Viability and validity of the bispectral index to measure sleep in patients in the intensive care unit

Pedrão, Rodolfo Augusto Alves; Riella, Rodrigo; Richards, Kathy; Valderramas, Sílvia

doi:10.5935/0103-507x.20200083

Cited by 12 publications

(10 citation statements)

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“…BIS scores increased during painful procedures in patients with traumatic brain injury in the ICU [ 61 ]. It also correlated with PSG and could discriminate between deep and light sleep in healthy adults [ 62 ]; however, it was only weakly correlated with self-reported sleep quality in ICU patients [ 63 ]. BIS monitoring with density spectral was tested for the detection of delirium in hospitals.…”

Section: Resultsmentioning

confidence: 99%

Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review

Xu,

Smaling,

Schoones

et al. 2024

BMC Palliat Care

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Background Discomfort and distressing symptoms are common at the end of life, while people in this stage are often no longer able to express themselves. Technologies may aid clinicians in detecting and treating these symptoms to improve end-of-life care. This review provides an overview of noninvasive monitoring technologies that may be applied to persons with limited communication at the end of life to identify discomfort. Methods A systematic search was performed in nine databases, and experts were consulted. Manuscripts were included if they were written in English, Dutch, German, French, Japanese or Chinese, if the monitoring technology measured discomfort or distressing symptoms, was noninvasive, could be continuously administered for 4 hours and was potentially applicable for bed-ridden people. The screening was performed by two researchers independently. Information about the technology, its clinimetrics (validity, reliability, sensitivity, specificity, responsiveness), acceptability, and feasibility were extracted. Results Of the 3,414 identified manuscripts, 229 met the eligibility criteria. A variety of monitoring technologies were identified, including actigraphy, brain activity monitoring, electrocardiography, electrodermal activity monitoring, surface electromyography, incontinence sensors, multimodal systems, and noncontact monitoring systems. The main indicators of discomfort monitored by these technologies were sleep, level of consciousness, risk of pressure ulcers, urinary incontinence, agitation, and pain. For the end-of-life phase, brain activity monitors could be helpful and acceptable to monitor the level of consciousness during palliative sedation. However, no manuscripts have reported on the clinimetrics, feasibility, and acceptability of the other technologies for the end-of-life phase. Conclusions Noninvasive monitoring technologies are available to measure common symptoms at the end of life. Future research should evaluate the quality of evidence provided by existing studies and investigate the feasibility, acceptability, and usefulness of these technologies in the end-of-life setting. Guidelines for studies on healthcare technologies should be better implemented and further developed.

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Section: Resultsmentioning

confidence: 99%

Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review

Xu,

Smaling,

Schoones

et al. 2024

BMC Palliat Care

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“…In the first night of observation, participants had a BIS Quatro™ sensor (Covidien IIc, Mainsfield, USA) attached to the left frontal region and connected to the BIS Vista™ Monitoring System (Covidien IIc, Mainsfield, USA) from 7 pm to 6:59 am of the following morning. BIS performed the electronic processing of the electroencephalographic record every minute during the observation period and calculated the Bispectral Index, which allowed the estimation of sleep duration and depth [22,23].The parameters recorded by the BIS were: total sleep volume and time; continuous sleep volume and time; deep sleep volume and time; and, in the second night of observation, latency for sleep onset after bath. Sleep periods lasting 10 minutes or more, with greater restorative potential, were computed as continuous [24].…”

Section: Methodsmentioning

confidence: 99%

“…Sleep periods lasting 10 minutes or more, with greater restorative potential, were computed as continuous [24]. Sleep time and latency for sleep onset after bath were expressed in minutes; sleep volume was expressed as a function of the area under the BIS curve versus time (in minutes) [22,25]. BIS values below 80 demarcated the onset of light sleep and below 40, deep sleep [23].…”

Section: Methodsmentioning

confidence: 99%

“…The frequency of sound capture was 2 seconds; the used uptake unit was the decibel (dB); and the compensation circuit was set to slow A-weighting. The equivalent continuous noise levels (LAEq) [22] of the observation nights were calculated. The environmental luminance was also recorded throughout the night with a professional digital lux meter with datalogger model DT-8809 (CEM Instruments, India), submitted to certified calibration, installed beside the decibel meter.…”

Section: Methodsmentioning

confidence: 99%

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Bed Bath and Sleep in Critically Ill Patients - An Observational Study

Pedrão¹,

Riella²,

Valderramas³

2022

Recent Adv Clin Trials

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Purpose: Critically ill patients are at risk of sleep deprivation. Sleep promotion should be routinely implemented. Passive body heating has the potential to promote sleep. It is not known whether it can be obtained with a bed bath in the intensive care unit. Methods: In this cross-sectional observational study, we compared the sleep of 30 adult critically ill patients in two sequential nights – without and with bed bath, recording potential intervening environmental and clinical factors. Additionally, we monitored the impact of baths on participants' body temperature, checking for correlations between changes triggered by bath and sleep parameters. Sleep was assessed with bispectral index and with Richards-Campbell Sleep Questionnaire. Environmental noise and luminance were measured with decibel and lux meters. Temperature was measured with iButtons sensors. Results: Patients had reduced total sleep time in both nights of observation (medians of 170 and 177 minutes), without reaching deep sleep. There was no difference in sleep between both nights of observation. We recorded high noise levels in both nights of observation (57dB) and bathing nights were associated with greater exposure to light. There was moderate correlation between epigastric temperature oscillation with bathing and sleep volume, but epigastric temperature predicts neither total sleep volume nor continuous sleep volume. Conclusion: In critically ill adult patients, nighttime bed baths do not correlate with sleep, but are associated with increased exposure to light. Post-bath epigastric skin temperature correlates with sleep volume but does not predict it.

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“…In addition, automated algorithms that use novel EEG montages have been tried to alleviate the challenges described above. The readily available Bispectral Index (Medtronic) has been studied as a method to assess the depth of sleep ( 100 – 102 ) but with poor results in scoring sleep stages ( 103 ); similarly, SedLine (Masimo) was evaluated in a single limited study ( 104 ). Other methods using automated EEG algorithms to score sleep depth, such as spectral power and the odds ratio product, have been proposed and studied in a small number of ICU patients ( 86 , 97 , 105 ).…”

Section: Subtopic 2: Measurement Of Sleep and Circadian Rhythm In The...mentioning

confidence: 99%

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

Knauert¹,

Ayas²,

Bosma³

et al. 2023

Am J Respir Crit Care Med

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Background Sleep and circadian disruption (SCD) is common and severe in the ICU. On the basis of rigorous evidence in non-ICU populations and emerging evidence in ICU populations, SCD is likely to have a profound negative impact on patient outcomes. Thus, it is urgent that we establish research priorities to advance understanding of ICU SCD. Methods We convened a multidisciplinary group with relevant expertise to participate in an American Thoracic Society Workshop. Workshop objectives included identifying ICU SCD subtopics of interest, key knowledge gaps, and research priorities. Members attended remote sessions from March to November 2021. Recorded presentations were prepared and viewed by members before Workshop sessions. Workshop discussion focused on key gaps and related research priorities. The priorities listed herein were selected on the basis of rank as established by a series of anonymous surveys. Results We identified the following research priorities: establish an ICU SCD definition, further develop rigorous and feasible ICU SCD measures, test associations between ICU SCD domains and outcomes, promote the inclusion of mechanistic and patient-centered outcomes within large clinical studies, leverage implementation science strategies to maximize intervention fidelity and sustainability, and collaborate among investigators to harmonize methods and promote multisite investigation. Conclusions ICU SCD is a complex and compelling potential target for improving ICU outcomes. Given the influence on all other research priorities, further development of rigorous, feasible ICU SCD measurement is a key next step in advancing the field.

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Viability and validity of the bispectral index to measure sleep in patients in the intensive care unit

Cited by 12 publications

References 41 publications

Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review

Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review

Bed Bath and Sleep in Critically Ill Patients - An Observational Study

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

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