Correlation Between Sleep Continuity and Patient-Reported Sleep Quality in Conscious Critically Ill Patients at High Risk of Reintubation: A Pilot Study

Eloïse Van Camp; Christophe Rault; Quentin Heraud; Jean-Pierre Frat; Anais Balbous; Arnaud W Thille; Pierre-Olivier Fernagut; Xavier Drouot

doi:10.1097/CCE.0000000000001016

Correlation Between Sleep Continuity and Patient-Reported Sleep Quality in Conscious Critically Ill Patients at High Risk of Reintubation: A Pilot Study

Crit Care Explor. 2023 Dec 1;5(12):e1016. doi: 10.1097/CCE.0000000000001016. eCollection 2023 Dec.

Authors

Eloïse Van Camp^{1

2}, Christophe Rault^{3

4}, Quentin Heraud⁴, Jean-Pierre Frat⁵, Anais Balbous^{1

4}, Arnaud W Thille⁵, Pierre-Olivier Fernagut¹, Xavier Drouot^{1

2

3

4}

Affiliations

¹ INSERM U-1084, Experimental and Clinical Neurosciences Laboratory, Neurobiology and Neuroplasticity and Neuro-development Group, Poitiers, France. INSERM, CIC 1402, Equipe IS-Alive; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France.
² CHU de Poitiers, Service d'Explorations Fonctionnelles, Physiologie Respiratoire et de l'Exercice, Poitiers, France.
³ INSERM, CIC 1402, CHU de Poitiers, Poitiers, France.
⁴ CHU de Poitiers, Service de Médecine intensive et réanimation, Poitiers, France.
⁵ CHU de Poitiers, Service de Neurophysiologie Clinique, Poitiers, France.

Abstract

Objectives: It is well-established that sleep quality of ICU patients is poor, with sleep being highly fragmented by multiple awakenings. These sleep disruptions are associated with poor outcomes such as prolonged weaning duration from mechanical ventilation. Polysomnography can measure sleep continuity, a parameter associated positively with outcomes in patients treated with noninvasive ventilation, but polysomnography is not routinely available in all ICUs, and simple means to assess sleep quality are needed. The Richards-Campbell sleep questionnaire (RCSQ) assesses sleep quality in ICU patients but is difficult to administrate in patients who are not fully awake, and a simpler sleep numeric rating scale (sleep-NRS) has been proposed as an alternative. We here investigated the relationships between sleep continuity and patients-reported sleep quality.

Design: Single-center retrospective study.

Setting: Medical ICU of Poitiers University Hospital.

Patients: Seventy-two patients were extubated from mechanical ventilation and at high risk of reintubation.

Interventions: None.

Measurements and main results: We analyzed 52 previously recorded polysomnographies in nonsedated and conscious ICU patients. Sleep was recorded the night after extubation. Sleep continuity was measured using an automated scoring algorithm from one electroencephalogram (EEG) channel of the polysomnography. Patient-reported sleep quality was assessed using RCSQ and sleep-NRS. Sleep continuity could be calculated on 45 polysomnographies (age: 68 [58-77], median [25th-75th]) RCSQ (62 [48-72]) and sleep-NRS (6.0 [5.0-7.0]) were obtained in 21 patients and 34 patients, respectively. Our results show a significant correlation between sleep continuity and sleep-NRS (p = 0.0037; ρ = 0.4844; n = 34) but not with RCSQ score (p = 0.6732; ρ = 0.1005; n = 20).

Conclusion: Sleep continuity correlates with patient-reported sleep quality assessed using sleep-NRS and may capture the refreshing part of sleep. Sleep-NRS can be easily administered in ICU patients. Sleep continuity and sleep-NRS are simple tools that may prove useful to evaluate sleep quality in ICU patients.

Keywords: algorithm; intensive care unit; polysomnography; questionnaire; sleep quality.