title: Overnight sedation with midazolam or propofol in the ICU: effects on sleep quality, anxiety and depression.
abstract: OBJECTIVE
  To assess and compare the impact of overnight sedation with midazolam or propofol on anxiety and depression levels, as well as sleep quality, in non-intubated patients in intensive care.
  
  
  METHODS
  Open, comparative prospective, randomised study.
  
  
  METHODS
  Surgical intensive care unit (ICU) in a university hospital.
  
  
  METHODS
  40 conscious patients expected to stay in the ICU for at least 5 days who were admitted following trauma or elective orthopaedic, thoracic or abdominal surgery.
  
  
  RESULTS
  Evaluation of a self-assessment scale (Hospital Anxiety and Depression Scale, HAD) on the day following the 1st, 3rd and 5th night of sedation with either midazolam or propofol. Heart rate, pulse oximetry and blood gases were monitored. Eight patients were excluded from the analysis. The level of anxiety was severe (HAD > 10) in 31% of the patients receiving midazolam and in 26% (p = 0.1) receiving propofol after the first night of sedation with no significant improvement over the next few days. The levels of depression remained high (> 10) in 54% of patients receiving midazolam, and in 16% of the patients receiving propofol (p = 0.15). Sleep quality tended to improve during the study in the two groups.
  
  
  CONCLUSIONS
  These data show that half of the patients in the ICU experienced high levels of anxiety and depression during the first 5 post-operative or post-trauma days in the ICU. The beneficial effects of sedation on sleep quality were comparable for midazolam and propofol, regardless of a lack of improvement in anxiety and depression. However, an improved quality of sleep could help to re-establish a physiological night and day rhythm.
authors.affiliation: Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, University Hospital of Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Treggiari-Venzi
authors.forename: A
authors.initials: A
authors.lastname: Borgeat
authors.forename: T
authors.initials: T
authors.lastname: Fuchs-Buder
authors.forename: J P
authors.initials: JP
authors.lastname: Gachoud
authors.forename: P M
authors.initials: PM
authors.lastname: Suter
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000188:drug therapy*; D003422:Critical Care; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000188:drug therapy*; D018709:Statistics, Nonparametric
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol