Melatonin, Light & Noise Reduction To Improve Sleep in the Neurological Intensive Care Unit (P01.025)

Abstract

OBJECTIVE: To increase total sleep time by using melatonin and mitigating environmental disruptions in brain injured patients.

BACKGROUND: 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.

DESIGN/METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Supported by: A 2011-2012 Pfizer Fellowships in Epilepsy from Pfizer's Medical and Academic Partnerships program.

Disclosure: Dr. Foreman has received research support from Pfizer's Medical and Academic Partnerships program. Dr. Claassen has nothing to disclose. Dr. Bazil has received personal compensation for activities with Pfizer, Inc., Lundbeck Research USA, Inc., and Eisai Inc. Dr. Bazil has received personal compensation in an editorial capacity for Current Neurology and Neuroscience Reports, and The Medical Letter.