Effects of gabapentin on slow-wave sleep period in critically ill adult patients: a randomized controlled trial

Abstract

Abstract Background: Sleep deprivation is a prevalent problem in critically ill patients, which leads to delayed recovery and delirium. Delirium prolongs the intensive care unit (ICU) and hospital lengths of stay and may increase mortality. Slow-wave sleep (SWS) is essential to energy restoration, tissue repair, and immune system strengthening. This study aimed to investigate the effects of gabapentin on SWS in critically ill patients. Methods: We performed a prospective open-label randomized controlled study to compare SWS and the clinical outcomes of gabapentin (initial dose 100 mg at bedtime) versus a control intervention in critically ill adult patients admitted to the ICU within 24 hours. The patients’ characteristics and sleep-related outcomes were recorded. The sleep-related outcomes, namely bispectral analysis (BIS), the Richards-Campbell Sleep Questionnaire (RCSQ), and insulin-like growth factor-1 (IGF-1) levels, were evaluated. Furthermore, clinical outcomes, 28-day ICU-free days, 28-day mechanical ventilator (MV)-free days, 28-day hospital-free days, and safety were assessed. Results: Sixty patients from 348 cases were eligible for randomization. On day 3 of the study, patients in the gabapentin group had significantly increased SWS (66.79 vs. 0.00 min; P < 0.001), total sleep time (TST) (331.39 vs. 46.16 min; P = 0.001), RCSQ score (55.05 ± 20.18 vs. 32.80 ± 15.31; P < 0.001), and insulin-like growth factor-1 (IGF-1) concentrations (84.33 ± 12.40 vs. 44. 00 ± 10.20 ng/mL, P < 0.001) compared with the control group. There was a trend in the improvement of clinical outcomes, such as delirium, ICU-free days, MV-free days, and hospital-free days; however, the differences were not significant. Over-sedation was reported in one case in the gabapentin group. Conclusions: Gabapentin (100–200 mg) at bedtime increased SWS, TST, and IGF-1 concentrations in critically ill patients. This regimen might be beneficial to critically ill patients for improving their sleep quality. Trial registration: The study was registered with ClinicalTrials.gov (NCT04818450), registered on March 25, 2021, https://clinicaltrials.gov/ct2/show/NCT04818450