title: Propofol versus flunitrazepam for inducing and maintaining sleep in postoperative ICU patients.
abstract: BACKGROUND
  Sleep deprivation is a common problem on intensive care units (ICUs) influencing not only cognition, but also cellular functions. An appropriate sleep-wake cycle should therefore be maintained to improve patients' outcome. Multiple disruptive factors on ICUs necessitate the administration of sedating and sleep-promoting drugs for patients who are not analgo-sedated.
  
  
  OBJECTIVE
  The objective of the present study was to evaluate sleep quantity and sleep quality in ICU patients receiving either propofol or flunitrazepam.
  
  
  METHODS
  Monocentric, randomized, double-blinded trial.
  
  
  METHODS
  A total of 66 ICU patients were enrolled in the study (flunitrazepam n = 32, propofol n = 34). Propofol was injected continuously (2 mg/kg/h), flunitrazepam as a bolus dose (0.015 mg/kg). Differences between groups were evaluated using a standardized sleep diary and the bispectral index (BIS).
  
  
  METHODS
  Group comparisons were performed by Mann-Whitney U-Test. P < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  Sleep quality and the frequency of awakenings were significantly better in the propofol group (Pg). In the same group lower BIS values were recorded (median BIS propofol 74.05, flunitrazepam 78.7 [P = 0.016]). BIS values had to be classified predominantly to slow-wave sleep under propofol and light sleep after administration of flunitrazepam. Sleep quality improved in the Pg with decreasing frequency of awakenings and in the flunitrazepam group with increasing sleep duration.
  
  
  CONCLUSIONS
  Continuous low-dose injection of propofol for promoting and maintaining night sleep in ICU patients who are not analgo-sedated was superior to flunitrazepam regarding sleep quality and sleep structure.
authors.affiliation: Department of Gastroenterology, Rheumatology and Hepatology, University Hospital Leipzig Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Engelmann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Helios Klinikum Aue, Gartenstraße 6, 08280 Aue, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Wallenborn
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Derk
authors.initials: D
authors.lastname: Olthoff
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig Liebigstrasse 20, 04103 Leipzig, Germany.
authors.forename: Udo X
authors.initials: UX
authors.lastname: Kaisers
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, Pain Therapy and Palliative Care, Helios Klinikum Borna, Rudolf-Virchow-Straße 2, 04552 Borna, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Rüffert
keywords: Bispectral index; intensive care unit; propofol; sleep