Martin Dres1,2,3, Magdy Younes4,5, Nuttapol Rittayamai1,2,6, Tetyana Kendzerska7, Irene Telias1,2, Domenico Luca Grieco1,2, Tai Pham1,2, Detajin Junhasavasdikul1,2, Edmond Chau2, Sangeeta Mehta2,8, M Elizabeth Wilcox2,9, Richard Leung7, Xavier Drouot10, Laurent Brochard1,2. 1. 1 Keenan Research Centre, Li Ka Shing Knowledge Institute, and. 2. 2 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 3. 3 Service de Pneumologie, Médecine Intensive-Réanimation, Département R3S AP-HP, Groupe Hospitalier Pitié-Salpétrière Charles Foix, Paris, France. 4. 4 YRT Ltd., Winnipeg, Manitoba, Canada. 5. 5 Sleep Disorders Centre, Winnipeg, Manitoba, Canada. 6. 6 Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 7. 7 Division of Respirology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 8. 9 Intensive Care Unit, Mount Sinai Hospital, Toronto, Ontario, Canada. 9. 10 Critical Care, Department of Medicine, Toronto Western Hospital, Toronto, Ontario, Canada; and. 10. 11 Neurophysiologie Clinique et Explorations Fonctionnelles, CHU de Poitiers, Poitiers, France.
Abstract
Rationale: Abnormal patterns of sleep and wakefulness exist in mechanically ventilated patients. Objectives: In this study (SLEEWE [Effect of Sleep Disruption on the Outcome of Weaning from Mechanical Ventilation]), we aimed to investigate polysomnographic indexes as well as a continuous index for evaluating sleep depth, the odds ratio product (ORP), to determine whether abnormal sleep or wakefulness is associated with the outcome of spontaneous breathing trials (SBTs). Methods: Mechanically ventilated patients from three sites were enrolled if an SBT was planned the following day. EEG was recorded using a portable sleep diagnostic device 15 hours before the SBT. The ORP was calculated from the power of four EEG frequency bands relative to each other, ranging from full wakefulness (2.5) to deep sleep (0). The correlation between the right and left hemispheres' ORP (R/L ORP) was calculated. Measurements and Main Results: Among 44 patients enrolled, 37 had technically adequate signals: 11 (30%) passed the SBT and were extubated, 8 (21%) passed the SBT but were not deemed to be clinically ready for extubation, and 18 (49%) failed the SBT. Pathological wakefulness or atypical sleep were highly prevalent, but the distribution of classical sleep stages was similar between groups. The mean ORP and the proportion of time in which the ORP was >2.2 were higher in extubated patients compared with the other groups (P < 0.05). R/L ORP was significantly lower in patients who failed the SBT, and the area under the receiver operating characteristic curve of R/L ORP to predict failure was 0.91 (95% confidence interval, 0.75-0.98). Conclusions: Patients who pass an SBT and are extubated reach higher levels of wakefulness as indicated by the ORP, suggesting abnormal wakefulness in others. The hemispheric ORP correlation is much poorer in patients who fail an SBT.
Rationale: Abnormal patterns of sleep and wakefulness exist in mechanically ventilated patients. Objectives: In this study (SLEEWE [Effect of Sleep Disruption on the Outcome of Weaning from Mechanical Ventilation]), we aimed to investigate polysomnographic indexes as well as a continuous index for evaluating sleep depth, the odds ratio product (ORP), to determine whether abnormal sleep or wakefulness is associated with the outcome of spontaneous breathing trials (SBTs). Methods: Mechanically ventilated patients from three sites were enrolled if an SBT was planned the following day. EEG was recorded using a portable sleep diagnostic device 15 hours before the SBT. The ORP was calculated from the power of four EEG frequency bands relative to each other, ranging from full wakefulness (2.5) to deep sleep (0). The correlation between the right and left hemispheres' ORP (R/L ORP) was calculated. Measurements and Main Results: Among 44 patients enrolled, 37 had technically adequate signals: 11 (30%) passed the SBT and were extubated, 8 (21%) passed the SBT but were not deemed to be clinically ready for extubation, and 18 (49%) failed the SBT. Pathological wakefulness or atypical sleep were highly prevalent, but the distribution of classical sleep stages was similar between groups. The mean ORP and the proportion of time in which the ORP was >2.2 were higher in extubated patients compared with the other groups (P < 0.05). R/L ORP was significantly lower in patients who failed the SBT, and the area under the receiver operating characteristic curve of R/L ORP to predict failure was 0.91 (95% confidence interval, 0.75-0.98). Conclusions: Patients who pass an SBT and are extubated reach higher levels of wakefulness as indicated by the ORP, suggesting abnormal wakefulness in others. The hemispheric ORP correlation is much poorer in patients who fail an SBT.
Authors: Ali Azarbarzin; Magdy Younes; Scott A Sands; Andrew Wellman; Susan Redline; Charles A Czeisler; Daniel J Gottlieb Journal: J Sleep Res Date: 2020-05-22 Impact factor: 3.981
Authors: Sadaf Farasat; Jennifer J Dorsch; Alex K Pearce; Alison A Moore; Jennifer L Martin; Atul Malhotra; Biren B Kamdar Journal: Curr Sleep Med Rep Date: 2020-07-27
Authors: Jennifer J Dorsch; Jennifer L Martin; Atul Malhotra; Robert L Owens; Biren B Kamdar Journal: Semin Respir Crit Care Med Date: 2019-12-11 Impact factor: 3.119