TY - JOUR
T1 - Nighttime Sleep Duration Is Associated with Length of Stay Outcomes among Older Adult Survivors of Critical Illness
AU - Elías, Maya N.
AU - Munro, Cindy L.
AU - Liang, Zhan
AU - Padilla Fortunatti, Cristobal F.
AU - Calero, Karel
AU - Ji, Ming
N1 - Funding Information:
C.F.P.F. acknowledges the Advanced Human Capital Program-CONICYT for supporting his research.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Background Older adults who required mechanical ventilation while in an intensive care unit (ICU) require adequate sleep throughout recovery from critical illness. Poor post-ICU sleep quality may contribute to worsening impairments in physical, cognitive, or psychological status after critical illness, known as post-ICU syndrome. Previous research has evaluated post-ICU sleep with qualitative or mixed methods (eg, interviews, questionnaires). We proposed measurement of sleep with actigraphy. We hypothesized that nighttime sleep is associated with length of stay (LOS). Objectives The aims of this study were to describe sleep quality of previously mechanically ventilated older adults recently transferred out of ICU and explore relationships between sleep duration and LOS outcomes. Methods We enrolled 30 older adults, 65 years and older, within 24 to 48 hours after ICU discharge. We collected actigraphy data on post-ICU sleep duration (total sleep time [TST]) and sleep fragmentation (wake time after sleep onset) over 2 consecutive nights. We explored associations between TST and LOS (in days) outcomes using multivariate regression. Results Subjects' mean TST was 7.55 ± 2.52 hours, and mean wake time after sleep onset was 2.26 ± 0.17 hours. In exploratory regression analyses, longer ICU LOS (β = 0.543, P <.001) and longer length of mechanical ventilation (β = 0.420, P =.028) were associated with greater post-ICU TST, after adjusting for potential confounding factors. Total sleep time was prospectively associated with total hospital LOS (β = 0.535, P <.001). Discussion Older ICU survivors demonstrate greater sleep duration and worse sleep fragmentation. Poor sleep may contribute to longer LOS, secondary to post-ICU syndrome and sequelae. We recommend nursing interventions to promote sleep consolidation throughout transitions of care in the acute post-ICU recovery period.
AB - Background Older adults who required mechanical ventilation while in an intensive care unit (ICU) require adequate sleep throughout recovery from critical illness. Poor post-ICU sleep quality may contribute to worsening impairments in physical, cognitive, or psychological status after critical illness, known as post-ICU syndrome. Previous research has evaluated post-ICU sleep with qualitative or mixed methods (eg, interviews, questionnaires). We proposed measurement of sleep with actigraphy. We hypothesized that nighttime sleep is associated with length of stay (LOS). Objectives The aims of this study were to describe sleep quality of previously mechanically ventilated older adults recently transferred out of ICU and explore relationships between sleep duration and LOS outcomes. Methods We enrolled 30 older adults, 65 years and older, within 24 to 48 hours after ICU discharge. We collected actigraphy data on post-ICU sleep duration (total sleep time [TST]) and sleep fragmentation (wake time after sleep onset) over 2 consecutive nights. We explored associations between TST and LOS (in days) outcomes using multivariate regression. Results Subjects' mean TST was 7.55 ± 2.52 hours, and mean wake time after sleep onset was 2.26 ± 0.17 hours. In exploratory regression analyses, longer ICU LOS (β = 0.543, P <.001) and longer length of mechanical ventilation (β = 0.420, P =.028) were associated with greater post-ICU TST, after adjusting for potential confounding factors. Total sleep time was prospectively associated with total hospital LOS (β = 0.535, P <.001). Discussion Older ICU survivors demonstrate greater sleep duration and worse sleep fragmentation. Poor sleep may contribute to longer LOS, secondary to post-ICU syndrome and sequelae. We recommend nursing interventions to promote sleep consolidation throughout transitions of care in the acute post-ICU recovery period.
KW - Critical care
KW - Hospitalization
KW - ICU outcomes
KW - Length of stay
KW - Mechanical ventilation
KW - Older adults
KW - Post-intensive care
KW - Sleep
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U2 - 10.1097/DCC.0000000000000411
DO - 10.1097/DCC.0000000000000411
M3 - Article
C2 - 32251163
AN - SCOPUS:85083022881
VL - 39
SP - 145
EP - 154
JO - Dimensions of Critical Care Nursing
JF - Dimensions of Critical Care Nursing
SN - 0730-4625
IS - 3
ER -