Effects of Dexmedetomidine on Sleep Quality in Critically Ill Patients: A Pilot Study

Background:Dexmedetomidine, a potent &agr;-2-adrenergic agonist, is widely used as sedative in critically ill patients. This pilot study was designed to assess the effect of dexmedetomidine administration on sleep quality in critically ill patients. Methods:Polysomnography was performed on hemodynamically stable critically ill patients for 57 consecutive hours, divided into three night-time (9:00 PM to 6:00 AM) and two daytime (6:00 AM to 9:00 PM) periods. On the second night, dexmedetomidine was given by a continuous infusion targeting a sedation level −1 to −2 on the Richmond Agitation Sedation Scale. Other sedatives were not permitted. Results:Thirteen patients were studied. Dexmedetomidine was given in a dose of 0.6 &mgr;g kg−1 h−1 (0.4 to 0.7) (median [interquartile range]). Compared to first and third nights (without dexmedetomidine), sleep efficiency was significantly higher during the second night (first: 9.7% [1.6 to 45.1], second: 64.8% [51.4 to 79.9], third: 6.9% [0.0 to 17.1], P < 0.002). Without dexmedetomidine, night-time sleep fragmentation index (7.6 events per hour [4.8 to 14.2]) and stage 1 of sleep (48.0% [30.1 to 66.4]) were significantly higher (P = 0.023 and P = 0.006, respectively), and stage 2 (47.0% [27.5 to 61.2]) showed values lower (P = 0.006) than the corresponding values (2.7 events per hour [1.6 to 4.9], 13.1% [6.2 to 23.6], 80.2% [68.9 to 92.8]) observed with dexmedetomidine. Without sedation, sleep was equally distributed between day and night, a pattern that was modified significantly (P = 0.032) by night-time dexmedetomidine infusion, with more than three quarters of sleep occurring during the night (79% [66 to 87]). Conclusion:In highly selected critically ill patients, dexmedetomidine infusion during the night to achieve light sedation improves sleep by increasing sleep efficiency and stage 2 and modifies the 24-h sleep pattern by shifting sleep mainly to the night.

[1]  Randall S Friese,et al.  Sleep in the intensive care unit. , 2015, American journal of respiratory and critical care medicine.

[2]  S. Kanba,et al.  Potential impact of propofol immediately after motor vehicle accident on later symptoms of posttraumatic stress disorder at 6-month follow up: a retrospective cohort study , 2012, Critical Care.

[3]  C. Seymour,et al.  Diurnal sedative changes during intensive care: Impact on liberation from mechanical ventilation and delirium* , 2012, Critical care medicine.

[4]  M. Nishimura,et al.  Sleep quality of mechanically ventilated patients sedated with dexmedetomidine , 2012, Intensive Care Medicine.

[5]  E. van Cauter,et al.  Temporal disorganization of circadian rhythmicity and sleep-wake regulation in mechanically ventilated patients receiving continuous intravenous sedation. , 2012, Sleep.

[6]  C. Alexopoulou,et al.  Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study , 2012, Intensive Care Medicine.

[7]  L. Brochard,et al.  A new classification for sleep analysis in critically ill patients. , 2012, Sleep medicine.

[8]  J. G. McCoy,et al.  The cognitive cost of sleep lost , 2011, Neurobiology of Learning and Memory.

[9]  V. Ranieri,et al.  Sleep disturbances in the critically ill patients: role of delirium and sedative agents. , 2011, Minerva anestesiologica.

[10]  M. Maze,et al.  THEME ISSUE: MECHANISMS OF ANESTHESIA Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway Article de synthèse court: Les agents sédatifs-hypnotiques contribuent au delirium en modulant les voies du sommeil , 2011 .

[11]  M. Maze,et al.  Open Access Research , 2022 .

[12]  M. Roizen.  Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial , 2010 .

[13]  J. Dasta,et al.  An Updated Focused Review of Dexmedetomidine in Adults , 2009, The Annals of pharmacotherapy.

[14]  E. Ely,et al.  Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. , 2009, JAMA.

[15]  Russell R. Miller,et al.  Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. , 2007, JAMA.

[16]  C. Alexopoulou,et al.  Sleep during proportional-assist ventilation with load-adjustable gain factors in critically ill patients , 2007, Intensive Care Medicine.

[17]  A. Chesson,et al.  The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications , 2007 .

[18]  Jennifer T Coull,et al.  Attentional effects of noradrenaline vary with arousal level: selective activation of thalamic pulvinar in humans , 2004, NeuroImage.

[19]  Theodore Speroff,et al.  Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). , 2003, JAMA.

[20]  Jun Lu,et al.  The &agr;2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects , 2003, Anesthesiology.

[21]  K. Narkiewicz,et al.  [Sleep apnea and cardiovascular disease]. , 2002, Herz.

[22]  C. Sessler,et al.  The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. , 2002, American journal of respiratory and critical care medicine.

[23]  T. Guo,et al.  The sedative component of anesthesia is mediated by GABAA receptors in an endogenous sleep pathway , 2002, Nature Neuroscience.

[24]  Theodore Speroff,et al.  Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) , 2001, Critical care medicine.

[25]  A. Pack,et al.  Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. , 2001, American journal of respiratory and critical care medicine.

[26]  M Irwin,et al.  Effects of sleep and sleep deprivation on interleukin-6, growth hormone, cortisol, and melatonin levels in humans. , 2000, The Journal of clinical endocrinology and metabolism.

[27]  A. Logan,et al.  Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. , 2000, Circulation.

[28]  C. Ryan,et al.  Intensive care unit syndrome: a dangerous misnomer. , 2000, Archives of internal medicine.

[29]  G. B. Young,et al.  Sleep in critically ill patients requiring mechanical ventilation. , 2000, Chest.

[30]  M. Irwin,et al.  Partial night sleep deprivation reduces natural killer and celhdar immune responses in humans , 1996, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[31]  E. Draper,et al.  APACHE II: A severity of disease classification system , 1985, Critical care medicine.