Circadian Rhythm in Critical Illness

Atılım University

Status: Completed

Conditions: Critical Illness

Treatments: Other: Intermittent feeding; Other: Continuous feeding

Study type: Interventional

Funder types: Other

Identifiers

NCT07063303

atılımnut

Details and patient eligibility

About

The goal of this clinical trial is to determine whether intermittent enteral feeding positively influences circadian rhythms in critically ill patients in intensive care units (ICUs). The main research questions are:

1. Does intermittent feeding improve circadian rhythms in ICU patients?
2. How does intermittent feeding affect metabolic markers and recovery outcomes? Researchers will compare intermittent feeding to continuous feeding, the current standard method, to assess its impact on circadian stability and patient health.

Participants will:

1. Receive intermittent enteral feeding or continuous enteral feeding for at least 10 days
2. Undergo blood sample collection at three time points daily (morning, afternoon, midnight) to analyze circadian gene expression and metabolic markers
3. Have their clinical condition, nutrition status, and recovery progress monitored throughout the study

Full description

Circadian rhythms regulate various physiological processes over a 24-hour cycle, including sleep-wake patterns, digestion, blood pressure, and hormone secretion. These rhythms are primarily controlled by the suprachiasmatic nucleus in the hypothalamus and influenced by environmental cues (zeitgebers), such as light exposure and meal timing. Critically ill patients often experience circadian rhythm disruptions due to prolonged artificial lighting, sleep disturbances, and continuous feeding, which may negatively impact metabolic health, immune function, and recovery. Given the significance of meal timing in circadian regulation, intermittent feeding might serve as a therapeutic strategy to restore circadian balance in ICU patients.

This study is a prospective, randomized controlled trial and will be conducted at Ankara Training and Research Hospital's Anesthesia Intensive Care Unit. Ethical approval for the study has been obtained from Ankara Training and Research Hospital with decision number E-93471371-514.99-226714167.

Patients will be randomly assigned to one of two groups:

• Intermittent Feeding Group - enteral nutrition will be provided at scheduled intervals (4-6 times daily) for 20-60 minutes per session, aligning with circadian cycles. Light exposure will also be adjusted, ensuring darkness during night hours.
• Continuous Feeding Group - patients will receive standard continuous enteral nutrition, without specific adjustments for circadian rhythms.

Blood samples will be collected on Day 1 and Day 7 at 08:00, 16:00, and 00:00 to analyze Brain and muscle aryl hydrocarbon receptor nuclear antigen-1 (BMAL1), Cyrptochrome 1 (CRY1), and Period 2 (PER2) gene expression and biochemical markers. No invasive procedures will be performed beyond routine ICU care. Patients' medical history, nutritional status, and clinical parameters will be recorded by using Acute Physiology and Chronic Health Evaluation II (APACHE II) Score, Sequential Organ Failure Assessment (SOFA) Score, Nutrition Risk in Critically ill (NUTRIC) Score and Global Leadership Initiative on Malnutrition (GLIM) Criteria.

Enrollment: 24 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• ICU admission for enteral feeding via a gastric tube
• Expected ≥10 days of enteral nutrition
• Age ≥18 years

Exclusion criteria

• Age <18 years
• Pregnancy
• Gastrointestinal surgery or diseases
• Tolerance issues with enteral feeding
• Parenteral feeding requirement

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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24 participants in 2 patient groups

Intermittent Feeding Group

Active Comparator group

Description:

Patients receive enteral nutrition at scheduled intervals to align with circadian rhythms.

Treatment:

Other: Intermittent feeding

Continuous Feeding Group

Active Comparator group

Description:

Patients receive enteral nutrition continuously, following the standard ICU practice.

Treatment:

Other: Continuous feeding