Nighttime Sleep Duration Is Associated With Length of Stay Outcomes Among Older Adult Survivors of Critical Illness

Overview

Journal Dimens Crit Care Nurs

Specialty Critical Care

Date 2020 Apr 7

PMID 32251163

Citations 2

Authors

Maya N Elias

Cindy L Munro

Zhan Liang

Cristobal F Padilla Fortunatti

Karel Calero

Ming Ji

Affiliations

Soon will be listed here.

Abstract

Background: Older adults who required mechanical ventilation while in an intensive care unit (ICU) require adequate sleep throughout recovery from critical illness. Poor post-ICU sleep quality may contribute to worsening impairments in physical, cognitive, or psychological status after critical illness, known as post-ICU syndrome. Previous research has evaluated post-ICU sleep with qualitative or mixed methods (eg, interviews, questionnaires). We proposed measurement of sleep with actigraphy. We hypothesized that nighttime sleep is associated with length of stay (LOS).

Objectives: The aims of this study were to describe sleep quality of previously mechanically ventilated older adults recently transferred out of ICU and explore relationships between sleep duration and LOS outcomes.

Methods: We enrolled 30 older adults, 65 years and older, within 24 to 48 hours after ICU discharge. We collected actigraphy data on post-ICU sleep duration (total sleep time [TST]) and sleep fragmentation (wake time after sleep onset) over 2 consecutive nights. We explored associations between TST and LOS (in days) outcomes using multivariate regression.

Results: Subjects' mean TST was 7.55 ± 2.52 hours, and mean wake time after sleep onset was 2.26 ± 0.17 hours. In exploratory regression analyses, longer ICU LOS (β = 0.543, P < .001) and longer length of mechanical ventilation (β = 0.420, P = .028) were associated with greater post-ICU TST, after adjusting for potential confounding factors. Total sleep time was prospectively associated with total hospital LOS (β = 0.535, P < .001).

Discussion: Older ICU survivors demonstrate greater sleep duration and worse sleep fragmentation. Poor sleep may contribute to longer LOS, secondary to post-ICU syndrome and sequelae. We recommend nursing interventions to promote sleep consolidation throughout transitions of care in the acute post-ICU recovery period.

Citing Articles

Daytime activity and sleep are associated with motor function in older intensive care unit survivors.

Elias M, Munro C, Liang Z Heart Lung. 2021; 50(4):542-545.

PMID: 33637322 PMC: 11073789. DOI: 10.1016/j.hrtlng.2021.02.008.

Daytime Activity Is Associated With Discharge to Home in Older Adults Recovering From Critical Illness.

Elias M, Munro C, Liang Z J Gerontol Nurs. 2021; 47(2):13-19.

PMID: 33497446 PMC: 10467819. DOI: 10.3928/00989134-20210107-03.

References

Ciesla J, Shi L, Stoskopf C, Samuels M . Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews. Eval Health Prof. 1993; 16(2):190-203. DOI: 10.1177/016327879301600204. View

Pagnucci N, Tolotti A, Cadorin L, Valcarenghi D, Forfori F . Promoting nighttime sleep in the intensive care unit: Alternative strategies in nursing. Intensive Crit Care Nurs. 2018; 51:73-81. DOI: 10.1016/j.iccn.2018.11.010. View

Kamdar B, Needham D, Collop N . Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med. 2011; 27(2):97-111. PMC: 3299928. DOI: 10.1177/0885066610394322. View

Yang C, Aibel K, Meyerhoff R, Wang F, Harpole D, Abernethy A . Actigraphy assessment of sleep quality among patients with acute myeloid leukaemia during induction chemotherapy. BMJ Support Palliat Care. 2018; 8(3):274-277. DOI: 10.1136/bmjspcare-2018-001509. View

Wunsch H, Guerra C, Barnato A, Angus D, Li G, Linde-Zwirble W . Three-year outcomes for Medicare beneficiaries who survive intensive care. JAMA. 2010; 303(9):849-56. DOI: 10.1001/jama.2010.216. View

Boulos M, Jairam T, Kendzerska T, Im J, Mekhael A, Murray B . Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis. Lancet Respir Med. 2019; 7(6):533-543. DOI: 10.1016/S2213-2600(19)30057-8. View

Bihari S, McEvoy R, Matheson E, Kim S, Woodman R, Bersten A . Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med. 2012; 8(3):301-7. PMC: 3365089. DOI: 10.5664/jcsm.1920. View

Kaw R, Golish J, Ghamande S, Burgess R, Foldvary N, Walker E . Incremental risk of obstructive sleep apnea on cardiac surgical outcomes. J Cardiovasc Surg (Torino). 2006; 47(6):683-9. View

Beaudreau S, Spira A, Stewart A, Kezirian E, Lui L, Ensrud K . Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women. Sleep Med. 2011; 13(1):36-42. PMC: 3586742. DOI: 10.1016/j.sleep.2011.04.005. View

10.

Reuben D, Magasi S, McCreath H, Bohannon R, Wang Y, Bubela D . Motor assessment using the NIH Toolbox. Neurology. 2013; 80(11 Suppl 3):S65-75. PMC: 3662336. DOI: 10.1212/WNL.0b013e3182872e01. View

11.

Boyko Y, Jennum P, Nikolic M, Holst R, Oerding H, Toft P . Sleep in intensive care unit: The role of environment. J Crit Care. 2016; 37:99-105. DOI: 10.1016/j.jcrc.2016.09.005. View

12.

Yoder J, Staisiunas P, Meltzer D, Knutson K, Arora V . Noise and sleep among adult medical inpatients: far from a quiet night. Arch Intern Med. 2012; 172(1):68-70. PMC: 3270707. DOI: 10.1001/archinternmed.2011.603. View

13.

Ng K, Teoh W, Khor A . The effect of melatonin on delirium in hospitalised patients: A systematic review and meta-analyses with trial sequential analysis. J Clin Anesth. 2019; 59:74-81. DOI: 10.1016/j.jclinane.2019.06.027. View

14.

Weinhouse G, Schwab R . Sleep in the critically ill patient. Sleep. 2006; 29(5):707-16. DOI: 10.1093/sleep/29.5.707. View

15.

Elliott R, McKinley S, Cistulli P . The quality and duration of sleep in the intensive care setting: an integrative review. Int J Nurs Stud. 2010; 48(3):384-400. DOI: 10.1016/j.ijnurstu.2010.11.006. View

16.

Collop N, Salas R, Delayo M, Gamaldo C . Normal sleep and circadian processes. Crit Care Clin. 2008; 24(3):449-60, v. DOI: 10.1016/j.ccc.2008.02.002. View

17.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

18.

Katz S, Ford A, Moskowitz R, Jackson B, JAFFE M . STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963; 185:914-9. DOI: 10.1001/jama.1963.03060120024016. View

19.

Stepanski E . The effect of sleep fragmentation on daytime function. Sleep. 2002; 25(3):268-76. DOI: 10.1093/sleep/25.3.268. View

20.

Lim A, Fleischman D, Dawe R, Yu L, Arfanakis K, Buchman A . Regional Neocortical Gray Matter Structure and Sleep Fragmentation in Older Adults. Sleep. 2015; 39(1):227-35. PMC: 4678338. DOI: 10.5665/sleep.5354. View