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Effect of Sleep on the Recovery of Patients Admitted to the ICU

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ClinicalTrials.gov Identifier: NCT04111900
Recruitment Status : Recruiting
First Posted : October 1, 2019
Last Update Posted : October 1, 2019
Sponsor:
Information provided by (Responsible Party):
Rush University Medical Center

Brief Summary:
The investigators plan to create several sleep/circadian rhythm friendly rooms within the medical intensive care unit to determine if decreasing sleep fragmentation effects recovery in patients hospitalized in the ICU.

Condition or disease Intervention/treatment Phase
Critical Illness Circadian Dysregulation Delirium Behavioral: Sleep/Circadian Friendly Not Applicable

Detailed Description:

Critically ill patients are known to suffer from severely fragmented sleep with a predominance of stage I sleep and a paucity of slow wave and REM sleep. The causes of this sleep disruption include the intensive care unit (ICU) environment, medical illness, psychological stress, and many of the medications and other treatments used to help those who are critically ill. Surveys have identified poor sleep as one of the most frequent complaints among patients who have survived a critical illness. Patients in medical, cardiac, and surgical ICUs almost uniformly have fragmented sleep.

Although illness, pain, and medications contribute to sleep disruption in ICU patients, the primary factor causing sleep disruption had been thought to be the ICU environment. Noise from various sources, including ventilators, alarms, television, phones, beepers, and conversation, have all been purported to disturb sleep in the ICU. Patients have reported that noise, specifically talking, is a frequent cause of sleep disruption in the ICU. Several studies have confirmed that peak noise levels in ICUs are far in excess of 45 dB during the day and 35 dB at night, which are the recommendations of the Environmental Protection Agency for peak noise levels in the ICU.

The clinical importance of this type of sleep disruption in critically ill patients, however, is not known. The investigators hope to determine if placing patients in sleep/circadian rhythm friendly rooms will enable them to achieve better sleep, suffer from decreased delirium, and have improved recovery from their critical illness.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Effect of Sleep on the Recovery of Patients Admitted to the ICU
Actual Study Start Date : February 27, 2017
Estimated Primary Completion Date : December 31, 2019
Estimated Study Completion Date : January 31, 2020

Arm Intervention/treatment
Experimental: Sleep/Circadian Friendly
initiation of sleep/circadian rhythm friendly intervention the first night spent in MICU after enrollment until patient transfers/discharges, ceases participation, or meets exclusion criteria.
Behavioral: Sleep/Circadian Friendly
This intervention attempts to improve sleep and prevent circadian rhythm dysregulation among patients admitted to the medical intensive care unit (MICU). Patients within his arm will be asked to try to keep their TV off and limit their telephone use from 10pm-7am, as well as limit the amount of visitors in their room as much as possible between those hours. Patients will also be offered ear plugs and eye masks if they wish to use at night to aid in helping them sleep, if deemed medically safe to do so. Additionally nurses will be asked to bathe patients either before 10pm or after 7am, to limit their conversations in the patient's room at night, and try as much as possible to limit blood draws and waking patients during those hours as is medically safe. Nurses will also be instructed to lower the blinds in the room at 10 pm and raise them up at 7am to help with patients sleep/wake cycle.

No Intervention: Usual Care
Usual care within intensive care unit



Primary Outcome Measures :
  1. Length of Stay in ICU [ Time Frame: through study completion, an average of 3-4 days ]
    Time spent from admission to ICU until transfer/discharge or study cessation

  2. Overall Hospital Length of Stay [ Time Frame: at study completion, an average of 5-7 days ]
    Total time spent from admission to ICU until discharge from hospital

  3. Rate of ICU mortality [ Time Frame: at study completion, up to 30 days ]
    rate of mortality while admitted to ICU

  4. Rate of Delirium [ Time Frame: Once daily throughout study, on average 3-4 days ]
    Assess development of delirium through administration of CAM-ICU and RASS performed daily by nursing staff per routine care. Delirium will be considered present if CAM-ICU is positive or RASS above +1 or below -1 at anytime during study.

  5. Hospital Readmission Rate [ Time Frame: 30 days after discharge ]
    rate of hospital readmission within 30-days of discharge


Secondary Outcome Measures :
  1. ICU sleep score [ Time Frame: daily through study completion, an average of 3-4 days ]
    Assess sleep quality through administration of Richard Campbell Sleep Questionnaire (RCSQ). RCSQ is a simple and validated survey to measure sleep quality in ICU settings. RCSQ consists of a series of 8 patient reported questions covering sleep depth, sleep latency, total amount of sleep, number of awakenings, sleep quality, noise rating, light rating, and sleep quality compared to at home. All questions are to be reported on a scale of 0-100 with higher values corresponding to better sleep values.

  2. Overnight Sound Intensity Levels [ Time Frame: through study completion, an average of 3-4 days ]
    sound intensity (decibel) within patient room with be continuously recorded through SDL-600 industrial decibel monitors.

  3. Overnight Light Intensity Exposure [ Time Frame: through study completion, an average of 3-4 days ]
    amount of light patients are exposed to overnight, measured in lux, will be continuously recorded through specialized medical lux monitors.

  4. Concentration of Interleukin-6 (IL-6) and interleukin-10 (IL-10) [ Time Frame: Study Day 1 and Day 2 ]
    concentrations of IL-6 (pg/mL) and IL-10 (pg/mL), inflammatory cytokines found to play a role in circadian regulation, levels will be measured from approximately 2mL of plasma that will be collected concurrently during morning routine care lab draw.

  5. Concentration of 6-sulphatoxymelatonin (aMT6s) [ Time Frame: Study Day 1 and Day 2 ]
    concentrations of 6-sulphatoxymelatonin (pg/mL), the primary urine metabolite of melatonin and circadian rhythm phase marker, will be measured from left-over voided urine collected from patients prior to discard.

  6. Concentration of Lipopolysaccharide binding protein (LBP) [ Time Frame: Study Day 1 and Day 2 ]
    Levels of LBP (pg/mL), an acute phase protein that upregulates during an inflammatory physiologic state, will be measured from 2mL of blood taken concurrently with routine morning labs.



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Ages Eligible for Study:   18 Years to 99 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • any adult patient admitted to the MICU with an expected length of stay of at least 3 days

Exclusion Criteria:

  • frequent overnight neurological checks or frequent peripheral vascular checks

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04111900


Contacts
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Contact: Garth R Swanson, MD 312-563-3871 garth_swanson@rush.edu

Locations
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United States, Illinois
Rush University Medical Center Recruiting
Chicago, Illinois, United States, 60612
Contact: Garth R Swanson, MD    312-942-5861    garth_swanson@rush.edu   
Sponsors and Collaborators
Rush University Medical Center
Investigators
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Principal Investigator: Garth R Swanson, MD Rush University Medical Center

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Responsible Party: Rush University Medical Center
ClinicalTrials.gov Identifier: NCT04111900    
Other Study ID Numbers: 16111002
First Posted: October 1, 2019    Key Record Dates
Last Update Posted: October 1, 2019
Last Verified: September 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Delirium
Chronobiology Disorders
Critical Illness
Confusion
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Neurocognitive Disorders
Mental Disorders
Disease Attributes
Pathologic Processes