TY - JOUR
T1 - Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness
T2 - an observational cohort study
AU - Altman, Marcus T.
AU - Knauert, Melissa P.
AU - Murphy, Terrence E.
AU - Ahasic, Amy M.
AU - Chauhan, Zeeshan
AU - Pisani, Margaret A.
N1 - Funding Information:
MTA was supported by the National Institutes of Health-NHLBI Medical Student Research Fellowship (Research reported in this publication was supported by National Heart, Lung, and Blood Institute of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health under Award Number T35HL007649.), the Yale University School of Medicine Medical Research Fellowship, and the William U. Gardner Memorial Student Research Fellowship. MAP is supported by funds from the Patrick and Catherine Weldon Donaghue Medical Research Foundation. MPK is supported by CTSA grant number KL2 TR000140 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). The contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Funding Information:
MTA and ZC collected patient data and performed follow-up interviews. TEM, MTA, MPK, AMA, and MAP analyzed data and performed statistical analysis. All authors contributed to study design and implementation. MTA wrote the primary manuscript, with feedback, editing, and intellectual contributions from all authors. All authors read and approved the final manuscript. We appreciate the contributions of Catherine Pulaski in patient enrollment, in-person delirium assessments, and data abstraction including delirium chart reviews. We appreciate the data management work of Margaret Doyle and Katy Araujo. We would like to thank the patients, nurses, and the other Yale New Haven Hospital MICU staff for their participation and contributions to this study. The authors declare that they have no competing interests. The datasets used in this study are available from the corresponding author on reasonable request. Not applicable. This study was approved by the Institutional Review Board of Yale University (IRB Number 1110009161). All participants provided informed consent. MTA was supported by the National Institutes of Health-NHLBI Medical Student Research Fellowship (Research reported in this publication was supported by National Heart, Lung, and Blood Institute of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health under Award Number T35HL007649.), the Yale University School of Medicine Medical Research Fellowship, and the William U. Gardner Memorial Student Research Fellowship. MAP is supported by funds from the Patrick and Catherine Weldon Donaghue Medical Research Foundation. MPK is supported by CTSA grant number KL2 TR000140 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). The contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Publisher Copyright:
© 2018, The Author(s).
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background: In medical intensive care unit (MICU) patients, the predictors of post-discharge sleep disturbance and functional disability are poorly understood. ICU delirium is a risk factor with a plausible link to sleep disturbance and disability. This study evaluated the prevalence of self-reported post-ICU sleep disturbance and increased functional disability, and their association with MICU delirium and other ICU factors. Methods: This was an observational cohort study of MICU patients enrolled in a biorepository and assessed upon MICU admission by demographics, comorbidities, and baseline characteristics. Delirium was assessed daily using the Confusion Assessment Method for the ICU. Telephone follow-up interview instruments occurred after hospital discharge and included the Pittsburgh Sleep Quality Index (PSQI), and basic and instrumental activities of daily living (BADLs, IADLs) for disability. We define sleep disturbance as a PSQI score > 5 and increased disability as an increase in composite BADL/IADL score at follow-up relative to baseline. Multivariable regression modeled the associations of delirium and other MICU factors on follow-up PSQI scores and change in disability scores. Results: PSQI and BADL/IADL instruments were completed by 112 and 122 participants, respectively, at mean 147 days after hospital discharge. Of those surveyed, 63% had sleep disturbance by PSQI criteria, and 37% had increased disability by BADL/IADL scores compared to their pre-MICU baseline. Total days of MICU delirium (p = 0.013), younger age (p = 0.013), and preexisting depression (p = 0.025) were significantly associated with higher PSQI scores at follow-up. Lower baseline disability (p < 0.001), older age (p = 0.048), and less time to follow-up (p = 0.024) were significantly associated with worsening post-ICU disability, while the occurrence of MICU delirium showed a trend toward association (p = 0.077). Conclusions: After adjusting for important covariates, total days of MICU delirium were significantly associated with increased post-discharge sleep disturbance. Delirium incidence showed a trend toward association with increased functional disability in the year following discharge.
AB - Background: In medical intensive care unit (MICU) patients, the predictors of post-discharge sleep disturbance and functional disability are poorly understood. ICU delirium is a risk factor with a plausible link to sleep disturbance and disability. This study evaluated the prevalence of self-reported post-ICU sleep disturbance and increased functional disability, and their association with MICU delirium and other ICU factors. Methods: This was an observational cohort study of MICU patients enrolled in a biorepository and assessed upon MICU admission by demographics, comorbidities, and baseline characteristics. Delirium was assessed daily using the Confusion Assessment Method for the ICU. Telephone follow-up interview instruments occurred after hospital discharge and included the Pittsburgh Sleep Quality Index (PSQI), and basic and instrumental activities of daily living (BADLs, IADLs) for disability. We define sleep disturbance as a PSQI score > 5 and increased disability as an increase in composite BADL/IADL score at follow-up relative to baseline. Multivariable regression modeled the associations of delirium and other MICU factors on follow-up PSQI scores and change in disability scores. Results: PSQI and BADL/IADL instruments were completed by 112 and 122 participants, respectively, at mean 147 days after hospital discharge. Of those surveyed, 63% had sleep disturbance by PSQI criteria, and 37% had increased disability by BADL/IADL scores compared to their pre-MICU baseline. Total days of MICU delirium (p = 0.013), younger age (p = 0.013), and preexisting depression (p = 0.025) were significantly associated with higher PSQI scores at follow-up. Lower baseline disability (p < 0.001), older age (p = 0.048), and less time to follow-up (p = 0.024) were significantly associated with worsening post-ICU disability, while the occurrence of MICU delirium showed a trend toward association (p = 0.077). Conclusions: After adjusting for important covariates, total days of MICU delirium were significantly associated with increased post-discharge sleep disturbance. Delirium incidence showed a trend toward association with increased functional disability in the year following discharge.
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U2 - 10.1186/s13613-018-0408-4
DO - 10.1186/s13613-018-0408-4
M3 - Article
AN - SCOPUS:85046699540
SN - 2110-5820
VL - 8
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 63
ER -