title: Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes.
abstract: 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.
authors.affiliation: Réanimation médicale, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil, France. MCabello@santpau.es
authors.forename: Belen
authors.initials: B
authors.lastname: Cabello
authors.forename: Arnaud W
authors.initials: AW
authors.lastname: Thille
authors.forename: Xavier
authors.initials: X
authors.lastname: Drouot
authors.forename: Fabrice
authors.initials: F
authors.lastname: Galia
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
authors.forename: Marie-Pia
authors.initials: MP
authors.lastname: d'Ortho
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: 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