Impact of Neck Inspiratory Muscle Activation During Sleep in ICU Patients After a COVID 19 ARDS

Sleep alteration is a common problem among ventilated ICU patient. About one third of the
patient have abnormal EEG pattern which cannot be scored by using the AASM standard criteria.
Patients experience marked fragmentation, absence of deep sleep, and REM sleep is decreased,
. It has been shown that sleep deprivation has a negative impact on respiratory muscle
endurance. So a good sleep is essential when the respiratory system is being challenged, as
in the ICU during the weaning period. Indeed, in the ICU, patients with altered sleep, had a
markedly longer weaning duration than in patients with normal sleep, and are more likely to
fail a spontaneous breathing trial. Many factors may influence the quality of sleep in the
ICU (noise, medication, mechanical ventilation …) but few studies have focus on the cause of
this altered sleep, and the cause of altered sleep remains unknown. Previous studies have
shown that decreasing nocturnal respiratory muscle activity through mechanical ventilation
might improve sleep quality. Mechanical ventilation can decrease the charge imposed on the
respiratory pump, and allows muscle to rest. Indeed, when the charge is too high (for example
after an ARDS during the weaning period), the diaphragm may be overloaded, and there could be
a greater involvement of other inspiratory muscles in breathing. In other pathological
condition, the neck inspiratory muscle activity is increased (e.g. COPD, amyotrophic lateral
sclerosis), and sometimes this activity persist during sleep with marked degradation in sleep
architecture. Nocturnal respiratory muscle activity may be one of the potential factor which
contribute to alter sleep in the ICU. Ttherefore, the aim of tis study is to analyse the
presence of NIM activation during the night and it's consequence in an ICU population with
the same pathology (COVID 19 ARDS).