PMID- 32669778
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240329
IS  - 1078-4497 (Print)
IS  - 1945-337X (Electronic)
IS  - 1078-4497 (Linking)
VI  - 37
IP  - 6
DP  - 2020 Jun
TI  - Steroid-Induced Sleep Disturbance and Delirium: A Focused Review for Critically 
      Ill Patients.
PG  - 260-267
AB  - OBJECTIVE: Insomnia and delirium have gained much attention since the publication 
      of recent guidelines for the management in critically ill adults. Neurologic 
      effects such as sleep disturbance, psychosis, and delirium are commonly cited 
      adverse effects (AEs) of corticosteroids. Steroid use is considered a modifiable 
      risk factor in intensive care unit patients; however, reported mechanisms are 
      often lacking. This focused review will specifically evaluate the effects of 
      steroids on sleep deprivation, psychosis, delirium, and what is known about these 
      effects in a critically ill population. OBSERVATIONS: The medical literature 
      proposes 3 pathways primarily responsible for neurocognitive AEs of steroids: 
      behavior changes through modification of the hypothalamic-pituitary-adrenal axis, 
      changes in natural sleep-wake cycles, and hyperarousal caused by modification in 
      neuroinhibitory pathways. Initial search fields produced 285 articles. Case 
      reports, reviews, letters, and articles pertaining to primary care or palliative 
      populations were excluded, leaving 8 relevant articles for inclusion. 
      CONCLUSIONS: Although steroid therapy often cannot be altered in the critically 
      ill population, research showed that steroid overuse is common in intensive care 
      units. Minimizing dosage and duration are important ways clinicians can mitigate 
      AEs.
CI  - Copyright (c) 2020 Frontline Medical Communications Inc., Parsippany, NJ, USA.
FAU - Cole, Jennifer L
AU  - Cole JL
AD  - is a Critical Care and Internal Medicine Pharmacy Specialist at the Veterans 
      Health Care System of the Ozarks in Fayetteville, Arkansas.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Fed Pract
JT  - Federal practitioner : for the health care professionals of the VA, DoD, and PHS
JID - 9500574
PMC - PMC7357890
COIS- Author disclosures The author reports no actual or potential conflicts of 
      interest with regard to this article.
EDAT- 2020/07/17 06:00
MHDA- 2020/07/17 06:01
PMCR- 2020/06/01
CRDT- 2020/07/17 06:00
PHST- 2020/07/17 06:00 [entrez]
PHST- 2020/07/17 06:00 [pubmed]
PHST- 2020/07/17 06:01 [medline]
PHST- 2020/06/01 00:00 [pmc-release]
AID - fp-37-6-260 [pii]
PST - ppublish
SO  - Fed Pract. 2020 Jun;37(6):260-267.