Sleep during and after critical illness and psychological health in recovery

Abstract

Introduction: Intensive care patients often report sleep disruption in ICU and during recovery from critical illness. Objectives: To assess patients’ self-reported sleep quality in ICU, on the hospital ward and 6 months after discharge, whether patients who experience sleep disruption in ICU experience problems sleeping during recovery and whether sleep disruption is associated with psychological recovery. Methods: Patients in ICU for ≥2 nights self-reported on their sleep prehospital (Insomnia Severity Index), in ICU and the ward (Richards Campbell Sleep Questionnaire) and 6 months after hospital discharge (Pittsburgh SleepQuality Index), and after discharge completed the Intensive Care Experience Questionnaire (ICEQ), the Depression, Anxiety and Stress Scales, the Posttraumatic Stress Checklist (PCL) and SF-36quality of life. Associations between sleep and outcomes were examined using bivariate and multiple linear regression analyses Results: Patients (n=222) were aged (mean± SD) 57.2±17.2 years, 35% female and had APACHE II scores of 25±5, ICU stays of 5±6 days and BMI 26±5. Poor sleep at 6 months was reported by 101 (57%), and by 38 patients (17%) at all timepoints. In multivariate analysis, prehospitalisation insomnia (p= .0005), sleep quality on theward (p= .006) plus anxiety (p= .002), andmental (p= .0005) and physical health (p=0005) were associated with sleep disruption in survivors 6 months after ICU treatment. Conclusions: Sleep is a significant issue for over half of survivors 6 months after ICU treatment. Poor sleep at 6 months was associated with prehospital insomnia, sleep quality on the hospital ward and anxiety, physical health and mental health at 6 months.