Introduction
Materials and methods
Design
Participants
Questionnaires
Study group (n = 497) | Nonresponders/withdrawals group (n = 226) | P valuea | Reference group (n = 6093) | P valueb | |
---|---|---|---|---|---|
Sex (male/female) | 274/223 | 136/90 | 0.23 | 2822/3271 |
<0.0001
|
Age (years) | 52.4 (15.7) | 52.5 (16.1) | 0.97 | 46.4 (15.1) |
<0.0001
|
Marital status | 0.09 |
0.006
| |||
Married | 327 (67) | 130 (59) | 4484 (74) | ||
Single | 135 (28) | 79 (35) | 1334 (22) | ||
Widow/widower | 27 (15) | 13 (6) | 274 (4)c | ||
Children at home < 19 years | 116 (24) | 40 (18) | 0.08 | ||
Born in Sweden | 454 (92) | 201 (89) | 0.26 | 5569 (91) | 0.74 |
Education |
<0.0001
| ||||
Compulsory school | 166 (34) | 84 (38) | 0.35 | 1785 (29) | |
High school/university | 121 (25) | 52 (23) | 0.78 | 1371 (22) | |
Employment before ICU stay |
0.04
|
<0.0001
| |||
Employed | 237 (50) | 103 (48) | 3589 (59) | ||
Retired | 192 (41) | 83 (39) | 1145 (19) | ||
Student | 20 (4) | 6 (3) | 402 (7) | ||
Other | 21 (5) | 23 (10) | 957 (16)d | ||
6 months after ICU stay | 0.31 | ||||
Employed | 201 (44) | 70 (35) | |||
Retired | 206 (45) | 101 (51) | |||
Student | 15 (3) | 9 (4) | |||
Other | 36 (8) | 20 (10) | |||
Sick leave before ICU stay | 70 (14) | 29 (13) | 0.46 | ||
Reported sick <100% | 13 (3) | 8 (3) | |||
Reported sick 100% | 50 (10) | 18 (3) | |||
6 months after ICU | 121 (24) | 59 (26) | 0.70 | ||
Reported sick <100% | 20 (4) | 8 (3) | |||
Reported sick 100% | 94 (19) | 48 (21) | |||
Concurrent diseasee | 342 (69) | 179 (79) |
0.005
| 3095 (51) |
<0.0001
|
Cancer | 48 (10) | 32 (18) | |||
Diabetes | 57 (11) | 29 (16) | |||
Cardiovascular | 83 (17) | 36 (20) | |||
Gastrointestinal | 50 (10) | 25 (14) | |||
Miscellaneous | 322 (65) | 168 (74) |
Instruments
Sleep disturbance
Health-related quality of life
Statistical analysis
Results
Characteristics of patients
Sleep disturbances
Before ICU staya | 6 months after ICU stayb | |
---|---|---|
Good | Bad | |
Good | 459 (70) | 60 (9) |
Bad | 56 (8) | 85 (13) |
Total patients | Concurrent disease patients | Previously healthy patients | |||||||
---|---|---|---|---|---|---|---|---|---|
ICU patients | Reference group | P value | ICU patients | Reference group | P value | ICU patients | Reference group | P value | |
Difficulties in falling asleep | |||||||||
Never or <1 times/week | 62% | 87% | <0.001 | 55% | 81% | <0.001 | 78% | 94% | <0.001 |
From 1 to 2 days/week to daily or almost daily | 38% | 13% | 45% | 19% | 22% | 6% | |||
Total (n) | 472 | 5826 | 326 | 2955 | 146 | 2871 | |||
Sleep quality during the past month | |||||||||
Neither good nor bad, good or very good | 80% | 88% | <0.001 | 77% | 81% | 0.080 | 88% | 95% | 0.001 |
Quite bad, poor or very poor | 20% | 12% | 23% | 19% | 12% | 5% | |||
Total (n) | 473 | 6047 | 326 | 3074 | 147 | 2973 | |||
Sleep deficit | |||||||||
Need for sleep higher than habitual sleep | 61% | 55% | 0.034 | 64% | 59% | 0.196 | 56% | 51% | 0.310 |
Need for sleep equal or less to habitual sleep | 39% | 45% | 36% | 41% | 44% | 49% | |||
Total (n) | 279 | 5605 | 192 | 2825 | 88 | 2780 |
Sleep disturbances (n = 419) | No sleep disturbances (n = 471) | P value | |
---|---|---|---|
Age (years)a | 55.7 (18.4) | 60.2 (18.0) | 0.419 |
Gender (male/female) (%) | 44.9/50.0 | 55.1/50.0 | 0.077 |
APACHE II scoreb | 15.2 (14.4 to 16.0) | 15.7 (15.0 to 16.4) | 0.525 |
Duration of stay in ICU (hours)c | 122.7 (55.0) | 126.0 (60.3) | 0.878 |
Duration of stay in hospital (days)c | 15.2 (9.0) | 15.2 (9.0) | 0.739 |
Diagnosis on admissiond | 0.067 | ||
Multiple trauma | 49 (11.7) | 51 (10.8) | |
Sepsis | 38 (9.1) | 38 (8.1) | |
Gastrointestinal | 80 (19.1) | 101 (21.4) | |
Respiratory | 84 (20.0) | 98 (20.8) | |
Cardiovascular | 29 (6.9) | 57 (12.1) | |
Miscellaneous | 139 (33.2) | 126 (26.8) |
Risk factors for sleep disturbances
Impact of different factors on sleep disturbances
Difficulties in falling asleep | Poor quality of sleep | Sleep deficit | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | OR | CI 95% for OR | P value | OR | CI 95% for OR | P value | OR | CI 95% for OR | P value | |
Concurrent disease | 2.32 | 1.67 to 3.23 |
<0. 001
| 2.51 | 1.62 to 3.89 |
<0. 001
| 1.14 | 0.76 to 1.72 | 0.52 | |
APACHE II score | ||||||||||
0 to 15 | 491 | 1.00 | 0.06 | 1.00 | 0.80 | 1.00 | 0.63 | |||
16 to 25 | 315 | 0.61 | 0.39 to 0.95 | 0.85 | 0.49 to 1.44 | 1.35 | 0.71 to 2.55 | |||
26 to 43 | 105 | 0.78 | 0.49 to 1.23 | 0.83 | 0.48 to 1.45 | 1.21 | 0.63 to 2.32 | |||
LoS in ICU | ||||||||||
<37 hours | 221 | 1.00 | 0.14 | 1.00 | 0.70 | 1.00 | 0.33 | |||
38 to 52 hours | 201 | 0.98 | 0.66 to 1.45 | 1.19 | 0.74 to 1.91 | 1.39 | 0.80 to 2.40 | |||
53 to 144 hours | 275 | 0.64 | 0.43 to 0.97 | 0.89 | 0.54 to 1.47 | 0.92 | 0.53 to 1.59 | |||
>144 hours | 214 | 0.85 | 0.58 to 1.23 | 0.99 | 0.63 to 1.57 | 0.90 | 0.54 to 1.50 | |||
LoS in hospital | ||||||||||
<5 days | 281 | 1.00 | 0.75 | 1.00 | 0.99 | 1.00 | 0.57 | |||
6 to 13 days | 320 | 1.00 | 0.71 to 1.41 | 0.97 | 0.64 to 1.46 | 1.03 | 0.65 to 1.62 | |||
>13 days | 310 | 0.90 | 0.64 to 1.25 | 0.99 | 0.66 to 1.47 | 1.25 | 0.80 to 1.95 | |||
Diagnosis at admission | ||||||||||
Multiple trauma | 102 | 1.00 | 0.59 | 1.00 | 0.14 | 1.59 | 0.17 | |||
Sepsis | 78 | 1.61 | 0.85 to 3.03 | 2.13 | 0.93 to 4.87 | 0.98 | 0.44 to 2.20 | |||
Gastrointestinal | 188 | 1.33 | 0.69 to 2.56 | 2.62 | 1.13 to 6.05 | 1.99 | 0.75 to 5.27 | |||
Respiratory | 185 | 1.19 | 0.69 to 2.08 | 1.31 | 0.60 to 2.85 | 1.35 | 0.65 to 2.81 | |||
Cardiovascular | 88 | 1.42 | 0.84 to 2.40 | 1.97 | 0.95 to 4.10 | 1.83 | 0.91 to 3.69 | |||
Miscellaneous | 270 | 1.10 | 0.63 to 1.92 | 1.59 | 0.74 to 3.40 | 1.89 | 0.90 to 3.97 |
Health-related quality of life
Difficulties in falling asleep | Poor quality of sleep | Sleep deficit | |||||||
---|---|---|---|---|---|---|---|---|---|
Predictor | OR | 95% CI for OR | P value | OR | 95% CI for OR | P value | OR | 95% CI for OR | P value |
Physical functioning | 1.0 | 0.93 to 1.06 | 0.887 | 1.08 | 0.99 to 1.16 | 0.076 | 1.04 | 0.96 to 1.13 | 0.322 |
Role limitations due to physical problems | 1.01 | 0.96 to 1.06 | 0.700 | 1.04 | 0.98 to 1.10 | 0.188 | 1.08 | 1.02 to 1.14 | 0.011 |
Bodily pain | 0.90 | 0.85 to 0.96 | 0.001 | 0.89 | 0.83 to 0.96 | 0.002 | 0.88 | 0.81 to 0.95 | 0.001 |
General health | 0.84 | 0.77 to 0.92 | <0.001 | 0.90 | 0.80 to 1.02 | 0.089 | 0.93 | 0.83 to 1.04 | 0.212 |
Vitality | 0.95 | 0.86 to 1.05 | 0.318 | 0.81 | 0.72 to 0.91 | <0.001 | 0.99 | 0.88 to 1.12 | 0.873 |
Social functioning | 1.02 | 0.95 to 1.10 | 0.598 | 1.00 | 0.91 to 1.10 | 0.993 | 1.02 | 0.92 to 1.12 | 0.759 |
Role limitations due to emotional problems | 0.98 | 0.94 to 1.02 | 0.364 | 0.95 | 0.90 to 1.00 | 0.056 | 0.99 | 0.93 to 1.05 | 0.660 |
Mental health | 0.80 | 0.74 to 0.87 | <0.001 | 0.80 | 0.72 to 0.89 | <0.001 | 0.89 | 0.81 to 0.98 | <0.001 |
Discussion
Sleep disturbances
Health-related quality of life
Limitations of the study
Conclusion
Key messages
-
Changes in quality of sleep prior to compared with after stays in the ICU and in the hospital seem to be minor.
-
Sleep disturbances are common after critical care at 6 months (from 5% to 25% more common than the general population), with little or no improvement over time.
-
Intensive-care-related factors do not seem to influence sleep at 6 and 12 months after ICU stay, whereas concurrent disease is the main explanation for the sleep problems registered.