Résumé
Le sommeil des patients de soins intensifs est souvent très altéré. Le meilleur moyen d’étudier le sommeil en réanimation est la polysomnographie; mais cet examen reste complexe à réaliser dans cet environnement. Ces altérations du sommeil sont particulières et incluent des anomalies de l’électroencéphalogramme de sommeil et de veille qui compliquent la reconnaissance des stades. D’autres outils de quantification du sommeil chez ces patients sont en cours de développement. Le sommeil de la plupart d’entre eux est désorganisé avec de fréquents épisodes de sommeil durant la journée. Un déficit en sommeil profond et paradoxal ainsi qu’une fragmentation importante sont rapportés par la plupart des études. Les causes sont liées à l’environnement sonore et lumineux ainsi qu’aux soins continus. La ventilation assistée, les médicaments, la sédation, la perte du cycle activité-repos et la diminution de la production de mélatonine concourent à ces altérations du sommeil. Les conséquences biologique et neuropsychiatrique de cette privation de sommeil pourraient avoir un impact sur la morbidité de ces patients. Des techniques visant à préserver le sommeil ont été tentées, mais les résultats restent pour le moment peu concluants.
Abstract
Intensive care unit (ICU) environment is not propitious for restoring sleep. Alterations in sleep have potential detrimental consequences, explaining increasing interest in the field over the last years. Methods to study sleep in the ICU have significant limitations. Accurate sleep analysis requires full polysomnography; however, polysomnographic patterns of normal sleep are frequently lacking in these patients and conventional scoring rules may be inadequate. Patients experience severe alterations of sleep with sleep loss, sleep fragmentation, and sleep-wake cycle disorganization. Many factors may contribute to these abnormalities, including patient-related (e.g., disease severity) and environmental factors (e.g., continuous exposure to light and noise, around-the-clock care, and medications). Health-support techniques like mechanical ventilation and sedation may also contribute to sleep disruption. The impact of sleep disturbances on morbidity and mortality in ICU patients remains unknown, but inferences from experimental studies or indirect evidence suggest possible immune function alterations and neuropsychological dysfunction that could hamper weaning from assisted ventilation. Whether sleep disruption in ICU patients is independently associated with adverse outcomes or merely represents a marker for cerebral dysfunction remains to be determined. However, whatever meaning and mechanisms of these alterations are, specific measures are recommended to protect sleep and circadian rhythm in ICU.
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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2013 dans la session: Le sommeil en réanimation.
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Drouot, X., Thille, A.W. Altérations du sommeil en unité de soins intensifs. Réanimation 22 (Suppl 2), 374–382 (2013). https://doi.org/10.1007/s13546-012-0567-5
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DOI: https://doi.org/10.1007/s13546-012-0567-5