title: Comparison of sleep quality with mechanical versus spontaneous ventilation during weaning of critically III tracheostomized patients.
abstract: BACKGROUND
  In mechanically ventilated patients under mechanical ventilation in the ICU, ventilatory mode or settings may influence sleep quality. The aim of this study was to evaluate the direct impact of mechanical ventilation per se on sleep quantity and quality in patients who were able to tolerate separation from mechanical ventilation over prolonged periods.
  
  
  METHODS
  Randomized crossover clinical trial in a medical ICU.
  
  
  METHODS
  Sixteen conscious patients, free of sedation and tracheostomized because of prolonged weaning from mechanical ventilation, were included in the study when able to tolerate at least 5 hours of spontaneous ventilation.
  
  
  METHODS
  Patients were randomized to receive either spontaneous ventilation or mechanical ventilation at low levels of pressure support for two crossover periods of 5-hour duration each, from 22:00 to 08:00. Polysomnography was performed throughout the study.
  
  
  RESULTS
  Total sleep time was higher during mechanical ventilation than during spontaneous ventilation (183 min vs 132 min, p = 0.04). No significant differences between mechanical ventilation and spontaneous ventilation were observed in slow wave sleep time (45 min vs 28 min), rapid eye movement sleep time (11 min vs 3 min), or the fragmentation index (25 vs 23 arousals and awakenings per hr). In four patients, however, our analysis of patient-ventilator interaction suggested that the ventilatory settings were suboptimal and could have been improved to potentially improve sleep.
  
  
  CONCLUSIONS
  In difficult-to-wean tracheostomized patients, sleep quality was similar with or without the ventilator. Sleep quantity was higher during mechanical ventilation. Reconnection to the ventilator during the night period may favor sleep efficiency in tracheostomized patients in prolonged weaning.
authors.affiliation: AP-HP, Medical Intensive Care Unit, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, France. ferranroche@yahoo.es
authors.forename: Ferran
authors.initials: F
authors.lastname: Roche-Campo
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: Laurent
authors.initials: L
authors.lastname: Margarit
authors.forename: Ana
authors.initials: A
authors.lastname: Córdoba-Izquierdo
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012121:Respiration, Artificial / Q000379:methods*; D012890:Sleep; D012894:Sleep Stages