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We have been reviewing the literature on sleep in intensive care unit (ICU) patients, concluding that lack of normal sleep is a common problem. Polysomnography studies have demonstrated sleep deprivation and fragmentation. Delirium commonly coincides with sleep deprivation and shares the same symptoms. Mechanically ventilated patients have traditionally been sedated, making sleep scoring unreliable. There is a need for further studies exploring the relationship between circadian rhythm disturbance, sleep disorders, delirium and sedation in ICU patients.

Cardiac arrest may occur while persons are being kept in hobble restraint. It has been suggested that asphyxia caused by the restraint position, so-called restraint asphyxia, is the cause, but experimental evidence has not confirmed this theory. Some of the sudden deaths are associated with excited delirium syndrome (EDS), an acute condition characterized by a hyperactive, combative behaviour in individuals, who are influenced by psychoactive drugs or suffer from psychiatric illness. Autopsy findings fail to explain this type of deaths. The pathophysiology of EDS is complex and poorly understood. Sensibilisation of the heart by a hyperadrenergic autonomous dysfunction, metabolic acidosis and hyperthermia offer possible mechanisms.

Interest in and the quantity of publications on delirium in critically ill patients have grown increasingly over the last decade. Critically ill patients have traditionally been sedated to facilitate mechanical ventilation. This practice impeded the recognition of delirium in the critically ill patients, and consequently the disorder was underdiagnosed. Delirium in the critically ill patients is associated with increased morbidity and mortality. Less sedation, guided by protocols with daily wake up trials, and validated delirium scoring systems, have improved the opportunities to diagnose and monitor delirium in the critically ill patients.

Introduction: Although delirium is a reversible cerebral syndrome, the effect of treatment of the elderly is unsatisfactory, involving prolonged hospitalizations and increased risk of relapse and mortality. The purpose of this study was to evaluate whether hospitalization for delirium (severe delirium) diagnosed by ICD-10 criteria predicts increased morbidity, utilization of health services and mortality., Materials and Methods: Delirious inpatients (n = 26) discharged after treatment in an old-age psychiatric university clinic were studied for nine years. In a register-based design, the above-mentioned parameters of the delirium cohort were compared with a group of controls (n = 116)., Results: There was a trend to increased mortality in the delirium cohort. Compared with the controls, the delirium cohort had a significantly increased incidence of disorders of vital organs, serious psychiatric disorders, particularly depression, increased use of hospital psychiatry and general practitioner's out-of-hours service, but less use of office-hour services. The incidence of delirium in the cohorts was low. In the delirium cohort, there was no significantly increased use of services or the number of diagnoses in somatic hospitals., Conclusion: Increased somatic and psychiatric morbidity and a trend to increased mortality indicate a serious prognosis after severe delirium in the elderly. It is noteworthy that the delirium cohort had increased use of GPs' out-of-hours services but less use of office-hour services.