Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes

Crit Care Med. 2008 Jun;36(6):1749-55. doi: 10.1097/CCM.0b013e3181743f41.

Abstract

Objectives: To compare the influence of three ventilatory modes on sleep.

Design: Prospective, comparative, crossover study.

Setting: Medical intensive care unit in a university hospital.

Patients: Fifteen conscious, nonsedated, mechanically ventilated patients.

Interventions: Patients were successively ventilated with assist-control ventilation, clinically adjusted pressure support ventilation (cPSV), and automatically adjusted pressure support ventilation (aPSV). Sleep polysomnography was performed during three consecutive 6-hr periods, one with each mode in random order. Airway pressure and thorax and abdomen plethysmography were used to diagnose central apneas and ineffective efforts.

Measurements and main results: The main abnormalities were a low percentage of rapid eye movement (REM) sleep counting, for a median (25th-75th percentiles) of 10% (3.5-12.5) of total sleep, and a highly fragmented sleep with 29 arousals and awakenings per hour of sleep. REM sleep duration was similar in the three ventilatory modes, 7% in assist-control, 4% in aPSV, and 1% during cPSV (p = .54), as well as in the fragmentation index, 31 arousals and awakenings per hour in assist-control, 32 in aPSV, and 34 during cPSV (p = .62). Ineffective efforts occurred similarly with the three modes (seven per hour of sleep in assist-control, 16 in aPSV, and 12 during cPSV) or central apneas during PSV (five in aPSV, seven during cPSV). Minute ventilation was similar with the three modes.

Conclusions: In conscious, mechanically ventilated patients, sleep architecture was highly abnormal, with a short REM stage and a high degree of fragmentation. The ventilatory mode did not influence sleep pattern, arousals, awakenings, and ineffective efforts.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cross-Over Studies
  • Cross-Sectional Studies
  • Dyssomnias / epidemiology
  • Dyssomnias / etiology*
  • Dyssomnias / prevention & control
  • Female
  • France
  • Hospitals, University / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Polysomnography
  • Prospective Studies
  • Respiration, Artificial / methods*
  • Risk Factors
  • Sleep Deprivation / epidemiology
  • Sleep Deprivation / etiology
  • Sleep Deprivation / prevention & control