Optimizing Sleep and Circadian Health in the NeuroICU

Abstract

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

Reporting on Neurological Decline as Identified by Hourly Neuroassessments

“…This study adds to the literature the finding that a nonnegligible percentage of neurological decline is noted outside scheduled neuro exams and does not change medical management. As the body of literature grows on the negative impact of sleep on physiological function, 14,15 there is increasing urgency for rigorous study of the risks and benefits of frequent neuro exams, as well as study of other biomarkers and modalities for predicting and monitoring for neurological decompensation, respectively. 16 In addition, hourly neuro exams are resource intensive; the burden to the nursing workforce in the context of the nursing shortage and burnout is also another consideration.…”