Sleep disturbances in patients admitted to a step-down unit after ICU discharge: the role of mechanical ventilation

Abstract

Background: Severe sleep disruption is a well-documented problem in mechanically ventilated, critically ill patients during their time in the intensive care unit (ICU), but little attention has been paid to the period when these patients become clinically stable and are transferred to a step-down unit (SDU). We monitored the 24-h sleep pattern in 2 groups of patients, one on mechanical ventilation and the other breathing spontaneously, admitted to our SDU to assess the presence of sleep abnormalities and their association with mechanical ventilation.

Methods: Twenty-two patients admitted to an SDU underwent 24-h polysomnography with monitoring of noise and light.

Results: One patient did not complete the study. At night, 10 patients showed reduced sleep efficiency, 6 had reduced percentage of REM sleep, and 3 had reduced percentage of slow wave sleep (SWS). Sleep amount and quality did not differ between patients breathing spontaneously and those on mechanical ventilation. Clinical severity (SAPS(II) score) was significantly correlated with daytime total sleep time and efficiency (r = 0.51 and 0.5, P < 0.05, respectively); higher pH was correlated with reduced sleep quantity and quality; and higher PaO(2) was correlated with increased SWS (r = 0.49; P = 0.02).

Conclusions: Patients admitted to an SDU after discharge from an ICU still have a wide range of sleep abnormalities. These abnormalities are mainly associated with a high severity score and alkalosis. Mechanical ventilation does not appear to be a primary cause of sleep impairment.

Keywords: Chronic obstructive pulmonary disease; mechanical ventilation; polysomnography; sleep alterations; sleep disordered breathing; step-down unit.

Figures

Figure 1

Distribution of daytime sleep time (expressed as % of total sleep time) in all patients.

Figure 2

Mean light intensity (top) and noise levels (bottom) along the 24-h recordings.

Figure 3

Correlation between daytime total sleep time (TST) and SAPSII score. Dashed lines represent the 95% confidence interval.

Figure 4

Correlation between pH and total sleep time (A) or arousal index (B) calculated for the entire recording. Dashed lines represent the 95% confidence interval.