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Observational Study
. 2024 Oct 9;28(1):331.
doi: 10.1186/s13054-024-05118-4.

Impact of sleep disturbances on outcomes in intensive care units

Laura Marchasson  1   2 , Christophe Rault  3   4 , Sylvain Le Pape  3   5 , François Arrivé  3   5 , Rémi Coudroy  3   5 , Jean-Pierre Frat  3   5 , Vanessa Bironneau  3   6 , Etienne-Marie Jutant  3   6 , Quentin Heraud  3   5 , Xavier Drouot  3   4 , Arnaud W Thille  3   5
Affiliations
Observational Study

Impact of sleep disturbances on outcomes in intensive care units

Laura Marchasson et al. Crit Care. .

Abstract

Background: Sleep deprivation is common in intensive care units (ICUs) and may alter respiratory performance. Few studies have assessed the role of sleep disturbances on outcomes in critically ill patients.

Objectives: We hypothesized that sleep disturbances may be associated with poor outcomes in ICUs.

Methods: Post-hoc analysis pooling three observational studies assessing sleep by complete polysomnography in 131 conscious and non-sedated patients included at different times of their ICU stay. Sleep was assessed early in a group of patients admitted for acute respiratory failure while breathing spontaneously (n = 34), or under mechanical ventilation in patients with weaning difficulties (n = 45), or immediately after extubation (n = 52). Patients admitted for acute respiratory failure who required intubation, those under mechanical ventilation who had prolonged weaning, and those who required reintubation after extubation were considered as having poor clinical outcomes. Durations of deep sleep, rapid eye movement (REM) sleep, and atypical sleep were compared according to the timing of polysomnography and the clinical outcomes.

Results: Whereas deep sleep remained preserved in patients admitted for acute respiratory failure, it was markedly reduced under mechanical ventilation and after extubation (p < 0.01). Atypical sleep was significantly more frequent in patients under mechanical ventilation than in those breathing spontaneously (p < 0.01). REM sleep was uncommon at any time of their ICU stay. Patients with complete disappearance of REM sleep (50% of patients) were more likely to have poor clinical outcomes than those with persistent REM sleep (24% vs. 9%, p = 0.03).

Conclusion: Complete disappearance of REM sleep was significantly associated with poor clinical outcomes in critically ill patients.

Keywords: Airway extubation; Endotracheal intubation; Intensive care unit; Rapid eye movement sleep, Polysomnography; Sleep; Ventilator weaning.

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Figures

Fig. 1
Fig. 1
Flowchart of the patients. Poor outcomes occurred in 22 out of the 131 patients (17%), including patients admitted for acute respiratory failure who needed intubation, patients under mechanical ventilation with prolonged weaning (> 7 days), and extubated patients who needed reintubation
Fig. 2
Fig. 2
Distribution of sleep stages according to the timings of polysomnography recordings. From the top to the bottom, theoretical distribution of sleep stages in healthy volunteers with normal sleep, patients with acute respiratory failure explored upon ICU admission while breathing spontaneously, patients under mechanical ventilation with weaning difficulties, and patients explored after extubation while breathing spontaneously. TST = Total Sleep Time
Fig. 3
Fig. 3
Distribution of sleep stages according to the clinical outcomes of included patients. Poor outcomes included the need for intubation in patients admitted for acute respiratory failure while breathing spontaneously, prolonged weaning defined (> 7 days) in patients under mechanical ventilation, and the need for reintubation in patients who were included after extubation while breathing spontaneously. TST = Total Sleep Time
See this image and copyright information in PMC

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