Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study
Abstract Background Patients treated in the intensive care unit (ICU) may experience a reversal of day and night. The circadian rhythm in ICU patients can be disturbed. Methods To explore the relationship between ICU delirium and the circadian rhythms of melatonin, cortisol and sleep. A prospective...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-023-02163-4 |
| _version_ | 1797801259566104576 |
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| author | Jingjing Li Shining Cai Xiao Liu Jinghua Mei Wenyan Pan Ming Zhong Yuxia Zhang |
| author_facet | Jingjing Li Shining Cai Xiao Liu Jinghua Mei Wenyan Pan Ming Zhong Yuxia Zhang |
| author_sort | Jingjing Li |
| collection | DOAJ |
| description | Abstract Background Patients treated in the intensive care unit (ICU) may experience a reversal of day and night. The circadian rhythm in ICU patients can be disturbed. Methods To explore the relationship between ICU delirium and the circadian rhythms of melatonin, cortisol and sleep. A prospective cohort study was carried out in a surgical ICU of a tertiary teaching hospital. Patients who were conscious during the ICU stay after surgery and were scheduled to stay in the ICU for more than 24 h were enrolled. Serum melatonin and plasma cortisol levels were measured three times a day by drawing arterial blood on the first three days after ICU admission. Daily sleep quality was assessed by the Richard-Campbell Sleep Questionnaire (RCSQ). The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was performed twice a day to screen for ICU delirium. Results A total of 76 patients were included in this study, and 17 patients developed delirium during their ICU stay. Melatonin levels were different at 8:00 (p = 0.048) on day 1, at 3:00 (p = 0.002) and at 8:00 (p = 0.009) on day 2, and at all three time points on day 3 (p = 0.032, 0.014, 0.047) between delirium and non-delirium patients. The plasma cortisol level in the delirium patients was significantly lower than that in the non-delirium patients at 16:00 on day 1 (p = 0.025). The changes in melatonin and cortisol secretion levels exhibited obvious biological rhythmicity in non-delirium patients (p < 0.001 for melatonin, p = 0.026 for cortisol), while no rhythmicity was found in melatonin and cortisol secretion levels in the delirium group (p = 0.064 for melatonin, p = 0.454 for cortisol). There was no significant difference in RCSQ scores in the first three days between the two groups. Conclusions The disturbance of the circadian rhythm of melatonin and cortisol secretion was associated with the development of delirium in ICU patients. Clinical staff should pay more attention to the importance of maintaining patients’ normal circadian rhythms in the ICU. Trial registration The study was registered with the US National Institutes of Health ClinicalTrials.gov(NCT05342987) (25/04/2022). |
| first_indexed | 2024-03-13T04:48:42Z |
| format | Article |
| id | doaj.art-abeb30a992234bf49182d9ad3bcd949e |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-13T04:48:42Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-abeb30a992234bf49182d9ad3bcd949e2023-06-18T11:23:16ZengBMCBMC Anesthesiology1471-22532023-06-012311910.1186/s12871-023-02163-4Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort studyJingjing Li0Shining Cai1Xiao Liu2Jinghua Mei3Wenyan Pan4Ming Zhong5Yuxia Zhang6Department of Nursing, Zhongshan Hospital, Fudan UniversityDepartment of Nursing, Zhongshan Hospital, Fudan UniversityDepartment of Nursing, Zhongshan Hospital, Fudan UniversityDepartment of Nursing, Zhongshan Hospital, Fudan UniversityDepartment of Nursing, Zhongshan Hospital, Fudan UniversityDepartment of Critical Care Medicine, Zhongshan Hospital, Fudan UniversityDepartment of Nursing, Zhongshan Hospital, Fudan UniversityAbstract Background Patients treated in the intensive care unit (ICU) may experience a reversal of day and night. The circadian rhythm in ICU patients can be disturbed. Methods To explore the relationship between ICU delirium and the circadian rhythms of melatonin, cortisol and sleep. A prospective cohort study was carried out in a surgical ICU of a tertiary teaching hospital. Patients who were conscious during the ICU stay after surgery and were scheduled to stay in the ICU for more than 24 h were enrolled. Serum melatonin and plasma cortisol levels were measured three times a day by drawing arterial blood on the first three days after ICU admission. Daily sleep quality was assessed by the Richard-Campbell Sleep Questionnaire (RCSQ). The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was performed twice a day to screen for ICU delirium. Results A total of 76 patients were included in this study, and 17 patients developed delirium during their ICU stay. Melatonin levels were different at 8:00 (p = 0.048) on day 1, at 3:00 (p = 0.002) and at 8:00 (p = 0.009) on day 2, and at all three time points on day 3 (p = 0.032, 0.014, 0.047) between delirium and non-delirium patients. The plasma cortisol level in the delirium patients was significantly lower than that in the non-delirium patients at 16:00 on day 1 (p = 0.025). The changes in melatonin and cortisol secretion levels exhibited obvious biological rhythmicity in non-delirium patients (p < 0.001 for melatonin, p = 0.026 for cortisol), while no rhythmicity was found in melatonin and cortisol secretion levels in the delirium group (p = 0.064 for melatonin, p = 0.454 for cortisol). There was no significant difference in RCSQ scores in the first three days between the two groups. Conclusions The disturbance of the circadian rhythm of melatonin and cortisol secretion was associated with the development of delirium in ICU patients. Clinical staff should pay more attention to the importance of maintaining patients’ normal circadian rhythms in the ICU. Trial registration The study was registered with the US National Institutes of Health ClinicalTrials.gov(NCT05342987) (25/04/2022).https://doi.org/10.1186/s12871-023-02163-4DeliriumCircadian rhythmMelatoninCortisol |
| spellingShingle | Jingjing Li Shining Cai Xiao Liu Jinghua Mei Wenyan Pan Ming Zhong Yuxia Zhang Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study BMC Anesthesiology Delirium Circadian rhythm Melatonin Cortisol |
| title | Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study |
| title_full | Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study |
| title_fullStr | Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study |
| title_full_unstemmed | Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study |
| title_short | Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study |
| title_sort | circadian rhythm disturbance and delirium in icu patients a prospective cohort study |
| topic | Delirium Circadian rhythm Melatonin Cortisol |
| url | https://doi.org/10.1186/s12871-023-02163-4 |
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