Delirium and sleep quality in the intensive care unit: the role of melatonin - Critical Care Science (CCS)

Delirium and sleep quality in the intensive care unit: the role of melatonin

Crit Care Sci. 2024;36:e20240083en

DOI: 10.62675/2965-2774.20240083-en

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Patients in intensive care units (ICUs) frequently face challenges related to delirium and sleep disturbances.() Despite extensive research in recent years, delirium remains a complex condition with uncertain pathophysiology, and its occurrence is associated with worse outcomes as well as longer durations cognitive and functional impairment.(,) Although no study has shown a strong relationship between ICU delirium and sleep to date, the development of delirium and sleep disturbance in the ICU is often multifactorial, with numerous related risk factors, including age, comorbidities, disease severity, environmental factors, and iatrogenic interventions.()

The lack of evidence supporting the use of pharmacological interventions (such as antipsychotics or sedatives) for delirium prevention or treatment in the ICU() highlights the importance of targeted interventions to mitigate the risk of delirium and its predisposing conditions.(,) Current recommendations for delirium prevention emphasize nonpharmacological measures, such as optimizing human care (eCASH),() the well-established A to F bundle,() and efforts to minimize modifiable risk factors. The PADIS guidelines maintain that sleep should be routinely monitored, and strategies for sleep hygiene enhancement should be discussed with patients.() Despite these efforts, sleep disturbances, such as sleep deprivation, are still reported by 66% of ICU patients() and are linked to neurocognitive dysfunction, which further increases the risk of delirium.()



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