Prevalence of sleep disorders in post-ICU patients： a systematic review

doi:10.3761/j.issn.0254-1769.2023.06.015

Abstract

Abstract:

Objective To systematically evaluate the prevalence of sleep disorders and provide evidence for early prevention of sleep disorders in post-ICU patients. Methods PubMed，Embase，Web of Science，the Cochrane Library，CINAHL，CBM，CNKI，WanFang Data and VIP were searched from inception to June 2022. There were 2 researchers who independently screened the literature and assessed the quality of included studies using Critical Appraisal Tools published by Newcastle-Ottawa Quality Scale（NOS）. The meta-analysis was performed by StataSE.12 software. Results A total of 28 studies were included in this study with a total of 3 170 patients. The prevalence of subjective sleep disorders by random effects model was 51.84%[95%CI（45.17%~58.51%）]. The results of subgroup analysis showed that the prevalence of subjective sleep disorders within 1 month，1~3 months，>3~6 months and >6 months after ICU discharge was 50.51%[95%CI（40.97%~60.05%）]、53.34%[95%CI（44.86%~61.82%）]、49.44%[95%CI（32.71%~66.16%）]、29.55%[95%CI（13.28%~45.82%）]，respectively. Meta regression results of single covariate showed that sample size and country were related to heterogeneity（P<0.05）. Conclusion The prevalence of sleep disorders in post-ICU patients is high. Nursing staff should take relevant interventions，strengthen sleep health education and guidance for patients，and reduce the incidence.

Key words: Sleep Disorders, Post-ICU Patient, Prevalence, Systematic Review, Nursing Care

摘要：

目的系统评价ICU转出患者睡眠障碍的发生率，为早期预防ICU转出患者发生睡眠障碍提供理论依据。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、CINAHL、中国生物医学文献数据库、中国知网、万方数据库和维普数据库，检索时限为建库至2022年6月，由2名研究者独立根据纳入和排除标准筛选文献，采用纽尔卡斯-渥太华量表（Newcastle-Ottawa Quality Scale，NOS）对纳入文献进行质量评价，采用Stata SE.12软件进行数据分析。结果共纳入28篇文献，共3 170例患者。ICU转出患者主观睡眠障碍总体发生率为51.84%[95%CI（45.17%~58.51%）]。亚组分析结果显示，ICU转出1个月内、1~3个月、>3~6个月和>6个月，主观睡眠障碍发生率分别为50.51%[95%CI（40.97%~60.05%）]、53.34%[95%CI(44.86%~61.82%)]、49.44%[95%CI（32.71%~66.16%）]、29.55% [95%CI（13.28%~45.82%）]。单个协变量Meta回归分析结果显示，样本量、国家与该研究的异质性有关（P<0.05）。结=论 ICU转出患者睡眠障碍发生率较高，护理人员应尽早采取相关预防措施，加强对患者睡眠教育的指导，降低睡眠障碍发生率。

关键词: 睡眠障碍, ICU转出患者, 发生率, 系统评价, 护理

SONG Xiuxiu, WU Juan, WANG Yinan. Prevalence of sleep disorders in post-ICU patients： a systematic review[J]. Chinese Journal of Nursing, 2023, 58(6): 743-750.

宋秀秀, 吴娟, 王逸楠. ICU转出患者睡眠障碍发生率的系统评价[J]. 中华护理杂志, 2023, 58(6): 743-750.

Figures/Tables 6

Figure 1 Search strategies

Figure 2 Flow chart of literature selection

Table 1 Characteristics of the included studies on subjective sleep disorders（n=23）

Table 1（Continued） Characteristics of the included studies on subjective sleep disorders（n=23）

Table 2 Meta-regression results of sleep disorders in post-ICU patients

Table 3 Subgroup analysis results of sleep disorders in post-ICU patients

References 37

[1]	Kaplow R. Sleep disturbances and critical illness[J]. Crit Care Nurs Clin North Am, 2016, 28(2):169-182. DOI URL
[2]	Elías MN, Munro CL, Liang Z. Sleep quality associated with motor function among older adult survivors of critical illness[J]. Nurs Res, 2020, 69(4):322-328. DOI PMID
[3]	魏月清, 李红, 李芸, 等. ICU后认知障碍风险预测模型的构建及验证[J]. 中华护理杂志, 2021, 56(1):14-20. DOI
	Wei YQ, Li H, Li Y, et al. Construction of a risk prediction model for post-intensive care syndrome-cognitive impairment[J]. Chin J Nurs, 2021, 56(1):14-20. DOI
[4]	Kamble N, Yadav R, Lenka A, et al. Impaired sleep quality and cognition in patients of Parkinson’s disease with REM sleep behavior disorder:a comparative study[J]. Sleep Med, 2019, 62: 1-5. DOI URL
[5]	何曼曼, 江智霞, 张芳, 等. ICU后综合征患者症状特征的潜在类别分析[J]. 中华护理杂志, 2021, 56(10):1445-1452. DOI
	He MM, Jiang ZX, Zhang F, et al. Latent class analysis of symptom characteristics in patients with post-intensive care syndrome[J]. Chin J Nurs, 2021, 56(10):1445-1452. DOI
[6]	Yang PL, Ward TM, Burr RL, et al. Sleep and circadian rhy-thms in survivors of acute respiratory failure[J]. Front Neurol, 2020, 11:94. DOI URL
[7]	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. DOI PMID
[8]	张芳, 江智霞, 袁晓丽, 等. 老年患者ICU后综合征早期症状特征及影响因素分析[J]. 遵义医科大学学报, 2022, 45(1):99-104.
	Zhang F, Jiang ZX, Yuan XL, et al. Analysis of early symptoms and influencing factors of post ICU syndrome in elderly patients[J]. J Zunyi Med Univ, 2022, 45(1):99-104.
[9]	Srikanth JK, Kumar R, Gupta NK, et al. A prospective study eva-luating sleep quality and disorders in post-ARDS patients[J]. Sleep Vigil, 2021, 5(2):267-274.
[10]	Wang S, Meeker JW, Perkins AJ, et al. Psychiatric symptoms and their association with sleep disturbances in intensive care unit survivors[J]. Int J Gen Med, 2019, 12:125-130. DOI PMID
[11]	李宝宝. 成人心脏术后ICU后综合征发生现状及影响因素的研究[D]. 济南: 山东大学, 2018.
	Li BB. The present status and influencing factors of post-in-tensive care syndrome in adult after cardiac surgery[D]. Jinan: Shandong University, 2018.
[12]	Caruana N, McKinley S, Elliott R, et al. Sleep quality during and after cardiothoracic intensive care and psychological health during recovery[J]. J Cardiovasc Nurs, 2018, 33(4):E40-E49. DOI URL
[13]	Altman MT, Knauert MP, Murphy TE, et al. Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness:an observational cohort study[J]. Ann Intensive Care, 2018, 8(1):63. DOI
[14]	Langerud AK, Rustøen T, Småstuen MC, et al. Intensive care survivor-reported symptoms:a longitudinal study of survivors’ symptoms[J]. Nurs Crit Care, 2018, 23(1):48-54. DOI URL
[15]	Solverson KJ, Easton PA, Doig CJ. Assessment of sleep quality post-hospital discharge in survivors of critical illness[J]. Respir Med, 2016, 114:97-102. DOI PMID
[16]	Dhooria S, Sehgal IS, Agrawal AK, et al. Sleep after critical illness:study of survivors of acute respiratory distress syndrome and systematic review of literature[J]. Indian J Crit Care Med, 2016, 20(6):323-331. DOI URL
[17]	Parsons EC, Hough CL, Vitiello MV, et al. Insomnia is associated with quality of life impairment in medical-surgical intensive care unit survivors[J]. Heart Lung, 2015, 44(2):89-94. DOI PMID
[18]	Choi J, Hoffman LA, Schulz R, et al. Self-reported physical sym-ptoms in intensive care unit(ICU) survivors:pilot exploration over four months post-ICU discharge[J]. J Pain Symp Man, 2014, 47(2):257-270.
[19]	Vesz PS, Costanzi M, Stolnik D, et al. Functional and psychological features immediately after discharge from an intensive care unit:prospective cohort study[J]. Rev Bras Ter Intens, 2013, 25(3):218-224. DOI URL
[20]	Mckinley S, Fien M, Elliott R, et al. Sleep and psychological health during early recovery from critical illness:an observational study[J]. J Psychosom Res, 2013, 75(6):539-545. DOI URL
[21]	Parsons EC, Kross EK, Caldwell ES, et al. Post-discharge insomnia symptoms are associated with quality of life impairment among survivors of acute lung injury[J]. Sleep Med, 2012, 13(8): 1106-1109. DOI PMID
[22]	Mckinley S, Aitken LM, Alison JA, et al. Sleep and other factors associated with mental health and psychological distress after intensive care for critical illness[J]. Intens Care Med, 2012, 38(4): 627-633. DOI URL
[23]	Kelly MA, Mckinley S. Patients’ recovery after critical illness at early follow-up[J]. J Clin Nurs, 2010, 19(5/6): 691-700. DOI URL
[24]	Cronberg T, Lilja G, Rundgren M, et al. Long-term neurological outcome after cardiac arrest and therapeutic hypothermia[J]. Resusc, 2009, 80(10): 1119-1123.
[25]	Lee CM, Herridge MS, Gabor JY, et al. Chronic sleep disorders in survivors of the acute respiratory distress syndrome[J]. Intens Care Med, 2009, 35(2):314-320. DOI URL
[26]	Orwelius L, Nordlund A, Nordlund P, et al. Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study[J]. Crit Care, 2008, 12(4): R97. DOI URL
[27]	Granja C, Lopes A, Moreira S, et al. Patients’ recollections of experiences in the intensive care unit may affect their quality of life[J]. Crit Care, 2005, 9(2): R96-R109. DOI URL
[28]	Eddleston JM, White P, Guthrie E. Survival,morbidity,and qua-lity of life after discharge from intensive care[J]. Crit Care Med, 2000, 28(7): 2293-2299. DOI PMID
[29]	Elías MN, Munro CL, Liang Z, et al. Nighttime sleep duration is associated with length of stay outcomes among older adult survivors of critical illness[J]. Dimens Crit Care Nurs, 2020, 39(3):145-154. DOI PMID
[30]	Wilcox ME, McAndrews MP, van J, et al. Sleep fragmentation and cognitive trajectories after critical illness[J]. Chest, 2021, 159(1):366-381. DOI PMID
[31]	BaHammam A. Sleep quality of patients with acute myocardial infarction outside the CCU environment:a preliminary study[J]. Med Sci Monit, 2006, 12(4):CR168-CR172.
[32]	Schiza SE, Simantirakis E, Bouloukaki I, et al. Sleep disorde-red breathing in patients with acute coronary syndromes[J]. J Clin Sleep Med, 2012, 8(1):21-26. DOI URL
[33]	Wilcox ME, Lim AS, Pinto R, et al. Sleep on the ward in intensive care unit survivors:a case series of polysomnography[J]. Intern Med J, 2018, 48(7):795-802. DOI URL
[34]	Zia S, Fields BG. Sleep telemedicine:an emerging field’s latest frontier[J]. Chest, 2016, 149(6):1556-1565. DOI URL
[35]	Locihová H, Axmann K, Padyšáková H, et al. Effect of the use of earplugs and eye mask on the quality of sleep in intensive care patients:a systematic review[J]. J Sleep Res, 2018, 27(3):e12607. DOI URL
[36]	孙闽闽, 吴娟, 李文霞, 等. 心肌梗死患者出院后重返社会体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(4):415-423. DOI
	Sun MM, Wu J, Li WX, et al. The experiences of patients with myocardial infarction returning to society after being discharged from the hospital:a meta synthesis of qualitative studies[J]. Chin J Nurs, 2022, 57(4):415-423.
[37]	Tembo AC, Parker V, Higgins I. The experience of sleep deprivation in intensive care patients:findings from a larger hermeneutic phenomenological study[J]. Intens Crit Care Nurs, 2013, 29(6):310-316. DOI URL