Sleep deprivation is common in intensive care units (ICUs) and may alter respiratory performance. Few studies have assessed the role of sleep disturbances on outcomes in critically ill patients. We hypothesized that sleep disturbances may be associated with poor outcomes in ICUs. Post-hoc analysis pooling three observational 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 a group of 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. Whereas deep sleep remained preserved in patients admitted for acute respiratory failure, 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). Complete disappearance of REM sleep was significantly associated with poor clinical outcomes in critically ill patients.

中文翻译：

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睡眠障碍对重症监护病房结局的影响


睡眠剥夺在重症监护病房 （ICU） 中很常见，可能会改变呼吸功能。很少有研究评估睡眠障碍对危重患者预后的影响。我们假设睡眠障碍可能与 ICU 的不良结局有关。事后分析汇集了三项观察性研究，通过完整的多导睡眠图评估了 131 名清醒和非镇静患者的睡眠，这些患者在 ICU 住院的不同时间被纳入。在一组因急性呼吸衰竭入院的患者中，在自主呼吸时 （n = 34） 或在脱机困难患者中在机械通气下 （n = 45） 或拔管后立即 （n = 52） 的早期评估睡眠。因急性呼吸衰竭入院但需要插管的患者、机械通气下脱机时间延长的患者以及拔管后需要重新插管的患者被认为临床结局不佳。根据多导睡眠图的时间和临床结局，比较深度睡眠、快速眼动 （REM） 睡眠和非典型睡眠的持续时间。虽然因急性呼吸衰竭入院的患者仍然保持深度睡眠，但在机械通气下和拔管后深度睡眠显着减少 （p < 0.01）。机械通气患者非典型睡眠的频率明显高于自主呼吸患者 （p < 0.01）。REM 睡眠在他们入住 ICU 的任何时候都不常见。REM 睡眠完全消失的患者 （50% 的患者） 比持续 REM 睡眠的患者 （24% vs. 9%，p = 0.03） 更有可能出现不良临床结果。REM 睡眠完全消失与危重患者不良临床结局显著相关。