Impact of obstructive sleep apnea on the obesity paradox in critically ill patients

This research by Bailly and others was published online in the Journal of Critical Care in December 2019
Objective:  Patients admitted to an intensive care unit (ICU) frequently suffer from multiple chronic diseases, including obstructive sleep apnea (OSA). Until recently OSA was not considered as a key determinant in an ICU patient’s prognosis. The objective of this study was to document the impact of OSA on the prognosis of ICU patients.
Methods:  Data were retrospectively collected concerning adult patients admitted to ICU at two university hospitals. In a nested study OSA status was checked using the hospital electronic medical records to identify exposed and unexposed cases. The following outcomes were considered: length of stay in the ICU, ICU mortality, in-hospital mortality, ventilator-associated pneumonia (VAP).
Results:  Out of 5146 patients included in the study, 289 had OSA at ICU admission (5.6%). After matching, the overall impact of OSA on length of ICU stay was not significant (p = .24). In a predefined subgroup analysis, there was a significant impact of OSA on the length of ICU stay for patients with BMI over 40 kg/m² (IRR: 1.56 [1.05; 2.32], p = .03). OSA status had no impact on ICU or hospital mortality and VAP.
Conclusion:  In general, known OSA did not increase the ICU stay except for patients with both OSA and morbid obesity.
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Development and daily use of a numeric rating score to assess sleep quality in ICU patients

This publication by Rood and colleagues appeared online in Journal of Critical Care during April 2019.
Purpose:  Insufficient sleep burdens critically ill patients, optimizing sleep may enhance patient’s outcomes. Current assessment methods may unnecessary burden patients. Therefore, a single numeric rating score was validated for sleep assessment.
Materials and methods:  First, two cross-sectional measurements on two separate days, from cooperative patients from 19 centres assessed their sleep sufficiency, the numeric rating score (NRS) and the Richards Campbell Sleep Questionnaire (RCSQ). Assessments were compared using a Bland Altman plot. A NRS cut-off was determined using regression analysis. Second, daily sleep assessment was implemented and monitored single centre for a year.
Results:  Multicentre, 194 patients assessed sleep quality, of which 53% was rated as sufficient. Mean (±SD) difference between RCSQ and NRS-Sleep using Bland-Altman analysis was 0.25 (±1.21, 95% limits of agreement −2.12 to 2.62). The optimal cut-off was >5. Single centre, 1603 patients ranked 4532 ICU nights of sleep, of which 71% was sufficient; median NRS was 6 [IQR 5–7].
Conclusions:  A single numeric rating score for sleep is interchangeable for the RCSQ score for assessment of sleep quality. Optimal cut-off is >5. Use of a numeric rating score for sleep is a practical way to evaluate and monitor sleep as perceived by patients in daily ICU practice.
The full text of this article is available to subscribers via this link to the journal’s homepage.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Journal of Critical Care.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Sleep deprivation determinants as perceived by intensive care unit patients: Findings from a systematic review, meta-summary and meta-synthesis

This research by Mattiussi and others was published in “Intensive and Critical Care Nursing” during March 2019.
Objectives:  To summarise evidence on sleep deprivation and/or poor sleep determinants as experienced by intensive care unit patients.
Research methodology/design:  A systematic review of qualitative studies identified through PubMed, CINAHL and Scopus databases published in English up to 2018 was performed following PRISMA guidelines. The included studies were critically evaluated by using the Critical Appraisal Screening Programme tool. Study findings were then subjected to a meta-summary and a meta-synthesis.
Setting:  Intensive Care Units.
Main outcome measures:  Critically ill patients’ experiences of sleep deprivation.
Results:  Seven qualitative studies were included documenting the experience of 109 adult patients. A total of 12 codes emerged as causes of sleep deprivation and ‘feeling fear/concern’ was reported with the greatest frequency (71.4%) in the meta-summary. The 12 codes were categorised into three main themes influencing both directly and also interdependently the quality of sleep: (1) Experiencing complex interactions with the environment (nursing activities, frightening or disturbing sounds, acceptable sounds, time and space disorientation); (2) Undergoing intensive emotions and feelings (fear/concerns, state of abandon, inexplicable insomnia, inability to move, inability to talk) and (3) Receiving an appropriate standard of care (physical pain, feeling safe/unsafe).
Conclusions:  Despite the increased relevance of sleep deprivation and poor sleep quality, only a few studies have been performed to date aimed at identifying the factors involved in the phenomenon according to patient experience. The majority of determinants as identified from patients’ perspective are modifiable.
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Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units

This article by Simons and colleagues was published in the Critical Care October 2018 issue.
Background:  High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about the effect of noise on sleep quality in ICU patients. The study aim is to determine the effect of noise on subjective sleep quality.
Methods:  This was a multi-centre observational study in six Dutch ICUs. Noise recording equipment was installed in 2-4 rooms per ICU. Adult patients were eligible for the study 48 h after ICU admission and were followed up to maximum of five nights in the ICU. Exclusion criteria were presence of delirium and/or inability to be assessed for sleep quality. Sleep was evaluated using the Richards Campbell Sleep Questionnaire (range 0-100 mm). Noise recordings were used for analysis of various auditory parameters, including the number and duration of restorative periods. Hierarchical mixed model regression analysis was used to determine associations between noise and sleep.
Results:  In total, 64 patients (68% male), mean age 63.9 (± 11.7) years and mean Acute Physiology and Chronic Health Evaluation (APACHE) II score 21.1 (± 7.1) were included. Average sleep quality score was 56 ± 24 mm. The mean of the 24-h average sound pressure levels (LAeq, 24h) was 54.0 dBA (± 2.4). Mixed-effects regression analyses showed that background noise (β = - 0.51, p < 0.05) had a negative impact on sleep quality, whereas number of restorative periods (β = 0.53, p < 0.01) and female sex (β = 1.25, p < 0.01) were weakly but significantly correlated with sleep.
Conclusions:  Noise levels are negatively associated and restorative periods and female gender are positively associated with subjective sleep quality in ICU patients.
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