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Table 2 Polysomnography studies of sleep in critical care patients

From: Clinical review: Sleep measurement in critical care patients: research and clinical implications

Author(s) (year)

Number of patients

Critical care population

Duration

Sedation

Number ventilated

Intervention monitored

Practical difficulties

Johns et al. (1974) [14]

4

Surgical

Continuously for first few days

Opioids and nocturnal hypnotics

Not stated

No

None identified

Karacan et al. (1974) [15]

4

Medical

Continuous × 24 to 108 hours

Majority nocturnal hypnotics

None

No

None identified

Hilton (1976) [16]

10

Medical

Continuous × 48 hours

Not stated

Not stated

No

Data incomplete for 3/10 patients

Orr and Stahl (1977) [17]

9

Surgical

3–4 nights

Majority nocturnal opioids and/or benzodiazepines

Not stated

No

Considerable muscle artifact across all recording channels

Broughton and Baron (1978) [18]

12 (10 reported)

Medical

Majority 9 nights but up to 13

Majority nocturnal benzodiazepines and/or barbiturates

None

No

Two patients withdrew due to inconvenience of monitoring

Aurell and Elmqvist (1985) [19]

9

Surgical

Continuous × approximately 72 hours

Opioid and local analgesia, some benzodiazepines

2/9

No

None identified

Richards and Bairnsfathera (1988) [20]

10

Medical

1–3 nights

Not stated

None

No

One patient withdrew from study after EEG electrodes were positioned

Fontaine (1989) [21]

20

Trauma

1 night

All received opioid and nocturnal benzodiazepine

1/20

No

None identified

Edwards and Schuring (1993) [22]

21

Medical

1 night

18/21 nocturnal benzodiazepine/barbiturate

20/21

No

None identified

Gottschlich et al. (1994) [23]

11

Burns

Continuous × 24 hours (repeated intervals)

Not stated

All

No

None identified

Aaron et al. (1996) [24]

6

Medical

Continuous × 24 hours 2/6, × 48 hours 4/6

3/6 received hypnotics/opioids

None

No – effect of environmental disturbances recorded

None identified

Richards et al.a(1996) [25]

9

Medical

1 night

3/9 received nocturnalbenzodiazepines

None

No

None identified

Richardsb(1998) [26]

69

Medical

1 night

Minority received nocturnal hypnotics

None

Yes – relaxation techniques

Standard sensitivity and paper speed settings for polygraph unavailable and were therefore altered; 23/94 refused most commonly due to study/polysomnography being an additional stressor. Only one patient could be studied per night.c

Cooper et al. (2000) [27] (20 reported)

26

Medical

Continuous × 24 hours

Majority received opioids, benzodiazepines or haloperidol

All

No

Six patient records unable to score due to technical difficulties: electrical artifact (4), respiratory artifact (2).

Richards et al.b(2000) [11]

70

Medical

1 night

Minority received nocturnalhypnotics

None

No – see above

cSee above entry

Freedman et al. (2001) [28]

22

Medical

Continuous × 24 hours 14/22, × 48 hours 8/22

8 of 22 intermittent benzodiazepine or opioid

20/22

No – effect of environmental disturbances recorded

Five patient records unable to be scored due to sepsis-induced alterations to EEG pattern

Parthasarathy and Tobin (2002) [6]

11

Medical

1 night

All received sedatives

All

Yes – mode of ventilation

None identified

Richards et al.b(2002) [29]

64

Medical

1 night

Minority received nocturnal hypnotics

None

No – see above

cSee above entry

Valente et al. (2002) [30]

24

Neuro-Trauma

Continuous × 24 hours

At least 24 hours post-sedation discontinued

Not stated

No

None identified

Gabor et al. (2003) [4]

7

Medical/Trauma

Continuous × 24 hours

Majority opioids, benzodiazepines, and/or antipsychotics

All

No – effect of environmental disturbances recorded

None identified

Cochen et al. (2005) [31]

17

Medical/Trauma

1–2 nights, some daytime

None

All

No

4/31 sleep recordings not scored due to electrical artifact

Hardin et al. (2006) [32]

18

Medical

Continuous × 24 hours

6/18 received intermittent sedation only and were awake and alert, 12/18 received continuous sedation

All

No – group comparison between neuromuscular blocking agents, continuous sedation, and intermittent sedation

Modified delta criteria used. Unknown quantity of epochs scored as non-classifiable. Recorder malfunctioned in one patient

Bosma et al. (2007) [33]

13

Medical/Surgical

2 nights (crossover study)

3/13 received opioids and 2 received All haloperidol

 

Yes – pressure support versus proportional assist controlled ventilation and patient-ventilator dysynchrony

None identified

  1. a,bMultiple reports refer to a single polysomnography study. EEG, electroencephalogram.