title: Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors.
abstract: OBJECTIVE
  Disrupted sleep is a common and potentially modifiable risk factor for delirium in the ICU. As part of a quality improvement project to promote sleep in the ICU, we examined the association of perceived sleep quality ratings and other patient and ICU risk factors with daily transition to delirium.
  
  
  METHODS
  Secondary analysis of prospective observational study.
  
  
  METHODS
  Medical ICU over a 201-day period.
  
  
  METHODS
  Two hundred twenty-three patients with greater than or equal to one night in the medical ICU in between two consecutive days of delirium assessment.
  
  
  METHODS
  None.
  
  
  RESULTS
  Daily perceived sleep quality ratings were measured using the Richards-Campbell Sleep Questionnaire. Delirium was measured twice daily using the Confusion Assessment Method for the ICU. Other covariates evaluated included age, sex, race, ICU admission diagnosis, nighttime mechanical ventilation status, prior day's delirium status, and daily sedation using benzodiazepines and opioids, via both bolus and continuous infusion. Perceived sleep quality was similar in patients who were ever versus never delirious in the ICU (median [interquartile range] ratings, 58 [35-76] vs 57 [33-78], respectively; p = 0.71), and perceived sleep quality was unrelated to delirium transition (adjusted odds ratio, 1.00; 95% CI, 0.99-1.00). In mechanically ventilated patients, receipt of a continuous benzodiazepine and/or opioid infusion was associated with delirium transition (adjusted odds ratio, 4.02; 95% CI, 2.19-7.38; p < 0.001), and patients reporting use of pharmacological sleep aids at home were less likely to transition to delirium (adjusted odds ratio, 0.40; 95% CI, 0.20-0.80; p = 0.01).
  
  
  CONCLUSIONS
  We found no association between daily perceived sleep quality ratings and transition to delirium. Infusion of benzodiazepine and/or opioid medications was strongly associated with transition to delirium in the ICU in mechanically ventilated patients and is an important, modifiable risk factor for delirium in critically ill patients.
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.
authors.forename: Biren B
authors.initials: BB
authors.lastname: Kamdar
authors.affiliation: Department of Medicine, Johns Hopkins University.
authors.forename: Timothy
authors.initials: T
authors.lastname: Niessen
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University.|Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University.|Medical Intensive Care Unit, Johns Hopkins Hospital.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: King
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University.|Department of Psychiatry and Behavioral Sciences, Johns Hopkins University.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Neufeld
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University.|Department of Psychiatry and Behavioral Sciences, Johns Hopkins University.
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.affiliation: Department of Pharmacy, Johns Hopkins Hospital.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Rowden
authors.affiliation: Emory Sleep Disorders Center, Wesley Woods Health Center, Emory University.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Collop
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins University.|Department of Physical Medicine and Rehabilitation, Johns Hopkins University.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000367:Age Factors; D000368:Aged; D003693:Delirium / Q000209:etiology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D012737:Sex Factors; D012890:Sleep; D012892:Sleep Deprivation / Q000150:complications* / Q000175:diagnosis; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives