중환자간호학회지 (Journal of Korean Critical Care Nursing)

  • 제17권3호
  • /
  • Pages.50-61
  • /
  • 2024
  • /
  • 2005-212X(pISSN)
  • /
  • 2671-8634(eISSN)
한국중환자간호학회 (Korean Society of Critical Care Nursing)
권호 표지
DOI QR코드

DOI QR Code

복부 수술 후 중환자실에 입원한 환자의 수면 특성

Sleep Characteristics of Patients Admitted to Intensive Care Units after Major Abdominal Surgery

  • 강지연 (동아대학교 간호학부) ;
  • 강정희 (동아대학교 간호학부 )
  • Kang, Jiyeon (College of Nursing, Dong-A University) ;
  • Kang, Jeonghee (College of Nursing, Dong-A University)
  • 투고 : 2024.02.02
  • 심사 : 2024.10.04
  • 발행 : 2024.10.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose : The aim of this study was to investigate sleep parameters and architecture in patients admitted to the intensive care unit (ICU) on the day of abdominal surgery. Methods : A total of ten patients who underwent laparotomy under general anesthesia at the hepatopancreatobiliary surgery department of a general hospital in Busan, South Korea participated in this observational study. We measured total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep stages on their first night in the ICU using the WatchPAT300. Furthermore, we used nonparametric statistics to examine differences in postoperative sleep based on sedative administration. Results : The Median (IQR) TST for the participants was 399.50(263.80) minutes; the SE was 75.1 (30.4)%; the WASO rate was 27.8(30.6)%; and the WASO frequency was 5.50(8.50) times. Patients' rapid eye movement (REM) sleep time was 114.31(87.88) minutes, with 55.8(11.9)% of N1, 18.2(5.3)% of N2, and 24.8 (11.7)% of N3 sleep stages. The sedation group had a longer TST (Z=-2.619, p =.008), higher SE (Z=-2.611, p =.008), lower WASO rate (Z=-2.611, p =.008), smaller number of WASOs (Z=-2.627, p =.008), and longer REM sleep (Z=-2.617, p =.008) compared to the non-sedation group. Conclusion : We observed a high rate of light sleep and awakenings during sleep in patients admitted to the ICU after surgery. Moreover, non-sedated patients lacked either deep or REM sleep. Sleep-improving interventions are needed for non-sedated surgical patients who are admitted to the ICU.

키워드

과제정보

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2022R1A2C1011917).

참고문헌

  1. Romagnoli S, Villa G, Fontanarosa L, Tofani L, Pinelli F, De Gaudio AR, et al. Sleep duration and architecture in non-intubated intensive care unit patients: an observational study. Sleep Medicine. 2020;70:79-87. https://doi.org/10.1016/j.sleep.2019.11.1265 
  2. Pandharipande P, Ely EW. Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. Critical Care Clinics. 2006;22(2):313-27, https://doi.org/10.1016/j.ccc.2006.02.010 
  3. Slaven JE, Andrew ME, Violanti JM, Burchfiel CM, Mnatsakanova A, Vila BJ. Dimensional analysis of actigraphic derived sleep data. Nonlinear Dynamics, Psychology, and Life Sciences. 2008;12(2):153-61. 
  4. Rosenberg J. Sleep disturbances after non-cardiac surgery. Sleep Medicine Reviews. 2001;5(2):129-37. https://doi.org/10.1053/smrv.2000.0121 
  5. Gogenur I, Wildschiotz G, Rosenberg J. Circadian distribution of sleep phases after major abdominal surgery. British Journal of Anaesthesia. 2008;100(1):45-9. https://doi.org/10.1093/bja/aem340 
  6. Onen SH, Onen F, Courpron P, Dubray C. How pain and analgesics disturb sleep. The Clinical Journal of Pain. 2005;21(5):422-31. https://doi.org/10.1097/01.ajp.0000129757.31856.f7 
  7. Krenk L, Jennum P, Kehlet H. Sleep disturbances after fast-track hip and knee arthroplasty. British Journal of Anaesthesia. 2012;109(5):769-75. https://doi.org/10.1093/bja/aes252 
  8. Kamdar BB, Martin JL, Needham DM, Ong MK. Promoting Sleep to Improve Delirium in the ICU. Critical Care Medicine. 2016;44(12):2290-1. https://doi.org/10.1097/CCM.0000000000001982 
  9. Daou M, Telias I, Younes M, Brochard L, Wilcox ME. Abnormal sleep, circadian rhythm disruption, and delirium in the ICU: Are they related? Frontiers in Neurology. 2020;11:549908. https://doi.org/10.3389/fneur.2020.549908 
  10. Gogenur I, Bisgaard T, Burgdorf S, van Someren E, Rosenberg J. Disturbances in the circadian pattern of activity and sleep after laparoscopic versus open abdominal surgery. Surgical Endoscopy. 2009;23(5):1026-31. https://doi.org/10.1007/s00464-008-0112-9 
  11. Ghorbani A, Hajizadeh F, Sheykhi MR, Mohammad Poor asl A. The effects of deep-breathing exercises on postoperative sleep duration and quality in patients undergoing coronary artery bypass graft (CABG): a randomized clinical trial. Journal of Caring Sciences. 2018;8(4):219-24. https://doi.org/10.15171/jcs.2019.031 
  12. Su X, Wang DX. Improve postoperative sleep: what can we do? Current Opinion in Anesthesiology. 2018;31(1):83-8. https://doi.org/10.1097/ACO.0000000000000538 
  13. Dolan R, Huh J, Tiwari N, Sproat T, Camilleri-Brennan J. A prospective analysis of sleep deprivation and disturbance in surgical patients. Annals of Medicine and Surgery. 2016;6:1-5. https://doi.org/10.1016/j.amsu.2015.12.046 
  14. Garcia-Miguel FJ, Serrano-Aguilar PG, Lipez-Bastida J. Preoperative assessment. The Lancet. 2003;362(9397):1749-57. https://doi.org/10.1016/S0140-6736(03)14857-X 
  15. Dianatkhah M, Ghaeli P, Hajhossein Talasaz A, Karimi A, Salehiomran A, Bina P. et al. Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder. Journal of Tehran University Heart Center. 2015;10(3):122-8. 
  16. Naiman R. Dreamless: the silent epidemic of REM sleep loss. Annals of the New York Academy of Sciences. 2017;1406(1):77-85. https://doi.org/10.1111/nyas.13447 
  17. Altman MT, Knauert MP, Pisani MA. Sleep disturbance after hospitalization and critical illness: A systematic review. Annals of the American Thoracic Society. 2017;14(9):1457-68. https://doi.org/10.1513/AnnalsATS.201702-148SR 
  18. Mo Y, Zimmermann AE. Role of dexmedetomidine for the prevention and treatment of delirium in intensive care unit patients. Annals of Pharmacotherapy. 2013;47(6):869-76. https://doi.org/10.1345/aph.1AR708 
  19. Reardon DP, Anger KE, Adams CD, Szumita PM. Role of dexmedetomidine in adults in the intensive care unit: an update. American Journal of Health-System Pharmacy. 2013;70(9):767-77. https://doi.org/10.2146/ajhp120211 
  20. Chen Z, Tang R, Zhang R, Jiang Y, Liu Y. Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy. Journal of Clinical Anesthesia. 2017;36:118-22. https://doi.org/10.1016/j.jclinane.2016.10.022 
  21. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical Pharmacokinetics. 2017;56(8):893-913. https://doi.org/10.1007/s40262-017-0507-7 
  22. Koh CK. Perception of sleep among patients at intensive care units and its related factors. Clinical Nursing Research. 2007:13(2):149-58. 
  23. Jang JI, Park EH. The experiences of patients in intensive care units (ICU). Korea Society for Wellness. 2020;15(3):135-44. https://doi.org/10.21097/ksw.2020.08.15.3.135 
  24. Kang JY, Kwon YB. Actigraphy-based assessment of sleep parameters in intensive care unit patients receiving respiratory support therapy. Journal of Korean Critical Care Nursing. 2022;15(3):115-27. https://doi.org/10.34250/jkccn.2022.15.3.115 
  25. Park J. Sleep in intensive care unit patients. Journal of Sleep Medicine. 2021;18(2):66-71. https://doi.org/10.13078/jsm.210016 
  26. Kim JW. Quantitative analysis of actigraphy in sleep research. Sleep Medicine and Psychophysiology. 2016;23(1):10-5. https://doi.org/10.14401/KASMED.2016.23.1.10 
  27. Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology. 2003;98(2):428-36. https://doi.org/10.1097/00000542-200302000-00024 
  28. Zhang Z, Sowho M, Otvos T, Sperandio LS, East J, Sgambati F, et al. A comparison of automated and manual sleep staging and respiratory event recognition in a portable sleep diagnostic device with in-lab sleep study. Journal of Clinical Sleep Medicine. 2020;16(4):563-73. https://doi.org/10.5664/jcsm.8278 
  29. Hedner J, White DP, Malhotra A, Herscovici S, Pittman SD, Zou D, et al. Sleep staging based on autonomic signals: a multi-center validation study. Journal of Clinical Sleep Medicine. 2011;7(3):301-6. https://doi.org/10.5664/JCSM.1078 
  30. Bresler M, Sheffy K, Pillar G, Preiszler M, Herscovici S. Differentiating between light and deep sleep stages using an ambulatory device based on peripheral arterial tonometry. Physiological Measurement. 2008;29(5):571-84. https://doi.org/10.1088/0967-3334/29/5/004 
  31. Carskadon MA, Dement WC. Normal human sleep: An overview. Principles and Practice of Sleep Medicine. 5th ed. St. Louis: Elsevier Health Sciences; 2011. p. 16-26. 
  32. Orwelius L, Nordlund A, Nordlund P, Edell-Gustafsson U, Sjoberg F. Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study. Critical Care. 2008;12(4):R97. https://doi.org/10.1186/cc6973 
  33. Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Critical Care. 2013;17(2):R46. https://doi.org/10.1186/cc12565 
  34. In J, Lim E, Kinjo S. Assessment of perioperative sleep characteristics using subjective and objective methods: A secondary analysis of prospective cohort study. Sleep Disorders. 2023;2023:9633764. https://doi.org/10.1155/2023/9633764 
  35. Elliott R, McKinley S, Cistulli P. The quality and duration of sleep in the intensive care setting: an integrative review. International Journal of Nursing Studies. 2011;48(3):384-400. https://doi.org/10.1016/j.ijnurstu.2010.11.006 
  36. Chung F, Liao P, Yegneswaran B, Shapiro CM, Kang W. Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):287-98. https://doi.org/10.1097/ALN.0000000000000040 
  37. Lin D, Huang X, Sun Y, Wei C, Wu A. Perioperative sleep disorder: A review. Frontiers in Medicine. 2021;8:640416. http://doi.org/10.3389/fmed.2021.640416 
  38. Alexopoulou C, Kondili E, Diamantaki E, Psarologakis C, Kokkini S, Bolaki M, et al. Effects of dexmedetomidine on sleep quality in critically ill patients: a pilot study. Anesthesiology. 2014;121(4):801-7. https://doi.org/10.1097/ALN.0000000000000361 
  39. Oto J, Yamamoto K, Koike S, Onodera M, Imanaka H, Nishimura M. Sleep quality of mechanically ventilated patients sedated with dexmedetomidine. Intensive Care Medicine. 2012;38(12):1982-9. https://doi.org/10.1007/s00134-012-2685-y 
  40. O'Gara BP, Gao L, Marcantonio ER, Subramaniam B. Sleep, pain, and cognition: modifiable targets for optimal perioperative brain health. Anesthesiology. 2021;135(6):1132-52. https://doi.org/10.1097/ALN.0000000000004046