Evaluation of Sleep Architecture Using 24-hour Polysomnography in Patients Recovering from Critical Illness in an Intensive Care Unit and High Dependency Unit: A Longitudinal, Prospective, and Observational Study

DOI: 10.2478/jccm-2021-0023

Background and objective: The sleep architecture of critically ill patients being treated in Intensive care units and High dependency units is frequently unsettled and inadequate both qualitatively and quantitatively. The study aimed to investigate and elucidate factors influencing sleep architecture and quality in intensive care units (ICU) and high dependency units (HDU) in a limited resource setting with financial constraints, lacking human resources and technology for routine monitoring of noise, light and sleep promotion strategies in intensive care units (ICU).
Methods: The study was longitudinal, prospective, hospital-based, analytic, and observational. Insomnia Severity Index (ISI) and the Epworth sleepiness scale (ESS) pre hospitalisation scores were recorded. Patients underwent 24-hour polysomnography (PSG) with the simultaneous monitoring of noise and light in their environments. Patients stabilised in intensive care units (ICU) were transferred to high dependency units (HDU), where the 24-hour polysomnography with the simultaneous monitoring of noise and light in their environments was repeated. Following PSG, the Richards-Campbell Sleep Questionnaire (RCSQ) was employed to rate patients’ sleep in both the intensive care units (ICU) and high dependency units (HDU).
Results: Of 46 screened patients, 26 patients were treated in the intensive care unit (ICU) and then transferred to the high dependency units (HDU). The mean (SD) of the study population’s mean (SD) age was 35.96 (11.6) years with a predominantly male population (53.2% (n=14)). The mean (SD) of the ISI and ESS scores were 6.88 (2.58) and 4.92 (1.99), respectively. The comparative analysis of PSG data recording from the ICU and high dependency units (HDU) showed a statistically significant reduction in N1, N2 and an increase in N3 stages of sleep (p<0.05). Mean(SD) of RCSQ in the ICU and the HDU were 54.65(7.70) and 60.19(10.85) (p-value = 0.04) respectively. The disease severity (APACHE II) has a weak correlation with the arousal index but failed to reach statistical significance (coeff= 0.347, p= 0.083).
Conclusion: Sleep in ICU is disturbed and persisting during the recovery period in critically ill. However, during recovery, sleep architecture shows signs of restoration.

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