Lê Dinh Matthieu, Darmon Michael, Kouatchet Achille, Jaber Samir, Meziani Ferhat, Perbet Sebastien, Chanques Gerald, Azoulay Elie, Demoule Alexandre
Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013 Paris, France.
UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005 Paris, France.
J Clin Med. 2022 Aug 8;11(15):4620. doi: 10.3390/jcm11154620.
Background. The objectives of this study were (1) to determine factors associated with impaired sleep and (2) to evaluate the relationship between impaired sleep and the outcome. Methods. Secondary analysis of a prospective observational cohort study in 54 intensive care units in France and Belgium. Sleep quality was quantified by the patients with a semi-quantitative scale. Results. Among the 389 patients included, 40% reported poor sleep during the first night in the ICU and the median (interquartile) total sleep time was 4 h (2−5). Factors independently associated with poor sleep quality were the SOFA score (odds ratio [OR] 0.90, p = 0.037), anxiety (OR 0.43, p = 0.001) and the presence of air leaks (OR 0.52, p = 0.013). Factors independently associated with short-estimated sleep duration (<4 h) were the SOFA score (1.13, p = 0.005), dyspnea on admission (1.13, p = 0.031) and the presence of air leaks (1.92, p = 0.008). Non-invasive ventilation failure was independently associated with poor sleep quality (OR 3.02, p = 0.021) and short sleep duration (OR 0.77, p = 0.001). Sleep quality and duration were not associated with an increase in mortality or length of stay. Conclusions. The sleep of patients with ARF requiring NIV is impaired and is associated with a high rate of NIV failure.
背景。本研究的目的是:(1)确定与睡眠障碍相关的因素;(2)评估睡眠障碍与预后之间的关系。方法。对法国和比利时54个重症监护病房的一项前瞻性观察队列研究进行二次分析。睡眠质量由患者使用半定量量表进行量化。结果。在纳入的389例患者中,40%报告在重症监护病房的第一晚睡眠不佳,总睡眠时间的中位数(四分位间距)为4小时(2 - 5小时)。与睡眠质量差独立相关的因素有序贯器官衰竭评估(SOFA)评分(比值比[OR]0.90,p = 0.037)、焦虑(OR 0.43,p = 0.001)和气漏的存在(OR 0.52,p = 0.013)。与估计睡眠时间短(<4小时)独立相关的因素有SOFA评分(1.13,p = 0.005)、入院时呼吸困难(1.13,p = 0.031)和气漏的存在(1.92,p = 0.008)。无创通气失败与睡眠质量差(OR 3.02,p = 0.021)和睡眠时间短(OR 0.77,p = 0.001)独立相关。睡眠质量和时长与死亡率增加或住院时间无关。结论。需要无创通气的急性呼吸衰竭患者的睡眠受到损害,且与高无创通气失败率相关。