Acute respiratory distress syndrome, critically ill, Intensive Care Unit, mechanical ventilation, obstructive sleep apnea, sleep apnea
Citation Information :
Behera D, Sehgal IS, Dhooria S, Agrawal AK, Aggarwal AN. Sleep after critical illness: Study of survivors of acute respiratory distress syndrome and systematic review of literature. Indian J Crit Care Med 2016; 20 (6):323-331.
Background and Aims: This study aims to evaluate the sleep quality, architecture, sleep-related quality of life, and sleep-disordered breathing (SDB) in acute respiratory distress syndrome (ARDS) survivors early after discharge.
Materials and Methods: In this prospective, observational study, consecutive patients with ARDS discharged from the Intensive Care Unit (ICU) underwent evaluation with Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and overnight polysomnography. Patients having one or more of the following characteristics were classified as having abnormal sleep: ESS>10, PSQI>5, FOSQ <17.9, apnea–hypopnea index (AHI) ≥5, or AHI during rapid eye movement (REM) sleep ≥5.
Results: Twenty patients (median interquartile range [IQR] age of 24 [22–28] years, 11 [55%] females) were included in the study. Acute febrile illness of unknown etiology with multi-organ dysfunction syndrome was the most common underlying etiology for ARDS. The median (IQR) PaO2/FiO2ratio and APACHE II scores on admission were 176 (151–191.5) and 14 (14–16), respectively. The median (IQR) duration of stay in the ICU was 10 days (7.3–19.5). The overall sleep efficiency (median [IQR], 54% [32.3–65.4%]) was poor. None of the patients had ESS>10, seven (35%) had global PSQI>5 and one had FOSQ <17.9. Ten (50%) patients had at least one characteristic that suggested abnormal sleep (4 insomnia, 2 central sleep apnea, 1 obstructive sleep apnea, 1 REM-SDB, and 2 with a high PSQI, but no specific sleep abnormality).
Conclusions: Sleep disturbances are common in ARDS survivors early after discharge from the ICU.
Freedman NS, Kotzer N, Schwab RJ. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med 1999;159(4 Pt 1):1155-62.
Hilton BA. Quantity and quality of patients' sleep and sleep-disturbing factors in a respiratory intensive care unit. J Adv Nurs 1976;1:453-68.
Broughton R, Baron R. Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction. Electroencephalogr Clin Neurophysiol 1978;45:348-60.
Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP. Adverse environmental conditions in the respiratory and medical ICU settings. Chest 1994;105:1211-6.
Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 2001;163:451-7.
Bosma K, Ferreyra G, Ambrogio C, Pasero D, Mirabella L, Braghiroli A, et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: Pressure support versus proportional assist ventilation. Crit Care Med 2007;35:1048-54.
Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000;117:809-18.
Lee CM, Herridge MS, Gabor JY, Tansey CM, Matte A, Hanly PJ. Chronic sleep disorders in survivors of the acute respiratory distress syndrome. Intensive Care Med 2009;35:314-20.
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011;364:1293-304.
Parsons EC, Kross EK, Caldwell ES, Kapur VK, McCurry SM, Vitiello MV, et al. Post-discharge insomnia symptoms are associated with quality of life impairment among survivors of acute lung injury. Sleep Med 2012;13:1106-9.
McKinley S, Fien M, Elliott R, Elliott D. Sleep and psychological health during early recovery from critical illness: An observational study. J Psychosom Res 2013;75:539-45.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European consensus conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149(3 Pt 1):818-24.
Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India. Chest 2006;130:724-9.
Agarwal R, Srinivasan A, Aggarwal AN, Gupta D. Adaptive support ventilation for complete ventilatory support in acute respiratory distress syndrome: A pilot, randomized controlled trial. Respirology 2013;18:1108-15.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000;342:1301-8.
Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth sleepiness scale. Chest 1993;103:30-6.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, et al. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 1997;20:835-43.
Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007;30:711-9.
Iber C, Ancoli-Israel S, Chesson A Jr., Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
Hall-Smith J, Ball C, Coakley J. Follow-up services and the development of a clinical nurse specialist in intensive care. Intensive Crit Care Nurs 1997;13:243-8.
Niskanen M, Ruokonen E, Takala J, Rissanen P, Kari A. Quality of life after prolonged intensive care. Crit Care Med 1999;27:1132-9.
Chishti A, Batchelor AM, Bullock RE, Fulton B, Gascoigne AD, Baudouin SV. Sleep-related breathing disorders following discharge from intensive care. Intensive Care Med 2000;26:426-33.
Dimopoulou I, Anthi A, Michalis A, Tzelepis GE. Functional status and quality of life in long-term survivors of cardiac arrest after cardiac surgery. Crit Care Med 2001;29:1408-11.
Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring>or=14 days of mechanical ventilation. Crit Care Med 2003;31:1373-81.
Strahan E, Mccormick J, Uprichard E, Nixon S, Lavery G. Immediate follow-up after ICU discharge: Establishment of a service and initial experiences. Nurs Crit Care 2003;8:49-55.
Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A, et al. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Crit Care 2005;9:R96-109.
Strahan EH, Brown RJ. A qualitative study of the experiences of patients following transfer from intensive care. Intensive Crit Care Nurs 2005;21:160-71.
BaHammam A. Sleep quality of patients with acute myocardial infarction outside the CCU environment: A preliminary study. Med Sci Monit 2006;12:CR168-72.
Orwelius L, Nordlund A, Nordlund P, Edéll-Gustafsson U, Sjöberg F. Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: A prospective multicenter cohort study. Crit Care 2008;12:R97.
Fanfulla F, Ceriana P, D'Artavilla Lupo N, Trentin R, Frigerio F, Nava S. Sleep disturbances in patients admitted to a step-down unit after ICU discharge: The role of mechanical ventilation. Sleep 2011;34:355-62.
McKinley S, Aitken LM, Alison JA, King M, Leslie G, Burmeister E, et al. Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness. Intensive Care Med 2012;38:627-33.
Vesz PS, Costanzi M, Stolnik D, Dietrich C, de Freitas KL, Silva LA, et al. Functional and psychological features immediately after discharge from an intensive care unit: Prospective cohort study. Rev Bras Ter Intensiva 2013;25:218-24.
Choi J, Hoffman LA, Schulz R, Tate JA, Donahoe MP, Ren D, et al. Self-reported physical symptoms in intensive care unit (ICU) survivors: Pilot exploration over four months post-ICU discharge. J Pain Symptom Manage 2014;47:257-70.
Soh KL, Soh KG, Ibrahim NA, Ahmad NZ, Japar S, Raman RA. Recalling ICU experiences: Patients' perspectives. Middle East J Sci Res 2014;19:106-11.
Ralls FM, Grigg-Damberger M. Roles of gender, age, race/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes. Curr Opin Pulm Med 2012;18:568-73.
Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF. Sleep in the intensive care unit. Am J Respir Crit Care Med 2015;191:731-8.