Discussion
delirious
We present several important findings in this study. First, ramelteon, as compared to placebo, did not have an impact on total sleep time, sleep fragmentation, or circadian parameters as measured by actigraphy in this ICU cohort. Those who received ramelteon had a lower activity level over the post-extubation ICU period compared to placebo, though other total activity measures seemed similar. Second, overall circadian fit was low for the whole cohort. Finally, we found that delirious patients had a lower stability in their rest-activity patterns compared to those who did not become delirious. Importantly, our study associated actigraphy data with clinical outcomes, and suggests that actigraphy and similar technologies could be useful in determining sleep, activity, and circadian differences between groups of individuals, even in the ICU.