Atypical-sleep EEG patterns during weaning of patients on long-term assisted ventilation predict weaning failure: Study

The study provided the first evidence that long-term acute care facility (LTACH) patients being weaned from prolonged ventilation exhibit atypical-sleep EEG patterns which were associated with weaning failure.

"Patients with atypical sleep EEG patterns had higher subsyndromal delirium rates and slowing of the wakeful EEG, indicating that these two findings represent a biological signal for brain dysfunction," the researchers reported.

About one-third of acute intensive care unit (ICU) patients have atypical sleep patterns that cannot be interpreted using standard EEG criteria for sleep. Atypical sleep patterns have been tied to poor weaning outcomes in acute ICUs. Hameeda Shaikh, Hines Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois, and colleagues aimed to determine whether patients weaning from prolonged mechanical ventilation experience atypical sleep EEG patterns, and if these patterns are linked with weaning outcomes.

For this purpose, the researchers performed EEG power-spectral analysis during wakefulness and overnight polysomnogram (PSG) on alert, non-delirious patients at a long-term acute care facility.

The study revealed the following findings:

• Forty-four patients ventilated for a median duration of 38 days at the time of PSG were studied. 25% of patients demonstrated atypical sleep EEG.
• During wakefulness, relative EEG power-spectral analysis revealed higher relative delta power in patients with atypical sleep than in patients with usual sleep — 53% versus 41%, and a higher slow-to-fast power ratio during wakefulness: 4.39 versus 2.17.
• Patients with atypical sleep demonstrated more subsyndromal delirium (36% vs 6%) and less REM sleep (4% vs 11% total sleep time).
• Weaning failure was more common in the atypical sleep group than in the usual sleep group: 91% vs. 45%.

"Our study provides the first evidence that long-term acute care facility patients being weaned from prolonged ventilation exhibit atypical-sleep EEG patterns which were linked with weaning failure," the researchers wrote.

They added, "Patients with atypical sleep EEG patterns had slowing of the wakeful EEG and higher rates of subsyndromal delirium, indicating that these two findings represent a biological signal for brain dysfunction."

Reference:

Shaikh, H., Ionita, R., Khan, U., Park, Y., Jubran, A., Tobin, M. J., & Laghi, F. (2024). Effect of atypical-sleep EEG patterns on weaning from prolonged mechanical ventilation. CHEST. https://doi.org/10.1016/j.chest.2024.01.005