Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes.
OBJECTIVE
To compare the influence of three ventilatory modes on sleep.


METHODS
Prospective, comparative, crossover study.


METHODS
Medical intensive care unit in a university hospital.


METHODS
Fifteen conscious, nonsedated, mechanically ventilated patients.


METHODS
Patients were successively ventilated with assist-control ventilation, clinically adjusted pressure support ventilation (cPSV), and automatically adjusted pressure support ventilation (aPSV). Sleep polysomnography was performed during three consecutive 6-hr periods, one with each mode in random order. Airway pressure and thorax and abdomen plethysmography were used to diagnose central apneas and ineffective efforts.


RESULTS
The main abnormalities were a low percentage of rapid eye movement (REM) sleep counting, for a median (25th-75th percentiles) of 10% (3.5-12.5) of total sleep, and a highly fragmented sleep with 29 arousals and awakenings per hour of sleep. REM sleep duration was similar in the three ventilatory modes, 7% in assist-control, 4% in aPSV, and 1% during cPSV (p = .54), as well as in the fragmentation index, 31 arousals and awakenings per hour in assist-control, 32 in aPSV, and 34 during cPSV (p = .62). Ineffective efforts occurred similarly with the three modes (seven per hour of sleep in assist-control, 16 in aPSV, and 12 during cPSV) or central apneas during PSV (five in aPSV, seven during cPSV). Minute ventilation was similar with the three modes.


CONCLUSIONS
In conscious, mechanically ventilated patients, sleep architecture was highly abnormal, with a short REM stage and a high degree of fragmentation. The ventilatory mode did not influence sleep pattern, arousals, awakenings, and ineffective efforts.
Cabello
Belen
B
Réanimation médicale, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil, France. MCabello@santpau.es
Thille
Arnaud W
AW
Drouot
Xavier
X
Galia
Fabrice
F
Mancebo
Jordi
J
d'Ortho
Marie-Pia
MP
Brochard
Laurent
L
D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D003430:Cross-Sectional Studies; D020920:Dyssomnias / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005602:France; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012307:Risk Factors; D012892:Sleep Deprivation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control