Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study

Abstract

IntroductionThe aim of the present prospective multicenter cohort study was to examine the prevalence of sleep disturbance and its relation to the patient's reported health-related quality of life after intensive care. We also assessed the possible underlying causes of sleep disturbance, including factors related to the critical illness.MethodsBetween August 2000 and November 2003 we included 1,625 consecutive patients older than 17 years of age admitted for more than 24 hours to combined medical and surgical intensive care units (ICUs) at three hospitals in Sweden. Conventional intensive care variables were prospectively recorded in the unit database. Six months and 12 months after discharge from hospital, sleep disturbances and the health-related quality of life were evaluated using the Basic Nordic Sleep Questionnaire and the Medical Outcomes Study 36-item Short-form Health Survey, respectively. As a nonvalidated single-item assessment, the quality of sleep prior to the ICU period was measured. As a reference group, a random sample (n = 10,000) of the main intake area of the hospitals was used.ResultsThe prevalence of self-reported quality of sleep did not change from the pre-ICU period to the post-ICU period. Intensive care patients reported significantly more sleep disturbances than the reference group (P < 0.01). At both 6 and 12 months, the main factor that affected sleep in the former hospitalised patients with an ICU stay was concurrent disease. No effects were related to the ICU period, such as the Acute Physiology and Chronic Health Evaluation score, the length of stay or the treatment diagnosis. There were minor correlations between the rate and extent of sleep disturbance and the health-related quality of life.ConclusionThere is little change in the long-term quality of sleep patterns among hospitalised patients with an ICU stay. This applies both to the comparison before and after critical care as well as between 6 and 12 months after the ICU stay. Furthermore, sleep disturbances for this group are common. Concurrent disease was found to be most important as an underlying cause, which emphasises that it is essential to include assessment of concurrent disease in sleep-related research in this group of patients.

Physical effects of trauma and the psychological consequences of preexisting diseases account for a significant portion of the health-related quality of life patterns of former trauma patients

“…This is in line what we have previously presented for ICU patients. (13)(14)(15) but is contrary to the findings of Ringdal et al who found a correlation between longer stay in ICU and worse physical function and limitations of roles as a result of physical problems. (26,30) This outcome may be due to a shorter follow-up period in that study 26 .…”

“…(8) In three recent studies we have found that pre-existing disease is a major contributor to a reduced HRQoL after critical care for reasons other than trauma. (13)(14)(15) However, pre-existing disease is thought to be less prevalent in this group of patients and is therefore seldom investigated in injured patients. The overall aim of the study was to assess pre-existing diseases, their rate and 4 distribution and to examine their possible long term (2 years) effects on HRQoL in a group of patients with trauma injuries who required intensive care.…”

Social integration: an important factor for health-related quality of life after critical illness

“…The cohort used in this study is a part of a large study that has previously been examined from several different perspectives [6,18,26] . Health related quality of life has been examined short and long term.…”

“…The instrument is internationally well known and has often been used [25]. SF-36 has previously been applied in intensive care [6,[26][27][28], and has recently been recommended as one of the best-suited instrument for measuring HRQoL in trials in critical care [29].…”

The experiences of patients and their families of visiting whilst in an intensive care unit – A hermeneutic interview study

“…Providing caring actions aimed at preventing the development of such negative memories and experiences is complex since it is the medical condition as such, drugs and not least the caring environment itself that influence memories from ICU care. Studies concerning health-related quality of life and patients show that it takes a long or a very long time to return to life as it was before the ICU stay (Orwelius et al, 2008;Ringdal et al, 2009Ringdal et al, , 2010Samuelson et al, 2007).…”