Abstract
Purpose
In patients receiving palliative care (PC), sleep is often negatively influenced by pain, anxiety and medication. Because these patients are often too sick to be investigated in a sleep laboratory, it is difficult to obtain objective information concerning their sleep. This study investigates whether bispectral index (BIS) monitoring reflects wakefulness, sleep and the effect of medication and whether it is tolerable for patients.
Methods
In all, 10 patients from an inpatient PC unit participated in the study. They were monitored using a BIS system for one night, while each event was carefully documented by patient care attendants. In addition, participants completed a questionnaire on the evening prior to and on the morning following the recording about their subjective wellbeing and sleep.
Results
On a scale from 0 to 100, BIS measurements covered values ranging from a minimum of 29–40 to a maximum of 74–98. Individual differences between minimum and maximum ranged between 38 and 68. High BIS values are associated with wakefulness, low BIS values with sleep. The administration of sedative and analgesic medication was followed by a long-lasting decrease in BIS measurements. In 3 patients, the measurements were discontinued due to the patient being disturbed or irritation of the skin.
Conclusion
BIS monitoring was well tolerated by most but not all patients. It can be useful in complementing patients’ reports in questionable cases. This might be of special interest in outpatient settings where continuous objective professional observation is not available.
Zusammenfassung
Hintergrund
Erholsamer Schlaf ist wichtig für die Lebensqualität von Palliativpatienten, wird aber oftmals negativ durch Schmerzen, Angst und Medikamente beeinflusst. Da die Patienten für eine Untersuchung im Schlaflabor meistens zu krank sind, ist es schwierig, objektive Informationen über ihren Schlaf zu erhalten. Die Studie untersucht, ob das Bispectral-Index(BIS)-Monitoring den nächtlichen Verlauf von Schlaf und Wachheit sowie die Auswirkung verschiedener Medikamente widerspiegelt und ob die Messmethode für Palliativpatienten tolerabel ist.
Methoden
In der Zeit zwischen November 2010 und Februar 2011 nahmen 10 Patienten der Palliativstation am Universitätsklinikum Aachen an der Studie teil. Sie wurden während einer Nacht mit dem BIS-Monitorsystem untersucht, und jedes Ereignis während des Schlafs wurde von Sitzwachen dokumentiert. Zudem beantworteten die Studienteilnehmer am Abend vor und am Morgen nach der Messung Fragebögen über ihr subjektives Wohlbefinden und ihren Schlaf.
Ergebnisse
Auf einer Skala zwischen 0 und 100 lagen die gemessenen BIS-Werte minimal zwischen 29 und 40 und maximal zwischen 74 und 98. Der individuelle Unterschied zwischen Minimum und Maximum variierte zwischen 38 und 68. Hohe BIS-Werte konnten mit Wachheit in Verbindung gebracht werden, niedrige mit Schlaf. Die Gabe von sedierenden und analgetischen Medikamenten hatte einen lange andauernden Abfall der Werte zur Folge. Bei 3 Patienten musste die Messung wegen Störgefühlen oder Hautrötungen abgebrochen werden.
Schlussfolgerungen
Mit dem BIS-Monitoring konnte der Verlauf von Schlaf und Wachheit gut abgebildet werden. Die Messungen wurden von der Mehrheit, aber nicht von allen Patienten toleriert. Die Methode könnte auch im ambulanten Setting helfen, subjektive Angaben der Patienten zum Schlaf und Auswirkungen von Medikamenten weiter zu untersuchen.
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Acknowledgements
We gratefully thank Covidien (Neustadt an der Donau, Germany) for loaning a BIS VISTA™ to us for the time of the study. The company did not influence the results or the writing of the manuscript in any way.
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Linda Bertram and Stephanie Stiel contributed equally to this manuscript.
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Bertram, L., Stiel, S., Krumm, N. et al. Bispectral index monitoring of sleep in palliative care patients. Somnologie 17, 115–121 (2013). https://doi.org/10.1007/s11818-013-0612-2
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DOI: https://doi.org/10.1007/s11818-013-0612-2