Association between death and loss of stage N2 sleep features among critically Ill patients with delirium

Melissa P Knauert; Emily J Gilmore; Terrence E Murphy; Henry K Yaggi; Peter H Van Ness; Ling Han; Lawrence J Hirsch; Margaret A Pisani

doi:10.1016/j.jcrc.2018.08.028

Association between death and loss of stage N2 sleep features among critically Ill patients with delirium

J Crit Care. 2018 Dec:48:124-129. doi: 10.1016/j.jcrc.2018.08.028. Epub 2018 Aug 23.

Authors

Melissa P Knauert¹, Emily J Gilmore², Terrence E Murphy³, Henry K Yaggi⁴, Peter H Van Ness⁵, Ling Han⁶, Lawrence J Hirsch⁷, Margaret A Pisani⁸

Affiliations

¹ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-8057, USA. Electronic address: Melissa.Knauert@yale.edu.
² Department of Neurology, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-8057, USA. Electronic address: Emily.Gilmore@yale.edu.
³ Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-2085, USA. Electronic address: Terrence.Murphy@yale.edu.
⁴ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-8057, USA. Electronic address: Henry.Yaggi@yale.edu.
⁵ Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-2085, USA. Electronic address: Peter.VanNess@yale.edu.
⁶ Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-2085, USA. Electronic address: Ling.Han@yale.edu.
⁷ Department of Neurology, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-8057, USA. Electronic address: Lawrence.Hirsch@yale.edu.
⁸ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520-8057, USA. Electronic address: Margaret.Pisani@yale.edu.

Abstract

Purpose: Critically ill patients experience significant sleep disruption. In this study of ICU patients with delirium, we evaluated associations between the loss of stage N2 features (K-complexes, sleep spindles), grade of encephalopathy based on electroencephalography (EEG), and intensive care unit (ICU) outcomes. We hypothesized that loss of stage N2 features is associated with more severe grades of encephalopathy and worse ICU outcomes including death.

Materials and methods: This was an observational cohort study of 93 medical ICU patients without primary acute brain injury who underwent continuous EEG. Type and severity of critical illness, sedative-hypnotic use, length of stay, modified Rankin Scale at hospital discharge, and death during hospitalization were abstracted from the medical record. EEG was evaluated for grade of encephalopathy and sleep features.

Results: Patients without K-complexes or without sleep spindles had more severe encephalopathy and higher odds of death. The odds ratio for patients without K-complexes was 18.8 (p = .046). The odds ratio for patients without sleep spindles was 6.3 (p = .036).

Conclusions: Loss of stage N2 features is common and associated with more severe encephalopathy and higher odds of death. The absence of either Stage N2 feature, K complexes or sleep spindles, may have important prognostic value.

Keywords: Critical illness; Delirium; Electroencephalography; Encephalopathy; Polysomnography; Sleep.

Publication types

Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Critical Care
Critical Illness / mortality*
Critical Illness / psychology*
Delirium / complications
Delirium / diagnostic imaging
Delirium / mortality*
Delirium / physiopathology*
Electroencephalography
Female
Humans
Male
Middle Aged
Retrospective Studies
Sleep Stages / physiology*
Sleep Wake Disorders / complications
Sleep Wake Disorders / mortality*
Sleep Wake Disorders / physiopathology*

Abstract

Publication types

MeSH terms

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