Sleep Disturbances in ICU

Q: ICU patients, particularly older patients, who sleep more during the day than at night, tend to have greater cognitive impairment during Post-ICU recovery.

A) True

B) False

Answer: A

Preserving physiological sleep during hospitalization remains a challenge for clinicians. Pragmatically, none of the patients achieve a normal sleep pattern in the ICU due to various environmental and pharmacological factors, some of which can be modified and some of which remain non-negotiable. Preservation of the normal sleep cycle remains more challenging in older, sedated, and ventilated patients.

Good sedation is not equivalent to a normal sleep cycle. This can be best described as "atypical sleep" or "pathologic wakefulness", due to sleep fragmentation and the absence of rapid eye (REM) movement.

Although all patients experience sleep disturbance in Post-ICU recovery, the older patients remained at high risk, particularly those patients who slept more during the day than at night while they were in the ICU.

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References:

1. Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care 2013; 17:R46.

2. Sun T, Sun Y, Huang X, et al. Sleep and circadian rhythm disturbances in intensive care unit (ICU)-acquired delirium: a case-control study. J Int Med Res 2021; 49:300060521990502.

3. Altman MT, Knauert MP, Pisani MA. Sleep Disturbance after Hospitalization and Critical Illness: A Systematic Review. Ann Am Thorac Soc 2017; 14:1457.

4. Elías MN, Munro CL, Liang Z. Daytime-to-Nighttime Sleep Ratios and Cognitive Impairment in Older Intensive Care Unit Survivors. Am J Crit Care 2021; 30:e40.