Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality

Abstract

Sleep patterns in critically ill patients’ polysomnographic sleep studies (PSG) are severely abnormal.

Purpose

We aimed to investigate the association of atypical sleep patterns, micro-sleep phenomena (sleep spindles and K-complexes) and rapid eye movement (REM) sleep with intensive care unit (ICU), in-hospital and 90-day mortality in conscious critically ill patients on mechanical ventilation.

Method

This was a prospective descriptive study. We analysed 52 PSGs recorded in conscious critically ill patients on mechanical ventilation. PSGs were scored according to standard classification when possible. Otherwise, modified classification proposed for scoring sleep in critically ill patients was used. The association of PSG findings with mortality was studied using logistic regression and Weibull model of survival analysis.

Results

The presence of atypical sleep patterns in accordance with modified sleep scoring classification was associated with higher odds for ICU mortality (odds ratio 11.63; p = 0.03). The absence of K-complexes was associated with higher odds for ICU mortality (odds ratio 11.63; p = 0.03), while the absence of sleep spindles was associated with higher odds for in-hospital (odds ratio 7.80; p = 0.02) and 90-day mortality (odds ratio 5.51; p = 0.02). Loss of sleep spindles was associated with higher mortality risk with cutoff point 90 days (hazard ratio 3.87; p = 0.03).

Conclusions

The presence of atypical sleep and absence of normal PSG sleep characteristics in conscious critically ill patients on mechanical ventilation indicates involvement of sleep producing brain structures in the pathological process and is associated with poor outcome.

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Acknowledgements

Special thanks to the ICU staff, Vejle Hospital and Odense University Hospital, for their great contribution to the project.

Funding

This study received financial support from the University of Southern Denmark; the Region of Southern Denmark; Department of Anesthesiology and Intensive Care Medicine, Vejle Hospital; The Research Foundation at Vejle Hospital; Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital; Danish Society of Anesthesiology and Intensive Care Medicine; Aage and Viola Holm-Madsens Research Foundation; A.P. Moellers Foundation and Exchange pool Rigshospitalet/Odense University Hospital.

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Correspondence to Yuliya Boyko.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The institutions where the work was performed: Department of Anesthesiology and Intensive Care Medicine, Vejle Hospital, Vejle; Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense

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Boyko, Y., Toft, P., Ørding, H. et al. Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality. Sleep Breath 23, 379–388 (2019). https://doi.org/10.1007/s11325-018-1718-3

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Keywords

  • Polysomnography
  • Sleep scoring classification
  • Atypical sleep
  • Critically ill patients