Daytime-to-nighttime sleep ratios and cognitive impairment in older intensive care unit survivors

Maya N. Elías, Cindy L. Munro, Zhan Liang

Research output: Contribution to journalArticlepeer-review


Background Sleep duration and proportion of daytime versus nighttime sleep may affect cognitive function in older patients in the transition out of the intensive care unit. Objective To explore the relationship between the daytime-to-nighttime sleep ratio and cognitive impairment in older intensive care unit survivors. Methods The study enrolled 30 older adults within 24 to 48 hours after intensive care unit discharge. All participants were functionally independent before admission and underwent mechanical ventilation in the intensive care unit. Actigraphy was used to estimate daytime (6 am to 9:59 pm) and nighttime (10 pm to 5:59 am) total sleep duration. Daytime-to-nighttime sleep ratios were calculated by dividing the proportion of daytime sleep by the proportion of nighttime sleep. The National Institutes of Health Toolbox Cognition Battery Dimensional Change Card Sort Test (DCCST) was used to assess cognition. Associations between sleep and cognition were explored using multivariate regression after adjusting for covariates. Results The mean (SD) daytime sleep duration was 7.55 (4.30) hours (range, 0.16-14.21 hours), and the mean (SD) nighttime sleep duration was 4.99 (1.95) hours (range, 0.36-7.21 hours). The mean (SD) daytime-to-nighttime sleep ratio was 0.71 (0.30) (range, 0.03-1.10). Greater daytime sleep duration (β = −0.351, P = .008) and higher daytime-to-nighttime sleep ratios (β = −0.373, P = .008) were negatively associated with DCCST scores. Conclusions The daytime-to-nighttime sleep ratio was abnormally high in the study population, revealing an altered sleep/wake cycle. Higher daytime-to-nighttime sleep ratios were associated with worse cognition, suggesting that proportionally greater daytime sleep may predict cognitive impairment. (American Journal of Critical Care. 2021;30:e40-e47).

Original languageEnglish (US)
Pages (from-to)e40-e47
JournalAmerican Journal of Critical Care
Issue number2
StatePublished - Mar 1 2021
Externally publishedYes

ASJC Scopus subject areas

  • Critical Care


Dive into the research topics of 'Daytime-to-nighttime sleep ratios and cognitive impairment in older intensive care unit survivors'. Together they form a unique fingerprint.

Cite this