Impact of Sleep Deprivation in the Neurological Intensive Care Unit: A Narrative Review

Chang, Victoria A.; Owens, Robert L.; LaBuzetta, Jamie Nicole

doi:10.1007/s12028-019-00795-4

Cited by 21 publications

(30 citation statements)

References 210 publications

(204 reference statements)

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“…18,19 This has particular relevance for patients with strict blood pressure parameters such as patients with hypertensive and aneurysmal bleeds and chronic blood loss. 10,20-22 Increased sympathetic and decreased parasympathetic cardiovascular modulation was shown in normal humans with sleep deprivation. 18-20 Irwin et al, 23 had indicated elevation in level of C-reactive protein (CRP), an inflammatory marker shown to be an independent predictor of future myocardial infarction and stroke.…”

Section: Discussionmentioning

confidence: 99%

Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Levy

Smiley

Latifi

2022

The American Surgeon™

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Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.

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Section: Discussionmentioning

confidence: 99%

Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Levy

Smiley

Latifi

2022

The American Surgeon™

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“… 35 Sleep disruption impacts several organ systems and has been found to be independently associated with delirium in the ICU. 36 , 37 Continuation of sleep disruption with hourly exams when no longer indicated may contribute to ICU delirium. Older age alone has been identified as a factor affecting sleep quality in the ICU.…”

Section: System-specific Considerations In Older Adultsmentioning

confidence: 99%

Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Brunker

Boncyk

Rengel

et al. 2023

CIA

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There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.

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“…Circadian disruption may contribute to the development of acquired immunodeficiency that is observed to develop after several days of critical illness and leaves patients vulnerable to nosocomial infectious complications [37]. Drawing upon studies in other populations, circadian disruption likely impairs the function of many other systems, including endocrine-regulated processes, glycemic control and other metabolic pathways, autonomic and cardiac stability, lung function, renal clearance and liver function, the basis for which has been reviewed in details elsewhere [38]. In the remainder of this article, we will discuss the rationale for specific pharmacologic and environmental interventions that may attenuate sleep and circadian disruption in the ICU, with special attention to the neurologic population.…”

Section: Effect Of Circadian Rhythm and Sleep Disruption On Icu Outcomesmentioning

confidence: 99%

Optimizing Sleep and Circadian Health in the NeuroICU

LaBuzetta

Malhotra

Zee

et al. 2022

Curr Treat Options Neurol

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Purpose of Review This article introduces fundamental concepts in circadian biology and the neuroscience of sleep, reviews recent studies characterizing circadian rhythm and sleep disruption among critically ill patients and potentially links to functional outcomes, and draws upon existing literature to propose therapeutic strategies to mitigate those harms. Particular attention is given to patients with critical neurologic conditions and the unique environment of the neuro-intensive care unit. Recent Findings Circadian rhythm disruption is widespread among critically ill patients and sleep time is reduced and abnormally fragmented. There is a strong association between the degree of arousal suppression observed at the bedside and the extent of circadian disruption at the system (e.g., melatonin concentration rhythms) and cellular levels (e.g., core clock gene transcription rhythms). There is a paucity of electrographically normal sleep, and rest-activity rhythms are severely disturbed. Common care interventions such as

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Impact of Sleep Deprivation in the Neurological Intensive Care Unit: A Narrative Review

Cited by 21 publications

References 210 publications

Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids

Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges

Optimizing Sleep and Circadian Health in the NeuroICU

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