Intensive Care Medicine

, Volume 38, Issue 10, pp 1640–1646 | Cite as

Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study

  • Eumorfia Kondili
  • Christina Alexopoulou
  • Nectaria Xirouchaki
  • Dimitris Georgopoulos
Original

Abstract

Purpose

To access the effect of propofol administration on sleep quality in critically ill patients ventilated on assisted modes.

Methods

This was a randomized crossover physiological study conducted in an adult ICU at a tertiary hospital. Two nights’ polysomnography was performed in mechanically ventilated critically ill patients with and without propofol infusion, while respiratory variables were continuously recorded. Arterial blood gasses were measured in the beginning and at the end of the study. The rate of propofol infusion was adjusted to maintain a sedation level of 3 on the Ramsay scale. Sleep architecture was analyzed manually using predetermined criteria. Patient–ventilator asynchrony was evaluated breath by breath using the flow–time and airway pressure–time waveforms.

Results

Twelve patients were studied. Respiratory variables, patient–ventilator asynchrony, and arterial blood gasses did not differ between experimental conditions. With or without propofol all patients demonstrated abnormal sleep architecture, expressed by lack of sequential progression through sleep stages and their abnormal distribution. Sleep efficiency, sleep fragmentation, and sleep stage distribution (1, 2, and slow wave) did not differ with or without propofol. Compared to without propofol, both the number of patients exhibiting REM sleep (p = 0.02) and the percentage of REM sleep (p = 0.04) decreased significantly with propofol.

Conclusions

In critically ill patients ventilated on assisted modes, propofol administration to achieve the recommended level of sedation suppresses the REM sleep stage and further worsens the poor sleep quality of these patients.

Keywords

REM sleep Sleep efficiency Respiratory variables Patient–ventilator asynchrony 

Supplementary material

134_2012_2623_MOESM1_ESM.doc (120 kb)
Supplementary material 1 (DOC 120 kb)

References

  1. 1.
    Parthasarathy S, Tobin MJ (2004) Sleep in the intensive care unit. Intensive Care Med 30:197–206PubMedCrossRefGoogle Scholar
  2. 2.
    Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ (2000) Sleep in critically ill patients requiring mechanical ventilation. Chest 117:809–818PubMedCrossRefGoogle Scholar
  3. 3.
    Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ (2001) Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 163:451–457PubMedGoogle Scholar
  4. 4.
    Sin DD, Logan AG, Fitzgerald FS, Liu PP, Bradley TD (2000) Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-stokes respiration. Circulation 102:61–66PubMedCrossRefGoogle Scholar
  5. 5.
    Leung RS, Bradley TD (2001) Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med 164:2147–2165PubMedGoogle Scholar
  6. 6.
    McGuire BE, Basten CJ, Ryan CJ, Gallagher J (2000) Intensive care unit syndrome: a dangerous misnomer. Arch Intern Med 160:906–909PubMedCrossRefGoogle Scholar
  7. 7.
    Irwin M, McClintick J, Costlow C, Fortner M, White J, Gillin JC (1996) Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J 10:643–653PubMedGoogle Scholar
  8. 8.
    Irwin M, Rinetti G, Redwine L, Motivala S, Dang J, Ehlers C (2004) Nocturnal proinflammatory cytokine-associated sleep disturbances in abstinent African American alcoholics. Brain Behav Immun 18:349–360PubMedCrossRefGoogle Scholar
  9. 9.
    Redwine L, Hauger RL, Gillin JC, Irwin M (2000) Effects of sleep and sleep deprivation on interleukin-6, growth hormone, cortisol, and melatonin levels in humans. J Clin Endocrinol Metab 85:3597–3603PubMedCrossRefGoogle Scholar
  10. 10.
    Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–141PubMedCrossRefGoogle Scholar
  11. 11.
    Kress JP, O’Connor MF, Pohlman AS, Olson D, Lavoie A, Toledano A, Hall JB (1996) Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam. Am J Respir Crit Care Med 153:1012–1018PubMedGoogle Scholar
  12. 12.
    Mendel PR, White PF (1993) Sedation of the critically ill patient. Int Anesthesiol Clin 31:185–200PubMedCrossRefGoogle Scholar
  13. 13.
    Tung A, Lynch JP, Mendelson WB (2001) Prolonged sedation with propofol in the rat does not result in sleep deprivation. Anesth Analg 92:1232–1236PubMedCrossRefGoogle Scholar
  14. 14.
    Tung A, Bergmann BM, Herrera S, Cao D, Mendelson WB (2004) Recovery from sleep deprivation occurs during propofol anesthesia. Anesthesiology 100:1419–1426PubMedCrossRefGoogle Scholar
  15. 15.
    Murphy M, Bruno MA, Riedner BA, Boveroux P, Noirhomme Q, Landsness EC, Brichant JF, Phillips C, Massimini M, Laureys S, Tononi G, Boly M (2011) Propofol anesthesia and sleep: a high-density EEG study. Sleep 34:283–291APubMedGoogle Scholar
  16. 16.
    Klimathianaki M, Kondili E, Alexopoulou C, Prinianakis G, Georgopoulos D (2010) Effect of propofol on breathing stability in adult ICU patients with brain damage. Respir Physiol Neurobiol 171:232–238PubMedCrossRefGoogle Scholar
  17. 17.
    Alexopoulou C, Kondili E, Vakouti E, Klimathianaki M, Prinianakis G, Georgopoulos D (2007) Sleep during proportional-assist ventilation with load-adjustable gain factors in critically ill patients. Intensive Care Med 33:1139–1147PubMedCrossRefGoogle Scholar
  18. 18.
    Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2:656–659PubMedCrossRefGoogle Scholar
  19. 19.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  20. 20.
    ASSM (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  21. 21.
    Georgopoulos D, Prinianakis G, Kondili E (2006) Bedside waveforms interpretation as a tool to identify patient-ventilator asynchronies. Intensive Care Med 32:34–47PubMedCrossRefGoogle Scholar
  22. 22.
    Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L (2006) Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 32:1515–1522PubMedCrossRefGoogle Scholar
  23. 23.
    Drouot X, Roche-Campo F, Thille AW, Cabello B, Galia F, Margarit L, d’Ortho MP, Brochard L (2012) A new classification for sleep analysis in critically ill patients. Sleep Med 13:7–14PubMedCrossRefGoogle Scholar
  24. 24.
    Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289:2983–2991PubMedCrossRefGoogle Scholar
  25. 25.
    Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166:1338–1344PubMedCrossRefGoogle Scholar
  26. 26.
    McCarthy MM, Brown EN, Kopell N (2008) Potential network mechanisms mediating electroencephalographic beta rhythm changes during propofol-induced paradoxical excitation. J Neurosci 28:13488–13504PubMedCrossRefGoogle Scholar
  27. 27.
    Brown EN, Lydic R, Schiff ND (2010) General anesthesia, sleep, and coma. N Engl J Med 363:2638–2650PubMedCrossRefGoogle Scholar
  28. 28.
    Siegel JM (2001) The REM sleep-memory consolidation hypothesis. Science 294:1058–1063PubMedCrossRefGoogle Scholar
  29. 29.
    McCoy JG, Strecker RE (2011) The cognitive cost of sleep lost. Neurobiol Learn Mem 96:564–582PubMedCrossRefGoogle Scholar
  30. 30.
    Fischer S, Hallschmid M, Elsner AL, Born J (2002) Sleep forms memory for finger skills. Proc Natl Acad Sci U S A 99:11987–11991PubMedCrossRefGoogle Scholar
  31. 31.
    Laureys S, Peigneux P, Phillips C, Fuchs S, Degueldre C, Aerts J, Del Fiore G, Petiau C, Luxen A, van der Linden M, Cleeremans A, Smith C, Maquet P (2001) Experience-dependent changes in cerebral functional connectivity during human rapid eye movement sleep. Neuroscience 105:521–525PubMedCrossRefGoogle Scholar
  32. 32.
    Karni A, Tanne D, Rubenstein BS, Askenasy JJ, Sagi D (1994) Dependence on REM sleep of overnight improvement of a perceptual skill. Science 265:679–682PubMedCrossRefGoogle Scholar
  33. 33.
    Maquet P (2001) The role of sleep in learning and memory. Science 294:1048–1052PubMedCrossRefGoogle Scholar
  34. 34.
    Frontera JA (2011) Delirium and sedation in the ICU. Neurocrit Care 14:463–474PubMedCrossRefGoogle Scholar
  35. 35.
    Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS (2010) Reducing iatrogenic risks: ICU-acquired delirium and weakness–crossing the quality chasm. Chest 138:1224–1233PubMedCrossRefGoogle Scholar
  36. 36.
    Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29:573–580PubMedCrossRefGoogle Scholar
  37. 37.
    Bosma K, Ferreyra G, Ambrogio C, Pasero D, Mirabella L, Braghiroli A, Appendini L, Mascia L, Ranieri VM (2007) Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med 35:1048–1054PubMedCrossRefGoogle Scholar
  38. 38.
    Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, Hanly PJ (2003) Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 167:708–715PubMedCrossRefGoogle Scholar
  39. 39.
    Parthasarathy S, Tobin MJ (2002) Effect of ventilator mode on sleep quality in critically ill patients. Am J Respir Crit Care Med 166:1423–1429PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Eumorfia Kondili
    • 1
  • Christina Alexopoulou
    • 1
  • Nectaria Xirouchaki
    • 1
  • Dimitris Georgopoulos
    • 1
  1. 1.Intensive Care Medicine DepartmentUniversity Hospital of Heraklion, School of Medicine, University of CreteHeraklionGreece

Personalised recommendations