Quality of sleep in severe acute respiratory distress syndrome survivors requiring invasive mechanical ventilation: a prospective observational study.

PURPOSE: Sleep disturbances arising during ICU stay among ARDS (acute-respiratory-distress-syndrome) patients may continue long after discharge. This study is aimed at evaluating the sleep quality in severe-pulmonary-ARDS survivors.

METHODS

This was a prospective-observational study recruiting all eligible patients, who survived after invasive-ventilation for ARDS diagnosis. Subjects were evaluated just before discharge and at 6-weeks after discharge with Epworth Sleepiness Scale(ESS), Richards-Campbell Sleep Questionnaire(RCSQ), Insomnia severity index(ISI), Pittsburgh Sleep Quality Index (PSQI) and overnight level 1 polysomnography(PSG).

RESULTS

Out of 54 non-COVID19 severe ARDS survivors, 23 were included and Scrub Typhus was the most common etiology. The mean PaO2/FiO2 ratio and APACHE-II scores were 110.90 ± 21.6 and 19.04 ± 5.1, respectively. The mean duration of stay in the ICU was 14.22 ± 10.5 days. The change in mean ESS and RCSQ scores at discharge and 6-weeks were statistically significant (p < 0.001). During the early evaluation, sleep efficiency was low (mean 61.6 ± 7.2% and predominantly N1 and N2 stage) which improved at 6-weeks evaluation (mean 68.52 ± 7.8%, p < 0.001). At 6 -weeks REM component increased from 10.96 ± 2.83 to 15.31 ± 9.96 (p < 0.001). Out of the total 23 patients, 7 had AHI > 5 in early and 4 in late evaluation. Oxygen desaturation index also decreased significantly at 6-weeks follow up. PSQI > 5 was present in 13 patients at 6 weeks after discharge. PaO2/FiO2 ratio had positive correlation with RCSQ score and duration of mechanical ventilation had positive correlation with PSQI and ISI score at 6-weeks (p < 0.001 for all 3).

CONCLUSION

Sleep disturbances are common in ARDS survivors in both early and late period after discharge from ICU.