Rationale/Objectives Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU. Methods A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified. Results Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging. Conclusions This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.

中文翻译：

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重症监护室干预措施促进睡眠和昼夜节律生物学以减少谵妄事件：范围界定审查


理由/目标 尽管病理生理学机制看似合理，但仍需要研究来证实入住重症监护病房 (ICU) 的患者的睡眠、昼夜节律和谵妄之间的关系。本综述的目的是总结现有的研究，这些研究全部或部分促进了睡眠和昼夜节律生物学的正常化及其对 ICU 中谵妄的发生率、患病率、持续时间和/或严重程度的影响。方法 2023 年 3 月完成了对电子数据库和会议记录的敏感检索。纳入标准是任何设计的英语研究，这些研究评估了 ICU 内非药理学、药理学或混合干预策略促进睡眠或昼夜节律生物学及其与睡眠的关系。谵妄，至少每天评估一次。数据被提取并独立验证。结果 在 7886 次引用中，我们收录了 50 篇文章。经常评估的干预措施包括护理包（n = 20）、光疗的调节或施用（n = 5）、眼罩和/或耳塞（n = 5）、一种以护理为重点的干预措施和药物干预（例如褪黑激素和药物干预）。雷美替胺；n=19)。这些干预措施与谵妄事件或谵妄严重程度之间的关联是复杂的。由于多种干预措施被纳入护理包研究中，并且考虑到各个要素的依从性报告各不相同，因此确定哪些组成部分可能对谵妄产生影响具有挑战性。结论 本次范围界定综述总结了与 ICU 睡眠和昼夜节律紊乱 (SCD) 以及 ICU 中谵妄相关的现有文献。需要进一步的研究来更好地了解 ICU SCD 促进干预措施在缓解谵妄方面的作用。