夜间睡眠时间与危重症老年幸存者的住院时间结局有关。
Nighttime Sleep Duration Is Associated With Length of Stay Outcomes Among Older Adult Survivors of Critical Illness.
机构信息
Maya N. Elías, PhD, MA, RN, is postdoctoral research fellow, School of Nursing & Health Studies, University of Miami, Coral Gables, Florida. Cindy L. Munro, PhD, ANP-BC, FAAN, FAANP, FAAAS, is dean and professor, School of Nursing & Health Studies, University of Miami, Coral Gables, Florida. Zhan Liang, PhD, MSN, RN, is assistant professor, School of Nursing & Health Studies, University of Miami, Coral Gables, Florida. Cristobal F. Padilla Fortunatti, MSN, is PhD student, School of Nursing & Health Studies, University of Miami, Coral Gables, Florida; and assistant clinical professor, School of Nursing, Pontificia Universidad Catolica de Chile, Santiago, Chile. Karel Calero, MD, is assistant professor, Department of Pulmonary, Critical Care & Sleep Medicine, College of Medicine, University of South Florida, Tampa, Florida. Ming Ji, PhD, is professor, College of Nursing, University of South Florida, Tampa, Florida.
出版信息
Dimens Crit Care Nurs. 2020 May/Jun;39(3):145-154. doi: 10.1097/DCC.0000000000000411.
BACKGROUND
Older adults who required mechanical ventilation while in an intensive care unit (ICU) require adequate sleep throughout recovery from critical illness. Poor post-ICU sleep quality may contribute to worsening impairments in physical, cognitive, or psychological status after critical illness, known as post-ICU syndrome. Previous research has evaluated post-ICU sleep with qualitative or mixed methods (eg, interviews, questionnaires). We proposed measurement of sleep with actigraphy. We hypothesized that nighttime sleep is associated with length of stay (LOS).
OBJECTIVES
The aims of this study were to describe sleep quality of previously mechanically ventilated older adults recently transferred out of ICU and explore relationships between sleep duration and LOS outcomes.
METHODS
We enrolled 30 older adults, 65 years and older, within 24 to 48 hours after ICU discharge. We collected actigraphy data on post-ICU sleep duration (total sleep time [TST]) and sleep fragmentation (wake time after sleep onset) over 2 consecutive nights. We explored associations between TST and LOS (in days) outcomes using multivariate regression.
RESULTS
Subjects' mean TST was 7.55 ± 2.52 hours, and mean wake time after sleep onset was 2.26 ± 0.17 hours. In exploratory regression analyses, longer ICU LOS (β = 0.543, P < .001) and longer length of mechanical ventilation (β = 0.420, P = .028) were associated with greater post-ICU TST, after adjusting for potential confounding factors. Total sleep time was prospectively associated with total hospital LOS (β = 0.535, P < .001).
DISCUSSION
Older ICU survivors demonstrate greater sleep duration and worse sleep fragmentation. Poor sleep may contribute to longer LOS, secondary to post-ICU syndrome and sequelae. We recommend nursing interventions to promote sleep consolidation throughout transitions of care in the acute post-ICU recovery period.
背景
在重症监护病房（ICU）需要机械通气的老年人在从危重病中康复期间需要充足的睡眠。 ICU 后睡眠质量差可能导致 ICU 后身体、认知或心理状态恶化，称为 ICU 后综合征。先前的研究已经使用定性或混合方法（例如访谈、问卷）评估了 ICU 后的睡眠。我们提出使用活动记录仪测量睡眠。我们假设夜间睡眠与住院时间（LOS）有关。
目的
本研究旨在描述最近从 ICU 转出的先前机械通气的老年患者的睡眠质量，并探讨睡眠时间与 LOS 结局之间的关系。
方法
我们在 ICU 出院后 24 至 48 小时内招募了 30 名 65 岁及以上的老年人。我们在连续两个晚上收集了 ICU 后睡眠持续时间（总睡眠时间[TST]）和睡眠片段化（睡眠开始后醒来时间）的活动记录仪数据。我们使用多元回归分析探索了 TST 与 LOS（天数）结局之间的关系。
结果
受试者的平均 TST 为 7.55 ± 2.52 小时，平均睡眠开始后醒来时间为 2.26 ± 0.17 小时。在探索性回归分析中，较长的 ICU LOS（β=0.543，P<0.001）和较长的机械通气时间（β=0.420，P=0.028）与 ICU 后 TST 增加相关，在调整了潜在混杂因素后。总睡眠时间与总住院 LOS 呈前瞻性相关（β=0.535，P<0.001）。
讨论
老年 ICU 幸存者表现出更长的睡眠时间和更差的睡眠片段化。睡眠不佳可能导致 LOS 延长，这是由于 ICU 后综合征和后遗症所致。我们建议在 ICU 后恢复期间的急性过渡护理中实施护理干预措施，以促进睡眠巩固。
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