Patients with exhibited less than 1.05% rapid eye movement (REM) sleep compared to controls.
levels were lower and levels were higher in patients with delirium than in the control group.
, melatonin, and cortisol levels are significantly associated with the occurrence of ICU-acquired delirium.
Optimal cutoff values for predicting delirium included REM sleep at ≤1.05%, mean melatonin at ≤422.09 pg/mL, and cortisol at ≥212.14 ng/mL.
Improving sleep patterns and restoring circadian rhythm may be potential therapeutic approaches for ICU-acquired delirium.
Simplified
OBJECTIVE: The relationships among sleep, circadian rhythm, and intensive care unit (ICU)-acquired are complex and remain unclear. This study aimed to examine the pathophysiological mechanisms of sleep and circadian rhythm disturbances in patients with ICU-acquired delirium.
METHODS: This study included critical adult patients aged 18 to 75 years who were treated in the ICU. Twenty-four-hour polysomnography was performed and serum and levels were measured six times during polysomnography. Receiver operating characteristic curves and binomial logistic regression were used to evaluate the potential of sleep, melatonin, and cortisol as indicators of delirium in the ICU.
RESULTS: Patients with delirium (n = 24) showed less rapid eye movement (REM) sleep compared with patients without delirium (n = 24, controls). Melatonin levels were lower and cortisol levels were higher in the delirium group than in the control group. , melatonin, and cortisol were significantly associated with delirium. The optimal cutoff values of REM sleep and mean melatonin and cortisol levels that predicted delirium were ≤1.05%, ≤422.09 pg/mL, and ≥212.14 ng/mL, respectively.
CONCLUSIONS: REM sleep, and melatonin and cortisol levels are significantly associated with the risk of ICU-acquired delirium. Improved sleep and readjustment of circadian rhythmicity may be therapeutic targets of ICU-acquired delirium.
Key numbers
≤1.05%
Decrease in
Optimal cutoff value predicting risk.
≤422.09 pg/mL
Lower Level
Optimal cutoff value predicting risk.
≥212.14 ng/mL
Higher Level
Optimal cutoff value predicting risk.
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