Gordon R BERNARD; Beth A MALOW; E. Wesley ELY

doi:10.1097/CCM.0b013e31828a3f75

Back

Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria

Journal article

Peer reviewed

Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria

Paula L WATSON, Pratik PANDHARIPANDE, Brian K GEHLBACH, Jennifer L THOMPSON, Ayumi K SHINTANI, Bob S DITTUS, Gordon R BERNARD, Beth A MALOW and E. Wesley ELY

Critical care medicine, Vol.41(8), pp.1958-1967

2013

DOI: 10.1097/CCM.0b013e31828a3f75

PMCID: PMC3875326

PMID: 23863228

View Online

Abstract

Objectives: Standard sleep scoring criteria may be unreliable when applied to critically ill patients. We sought to quantify typical and atypical polysomnographic findings in critically ill patients and to begin development and reliability testing of methodology to characterize the atypical polysomnographic tracings that confound standard sleep scoring criteria. Design: Prospective convenience sample. Setting: Two academic, tertiary care medical centers. Patients: Thirty-seven critically ill, mechanically ventilated, medical ICU patients. Interventions: None. Measurements and main results: Mechanically ventilated subjects were monitored by continuous polysomnography. After noting frequent atypical polysomnographic findings (i.e., lack of stage N2 markers, the presence of polymorphic delta, burst suppression, or isoelectric electroencephalography), attempts to use standard sleep scoring criteria alone were abandoned. Atypical polysomnographic findings were characterized and used to develop a modified scoring system. Polysomnographic data were scored manually via this revised scoring scheme. Of 37 medical ICU patients enrolled, 36 experienced atypical sleep, which accounted for 85% of all recorded data, with 5.1% normal sleep and 9.4% wake. Coupling observed patient arousal levels with polysomnographic characteristics revealed that standard polysomnographic staging criteria did not reliably determine the presence or absence of sleep. Rapid eye movement occurred in only five patients (14%). The revised scoring system incorporating frequently seen atypical characteristics yielded very high interrater reliability (weighted κ = 0.80; bootstrapped 95% CI, [0.48, 0.89]). Conclusions: Analysis of polysomnographic data revealed profound deficiencies in standard scoring criteria due to a predominance of atypical polysomnographic findings in ventilated patients. The revised scoring scheme proved reliable in sleep staging and may serve as a building block in future work.

Organic mental disorders. Neuropsychology

Psychology. Psychoanalysis. Psychiatry

Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy

Adult and adolescent clinical studies

Psychopathology. Psychiatry

Biological and medical sciences

Intensive care medicine

Medical sciences

Details

Title: Subtitle: Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria
Creators: Paula L WATSON - Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States
Pratik PANDHARIPANDE - Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States
Brian K GEHLBACH - Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, IA, United States
Jennifer L THOMPSON - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
Ayumi K SHINTANI - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
Bob S DITTUS - Division of General Health, Vanderbilt University Medical Center, Nashville, TN, United States
Gordon R BERNARD - Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States
Beth A MALOW - Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
E. Wesley ELY - Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States
Resource Type: Journal article
Publication Details: Critical care medicine, Vol.41(8), pp.1958-1967
DOI: 10.1097/CCM.0b013e31828a3f75
PMID: 23863228
PMCID: PMC3875326
NLM abbreviation: Crit Care Med
ISSN: 0090-3493
eISSN: 1530-0293
Publisher: Ovid Technologies (Wolters Kluwer Health); Hagerstown, MD
Language: English
Date published: 2013
Academic Unit: Neurology; Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
Record Identifier: 9984020736502771

Metrics

40 Record Views

119 Times Cited - Web of Science

See more details