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Original Research: Critical Care |

Altered Circadian Rhythmicity in Patients in the ICUAltered Circadian Rhythmicity in ICU Patients

Joost A. C. Gazendam, MD, PhD; Hans P. A. Van Dongen, PhD; Devon A. Grant, MS; Neil S. Freedman, MD; Jan H. Zwaveling, MD, PhD; Richard J. Schwab, MD
Author and Funding Information

From University Medical Center Groningen (Dr Gazendam), Groningen, The Netherlands; Maxima Medical Center (Dr Zwaveling), Eindhoven, The Netherlands; the Sleep and Performance Research Center (Dr Van Dongen and Ms Grant), Washington State University, Spokane, WA; the Division of Pulmonary and Critical Care Medicine (Dr Freedman), NorthShore University Healthsystem, Bannockburn, IL; and the Division of Sleep Medicine (Dr Schwab), Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Center, Philadelphia, PA.

Correspondence to: Richard Schwab, MD, Pulmonary, Allergy and Critical Care Division/Sleep Medicine Division, University of Pennsylvania Medical Center, 3624 Market St, Ste 205, Philadelphia, PA 19104; e-mail: rschwab@mail.med.upenn.edu


Funding/Support: This work and Dr Schwab were supported by National Institutes of Health [Award K24 HL67948]. Dr Van Dongen and Ms Grant were supported by Congressionally Directed Medical Research Program [Award W81XWH-05-1-0099].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):483-489. doi:10.1378/chest.12-2405
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Background:  Patients in the ICU are thought to have abnormal circadian rhythms, but quantitative data are lacking.

Methods:  To investigate circadian rhythms in the ICU, we studied core body temperatures over a 48-h period in 21 patients (59 ± 11 years of age; eight men and 13 women).

Results:  The circadian phase position for 17 of the 21 patients fell outside the published range associated with morningness/eveningness, which determines the normative range for variability among healthy normal subjects. In 10 patients, the circadian phase position fell earlier than the normative range; in seven patients, the circadian phase position fell later than the normative range. The mean ± SD of circadian displacement in either direction (advance or delay) was 4.44 ± 3.54 h. There was no significant day-to-day variation of the 24-h temperature profile within each patient. Stepwise linear regression was performed to determine if age, sex, APACHE (Acute Physiology and Chronic Health Evaluation) III score, or day in the ICU could predict the patient-specific magnitude of circadian displacement. The APACHE III score was found to be significantly predictive of circadian displacement.

Conclusions:  The findings indicate that circadian rhythms are present but altered in patients in the ICU, with the degree of circadian abnormality correlating with severity of illness.

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