Circadian Rhythm and Delirium in ICU

Study Overview
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Brief Summary
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The study aims to investigate the status of circadian rhythm and sleep quality in ICU patients and their influence factors. And explore the pathway of circadian rhythm on ICU delirium. The hypothesis of study is that icu patients experience circadian and sleep rhythm disorder, especially in patient who have delirium.

Detailed Description
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Delirium is an acute and fluctuating alteration of mental state characterized by a disturbance in attention, level of consciousness and cognition. At present, there is no unified conclusion on the pathogenesis of delirium. There are many different hypotheses, such as the neuroinflammation hypothesis, the neuronal aging hypothesis, the oxidative stress hypothesis, the neurotransmitter hypothesis, the neuroendocrine hypothesis and the circadian rhythm disturbance hypothesis. Among them, the circadian rhythm disturbance hypothesis believes that the circadian rhythm disorder caused by various reasons, which leads to sleep disturbance and melatonin secretion disorder promotes the occurrence of acute cognitive impairment, which in turn leads to the occurrence of delirium. Circadian rhythm refers to the rhythm of any biological process in the human body that repeats and maintains within 24 hours without external stimulation. By far, the most common way to measure circadian rhythm is through vital signs rhythms, hormone secretion (cortisol and melatonin levels), and sleep-wake cycle. Due to the special environment and treatment needs in ICU make patients' circadian rhythm easily broken, and produced a large latent harm to patients. Most studies are in the process of delirium and sleep research, selecting a small subgroup to evaluate the circadian rhythm indicators of patients, and the overall relationship between delirium and circadian rhythm is not clear. Thus, the study aims to investigate the status of circadian rhythm and sleep quality in ICU patients and their influence factors, and explore the pathway of circadian rhythm action on ICU delirium.

Official Title
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The Relationship Between Delirium and Circadian Rhythm in Intensive Care Unit

Conditions
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Circadian Rhythm, Sleep Quality, Intensive Care Unit Delirium

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged above 18 RASS>-4 Exclusion Criteria: History of mental or psychological illness The patient remained in coma or deep sedation Delirium was occurring at the time of admission Unable to fully participate in delirium testing, including blind, deaf, illiterate or inability to understand Chinese Neurosurgery and maternal patients

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes of melatonin level | Test Serum melatonin level | Three time a day in 3, 8 and 16 clock on day 1 to day 3 and day 7 after admission in ICU | 
| Sleep Quality | Investigators screen sleep quality by Richards-Campbell Sleep Questionnaire | up to 14 days after admission in ICU | 
| Changes of cortisol level | Test Serum cortisol level | Three time a day in 0, 8 and 16 clock on day 1 to day 3 and day 7 after admission in ICU | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ICU delirium | Investigators screen delirium by CAM-ICU twice a day, each time during day and night | up to 14 days after admission in ICU | 
| patient outcome | Mortality in ICU | up to 14 days after admission in ICU | 
| LOS | length of ICU stay | up to 14 days after admission in ICU |