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

Yuliya Boyko, Palle Toft, Helle Ørding, Jørgen T Lauridsen, Miki Nikolic, Poul Jennum

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalSleep and Breathing
Volume23
Issue number1
Pages (from-to)379-388
ISSN1520-9512
DOIs
Publication statusPublished - Mar 2019

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Critical Illness
Odds Ratio
Intensive Care Units
REM Sleep
Survival Analysis
Logistic Models
Prospective Studies

Keywords

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

Cite this

@article{55d6b9a5ffe743579387c4ec78119941,
title = "Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality",
abstract = "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.",
keywords = "Atypical sleep, Critically ill patients, Polysomnography, Sleep scoring classification",
author = "Yuliya Boyko and Palle Toft and Helle {\O}rding and Lauridsen, {J{\o}rgen T} and Miki Nikolic and Poul Jennum",
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language = "English",
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Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality. / Boyko, Yuliya; Toft, Palle; Ørding, Helle; Lauridsen, Jørgen T; Nikolic, Miki; Jennum, Poul.

In: Sleep and Breathing, Vol. 23, No. 1, 03.2019, p. 379-388.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Atypical sleep in critically ill patients on mechanical ventilation is associated with increased mortality

AU - Boyko, Yuliya

AU - Toft, Palle

AU - Ørding, Helle

AU - Lauridsen, Jørgen T

AU - Nikolic, Miki

AU - Jennum, Poul

PY - 2019/3

Y1 - 2019/3

N2 - 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.

AB - 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.

KW - Atypical sleep

KW - Critically ill patients

KW - Polysomnography

KW - Sleep scoring classification

U2 - 10.1007/s11325-018-1718-3

DO - 10.1007/s11325-018-1718-3

M3 - Journal article

VL - 23

SP - 379

EP - 388

JO - Sleep and Breathing

JF - Sleep and Breathing

SN - 1520-9512

IS - 1

ER -