{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:40:14Z","timestamp":1788536414008,"version":"build-2803163510"},"reference-count":64,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["113\u20102314\u2010B\u2010038\u2010058"],"award-info":[{"award-number":["113\u20102314\u2010B\u2010038\u2010058"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delirium is a common neuropsychiatric complication in the intensive care unit (ICU), the occurrence of which is closely associated with patient prognoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To examine the associations between sleep quality and circadian rhythm stability measured by actigraphy and changes in delirium state in intensive care unit (ICU) patients, as well as their predictive power for mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>\n                      ICUs of a medical centre in Taiwan, from September 1, 2024, to January 31, 2025. A prospective observational study was conducted in adult ICU patients. Wrist\u2010worn actigraphy was used to monitor total sleep time (TST, h), wake after sleep onset (WASO, h), and circadian rhythm stability (24\u2010h autocorrelation coefficient,\n                      <jats:italic>r<\/jats:italic>\n                      24) for 72 consecutive hours. Delirium was assessed twice daily for three days using the Confusion Assessment Method for the ICU (CAM\u2010ICU) and categorized as no delirium, prolonged delirium (lasting \u2265\u20093\u2009days), or new\u2010onset delirium (developed after enrollment).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 74 ICU patients were included. Among them, 30 had no delirium, 20 had prolonged delirium, and 24 developed new\u2010onset delirium. Mortality rates in both the prolonged delirium and new\u2010onset delirium groups were 45%, significantly higher than in the no\u2010delirium group (13.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.015). The prolonged delirium group had higher Sequential Organ Failure Assessment (SOFA) scores, longer WASO and lower\n                      <jats:italic>r<\/jats:italic>\n                      24 than the no\u2010delirium group, with\n                      <jats:italic>r<\/jats:italic>\n                      24 significantly associated with prolonged delirium (OR\u2009=\u20090.001,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). The new\u2010onset delirium group showed higher WASO, which was significantly associated with delirium (OR\u2009=\u20091.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046). Multivariate Cox analysis identified prolonged delirium (HR\u2009=\u20093.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049) and SOFA score (HR\u2009=\u20091.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.027) as independent predictors of mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      WASO and\n                      <jats:italic>r<\/jats:italic>\n                      24 were closely linked to delirium state changes. Lower\n                      <jats:italic>r<\/jats:italic>\n                      24 was strongly associated with prolonged delirium and higher mortality, while higher WASO was related to new\u2010onset delirium.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Continuous monitoring of sleep continuity and circadian rhythms in ICU patients is recommended. Incorporating WASO into early delirium risk assessments may facilitate timely interventions, reduce delirium incidence and mortality and improve critical care quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70241","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:31:02Z","timestamp":1763375462000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Sleep Quality, Circadian Rhythm Stability and Changes in Delirium State in Predicting Mortality Risk in Intensive Care Unit Patients: A Prospective Observational Study"],"prefix":"10.1111","volume":"30","author":[{"given":"Hui\u2010Ju","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Nursing, Shuang Ho Hospital Taipei Medical University  New Taipei City 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