How did you sleep in the ICU?

Introduction

It has been proven that patients' sleep is extremely disturbed in the ICU for many reasons: illness pathophysiology and severity, pain, or the ICU environment itself. The aim of our survey was to describe the memorization of sleep disturbances during an ICU stay and the patients' reported sleep quality after critical care. We also assessed the possible underlying causes of sleep disturbances including factors related to the critical illness.

Methods

A telephone interview including a random sample of 60 patients admitted to our ICU (between December 2008 and May 2009) was performed 6 to 12 months after their discharge. Eight patients were excluded (two for language barrier, two were dead, four were not joined). Conventional intensive care variables were retrospectively recorded from the ICU database and sleep disturbances were evaluated using the Basic Nordic Sleep Questionnaire. Two nonvalidated questions were analysed, one estimated the quality of sleep in the ICU and the other compared the quality of sleep before and after the ICU stay. Data were presented descriptively using logistic regression to evaluate the independent effects of sex, age, BMI at admission, SAPS II, length of stay, hemodialysis, length of mechanical ventilation, length of central venous catheterization and prescription of vasopressor agents or transfusion.

Results

Among responding patients, 47% remembered sleep disturbances in the ICU and among them 43% still declared a decreased long-term quality of sleep. In addition, 30% of patients report a worse quality of sleep after the ICU than it used to be before. No relation was found when we assessed the possible effects of intensive care variables on the sleeping patterns during critical illness.

Conclusions

Sleep disturbances were described in one-half of the patients we studied during their ICU stay. As interesting (but alarming) is that one-third of the group declared having a worse quality of sleep a long time after their discharge from the ICU. The sleep disturbances were not affected by ICU factors but their high self-reported prevalence probably reveals the necessity of protocols evaluating the effects of strategies to improve sleep quality in patients' recovery of critical illness and long-term sleep.