Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: an observational cohort study

Marcus T Altman, Melissa P Knauert, Terrence E Murphy, Amy M Ahasic, Zeeshan Chauhan, Margaret A Pisani, Marcus T Altman, Melissa P Knauert, Terrence E Murphy, Amy M Ahasic, Zeeshan Chauhan, Margaret A Pisani

Abstract

Background: In medical intensive care unit (MICU) patients, the predictors of post-discharge sleep disturbance and functional disability are poorly understood. ICU delirium is a risk factor with a plausible link to sleep disturbance and disability. This study evaluated the prevalence of self-reported post-ICU sleep disturbance and increased functional disability, and their association with MICU delirium and other ICU factors.

Methods: This was an observational cohort study of MICU patients enrolled in a biorepository and assessed upon MICU admission by demographics, comorbidities, and baseline characteristics. Delirium was assessed daily using the Confusion Assessment Method for the ICU. Telephone follow-up interview instruments occurred after hospital discharge and included the Pittsburgh Sleep Quality Index (PSQI), and basic and instrumental activities of daily living (BADLs, IADLs) for disability. We define sleep disturbance as a PSQI score > 5 and increased disability as an increase in composite BADL/IADL score at follow-up relative to baseline. Multivariable regression modeled the associations of delirium and other MICU factors on follow-up PSQI scores and change in disability scores.

Results: PSQI and BADL/IADL instruments were completed by 112 and 122 participants, respectively, at mean 147 days after hospital discharge. Of those surveyed, 63% had sleep disturbance by PSQI criteria, and 37% had increased disability by BADL/IADL scores compared to their pre-MICU baseline. Total days of MICU delirium (p = 0.013), younger age (p = 0.013), and preexisting depression (p = 0.025) were significantly associated with higher PSQI scores at follow-up. Lower baseline disability (p < 0.001), older age (p = 0.048), and less time to follow-up (p = 0.024) were significantly associated with worsening post-ICU disability, while the occurrence of MICU delirium showed a trend toward association (p = 0.077).

Conclusions: After adjusting for important covariates, total days of MICU delirium were significantly associated with increased post-discharge sleep disturbance. Delirium incidence showed a trend toward association with increased functional disability in the year following discharge.

Keywords: Activities of daily living; Critical care; Delirium; Disability; Post-ICU; Post-hospital; Sleep disturbance.

Figures

Fig. 1
Fig. 1
Consort diagram for cohort development, ADL activities of daily living, IADL instrumental activities of daily living, ICU intensive care unit, LOS length of stay, PSQI Pittsburgh Sleep Quality Index
Fig. 2
Fig. 2
Change in disability counts from ICU admission to follow-up for 122 patients completing BADL/IADL instruments. Legend For changes in disability counts, positive values indicate increased disability at follow-up. BADL/IADL basic and instrumental activities of daily living, ICU intensive care unit

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