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Abstract Details

Melatonin, Light & Noise Reduction To Improve Sleep in the Neurological Intensive Care Unit
Critical Care/Emergency Neurology/Trauma
P01 - (-)
025
Sleep in the ICU is often abnormal. Patients in medical ICUs have deficient melatonin production, which may lead to decreased sleep; light and sound levels have been implicated in fragmented sleep in medical/surgical ICUs. Given the cognitive, autonomic, and metabolic impact of sleep deprivation, both supplemental melatonin and mitigating environmental disruption in the ICU have been tried, but with variable results. Sleep has not been well studied in neurological ICU patients.
Adult neurological ICU patients undergoing continuous electroencephalography were randomized to receive oral melatonin, sound-reducing headphones, and eye covers vs standard care. A sleep montage including electromyography and flow was used to score sleep on 24-hr periods 1 & 3 as per American Academy of Sleep Medicine criteria. Primary endpoint was total sleep time. Secondary endpoints included the ability to measure sleep and outcome at discharge.
12 patients were enrolled, 6 in each arm. The mean age was 57.9; there were no significant differences between those who received intervention and those who did not regarding illness severity, intubation, or neurological exam. There were no differences between total sleep time on days 1 or 3. There were no significant differences in functional outcome upon discharge. Up to 78% of patients could not be scored using standard criteria; those who could had disorganized sleep, decreased slow-wave sleep and a mean of 85 awakenings over an average of 7 hours of sleep during 19 hours of recording.
Sleep in many neurological ICU patients cannot be scored using standard methods. Those who could be scored had fragmented sleep with loss of restorative sleep stages. Larger patient sample size or alternative methods of scoring sleep are needed to better evaluate the use of sleep interventions in brain injured patients.
Authors/Disclosures
Brandon P. Foreman, MD (University of Cincinnati)
PRESENTER 		Dr. Foreman has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB Pharma Inc. Dr. Foreman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell, Inc. Dr. Foreman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sage Therapeutics. Dr. Foreman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus Pharmaceuticals. Dr. Foreman has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for UCB Pharma Inc.. The institution of Dr. Foreman has received research support from DOD/AMRMC. The institution of Dr. Foreman has received research support from Biogen, Inc.. The institution of Dr. Foreman has received research support from DOD/AFRL. The institution of Dr. Foreman has received research support from NSF SCH:INT. The institution of Dr. Foreman has received research support from NIH/NIBIB. The institution of Dr. Foreman has received research support from DOD/JWMRP. The institution of Dr. Foreman has received research support from Marinus Pharmaceuticals. Dr. Foreman has received personal compensation in the range of $500-$4,999 for serving as a Honoraria with Natus Medical Incorporated. Dr. Foreman has received personal compensation in the range of $500-$4,999 for serving as a Honoraria with Ceribell, Inc.. Dr. Foreman has received personal compensation in the range of $0-$499 for serving as a Peer-to-peer program honoraria with Marinus Pharmaceuticals.
Jan Claassen, MD, PhD (Columbia University College of Physicians & Surgeons) Dr. Claassen has stock in iCE Neurosystems. The institution of Dr. Claassen has received research support from NINDS. The institution of Dr. Claassen has received research support from McDonnel Foundation. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Claassen has received publishing royalties from a publication relating to health care.
Carl W. Bazil, MD, PhD, FAAN (Columbia University) Dr. Bazil has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medical Letter . Dr. Bazil has received publishing royalties from a publication relating to health care.
No disclosure on file