Presentation

Background and Purpose: Following acute brain injury, patients are monitored in the intensive care unit (ICU) where providers rely on frequent neurological examinations (“neurochecks”) to assess for neurological decline. Serial neurochecks are part of guideline recommendations, but there is equipoise between hourly (Q1) and every-other-hour (Q2) evaluation. This project evaluates the impact of neurocheck frequency on objective and subjective sleep parameters in patients admitted to the neurological ICU.

Methods: Patients who underwent elective aneurysm coiling and did not meet exclusion criteria were consented and enrolled in this clinical trial (NCT05864300). Enrolled patients were randomized to Q1 or Q2 neurochecks following the institutionally required period of neurological and vascular stability. Once randomized, patients underwent placement of electroencephalogram (EEG) with video, electrooculogram, and chin lead. This EEG remained in place for at least 10 hours to include the overnight (10PM-6AM) timeframe. Following completion of the recording, the signals were reviewed and scored by a blinded researcher for sleep characteristics including sleep efficiency (primary outcome), quantitative assessments of wakefulness, restorative (N2+N3) sleep, REM sleep, total sleep time, and arousals. On POD1, patients filled out the Richards-Campbell Sleep Questionnaire (visual analog scale) to rate subjective sleep quality. Enrollment goal is 20 patients (N=10 per group; power=0.8, alpha=0.05).

Results: Sixteen patients with a median age of 62 years (male: 25%) have been enrolled over eight months. Median sleep efficiency was 37% in the Q1 group and 49% in the Q2 group. Total sleep time ranged from 3min to 421min. Total median restorative sleep was 179min in the Q2 group (versus 134min in Q1). Arousals were 17/hr (Q2) versus 26/hr (Q1). Subjectively, patients awakened Q2 rated their sleep closer towards “a good night’s sleep” than the Q1 patients (0.51 vs 0.34).

Conclusion: In the ICU, care-related awakenings occur frequently. Differential neurocheck frequency may further impact objective sleep characteristics and subjective sleep quality.