University of Oulu

Ala-Kokko, T, Erikson, K, Koskenkari, J, Laurila, J, Kortelainen, J. Monitoring of nighttime EEG slow-wave activity during dexmedetomidine infusion in patients with hyperactive ICU delirium: An observational pilot study. Acta Anaesthesiol Scand. 2022; 66( 10): 1211- 1218. doi:10.1111/aas.14131

Monitoring of nighttime EEG slow-wave activity during dexmedetomidine infusion in patients with hyperactive ICU delirium : an observational pilot study

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Author: Ala-Kokko, Tero1; Erikson, Kristo1; Koskenkari, Juha1;
Organizations: 1Division of Intensive Care Medicine, Research Group of Surgery, Anesthesiology, and Intensive Care Medicine, Oulu University Hospital and Medical Research Center, Oulu, Finland
2Physiological Signal Analysis Team, Center for Machine Vision and Signal Analysis, University of Oulu and Medical Research Center, Oulu, Finland
3Cerenion Oy, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.8 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-11-23


Background: The disturbance of sleep has been associated with intensive care unit (ICU) delirium. Monitoring of EEG slow-wave activity (SWA) has potential in measuring sleep quality and quantity. We investigated the quantitative monitoring of night-time SWA and its association with the clinical evaluation of sleep in patients with hyperactive ICU delirium treated with dexmedetomidine.

Methods: We performed overnight EEG recordings in 15 patients diagnosed with hyperactive delirium during moderate dexmedetomidine sedation. SWA was evaluated by offline calculation of the C-Trend Index, describing SWA in one parameter ranging 0 to 100 in values. Average and percentage of SWA values <50 were categorized as poor. The sleep quality and depth was clinically evaluated by the bedside nurse using the Richards-Campbell Sleep Questionnaire (RCSQ) with scores <70 categorized as poor.

Results: Nighttime SWA revealed individual sleep structures and fundamental variation between patients. SWA was poor in 67%, sleep quality (RCSQ) in 67%, and sleep depth (RCSQ) in 60% of the patients. The category of SWA aligned with that of RCSQ-based sleep quality in 87% and RCSQ-based sleep depth in 67% of the patients.

Conclusions: Both, SWA and clinical evaluation suggested that the quality and depth of nighttime sleep were poor in most patients with hyperactive delirium despite dexmedetomidine infusion. Furthermore, the SWA and clinical evaluation classifications were not uniformly in agreement. An objective mode such as practical EEG-based solution for sleep evaluation and individual drug dosing in the ICU setting could offer potential in improving sleep for patients with delirium.

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Series: Acta anaesthesiologica Scandinavica
ISSN: 0001-5172
ISSN-E: 1399-6576
ISSN-L: 0001-5172
Volume: 66
Issue: 10
Pages: 1211 - 1218
DOI: 10.1111/aas.14131
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
217 Medical engineering
Funding: Academy of Finland, Grant/Award Number: 308935; Orion Pharma
Academy of Finland Grant Number: 308935
Detailed Information: 308935 (Academy of Finland Funding decision)
Copyright information: © 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.