Impact of sleep disturbances on outcomes in intensive care units

Background Sleep deprivation is common in ICUs and may alter respiratory performance. Few studies have assessed the role of sleep disturbances on outcomes in critically ill patients. Objectives We hypothesized that sleep disturbances may be associated with poor outcomes in ICUs. Methods Post-hoc analysis pooling 3 studies assessing sleep by complete polysomnography in 131 conscious and non-sedated patients included at different times of their ICU stay. Sleep was assessed early in patients admitted for acute respiratory failure while breathing spontaneously (n = 34), or under mechanical ventilation in patients with weaning difficulties (n = 45), or immediately after extubation (n = 52). Patients admitted for acute respiratory failure who required intubation, those under mechanical ventilation who had prolonged weaning, and those who required reintubation after extubation were considered as having poor clinical outcomes. Durations of deep sleep, rapid eye movement (REM) sleep, and atypical sleep were compared according to the timing of polysomnography and the clinical outcomes. Results While deep sleep remained preserved in patients admitted for acute respiratory failure whereas it was markedly reduced under mechanical ventilation and after extubation (p < 0.01). Atypical sleep was significantly more frequent in patients under mechanical ventilation than in those breathing spontaneously (p < 0.01). REM sleep was uncommon at any time of their ICU stay. Patients with complete disappearance of REM sleep (50% of patients) were more likely to have poor clinical outcomes than those with persistent REM sleep (24% vs. 9%, p = 0.03). Conclusion Complete disappearance of REM sleep was significantly associated with poor clinical outcomes in critically ill patients.