Poor sleep quality and resistant hypertension

Objectives

We aimed to determine the relationship between sleep quality and treatment-resistant hypertension (RH).

Methods

In our cross-sectional cohort study, 270 consecutive essential hypertensive patients were recruited at the Outpatient Hypertension Unit, University of Pisa, Italy. The Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI-Y2) were administered to all subjects. RH was defined as office blood pressure (BP) >140/90 mmHg with three or more antihypertensive drugs or controlled BP with four or more drugs. Poor sleep quality was defined as PSQI >5, depressive symptoms as BDI >10, and trait anxiety as STAI-Y2 >40. Patients with other sleep disorders were excluded.

Results

Complete data were available for 222 patients (50.9% men; mean age, 56.6 ± 12.5 y; RH, 14.9%). Poor sleep quality had a prevalence of 38.2% in the overall population. RH was associated with poor sleep quality, increased sleep latency and reduced sleep efficiency. No significant relationship was found between RH and short sleep duration or depressive symptoms and trait anxiety. Poor sleep quality was more prevalent in resistant vs nonresistant hypertensive women (70.6% vs 40.2%; P = .02) but not in resistant vs nonresistant men (43.8% vs 29.2%; P = .24). In women poor sleep quality was an independent predictor of RH, even after adjustment for cardiovascular and psychiatric comorbidities (odds ratio [OR], 5.3 [confidence interval {CI}, 1.1–27.6), explaining 4.7% of its variance. In men age, diabetes mellitus (DM), and obesity were the only variables associated with RH.

Conclusions

Poor sleep quality is significantly associated with resistance to treatment in hypertensive women, independent of cardiovascular and psychiatric confounders.     

Familiality and clinical outcomes of sleep disturbances in major depressive and bipolar disorders

Objective

Sleep disturbances are frequently observed in major depressive (MDD) and bipolar disorder (BD). This study reported sleep profiles of patients and their relatives versus controls, and examined the familiality of sleep features in mood disorder families. We also evaluated the influences of sleep disturbance on patients' quality of life (QOL), functional impairment, and suicidality.

Methods

We recruited 363 BD and 157 MDD patients, 521 first-degree relatives, and 235 healthy controls, which completed a diagnostic interview, Pittsburgh Sleep Quality Index (PSQI), and QOL questionnaire. The magnitude of heritability of sleep features was calculated and familiality was evaluated by mixed regression models and intraclass correlation coefficient (ICC). The associations between sleep problems and clinical outcomes were examined using multiple regression models.

Results

More than three-quarters of mildly-ill patients were classified as “poor sleepers”. MDD patients had significantly worse sleep quality as compared to BD patients. Moderate but significant familial aggregation was observed in subjective sleep quality, sleep latency, disturbance, daytime dysfunction, and global score (ICC = 0.10–0.21, P < .05). Significant heritability was found in sleep quality (0.45, P < .001) and sleep disturbance (0.23, P < .001). Patients with good sleep quality had better QOL and less functional impairment (P < .05) than poor sleepers. Poor sleep quality and nightmares further increased the risk for suicidal ideation (OR_adj = 2.8) and suicide attempts (OR_adj = 1.9–2.8).

Conclusion

Subjectively measured sleep features demonstrated significant familiality. Poor sleep quality further impaired patients' daily function and QOL, in addition to increasing the risk of suicidality, and thus requires special attention in related clinical settings.     

The relationship of chronic pain with and without comorbid psychiatric disorder to sleep disturbance and health care utilization: results from the Israel National Health Survey

Objective

Chronic pain is associated with health problems including sleep difficulties and increased medical utilization. Because chronic pain is frequently comorbid with psychiatric disorders, it is unclear to what degree chronic pain itself is associated with these problems. In a large population sample, we examined the relationship between chronic pain, both alone and comorbid with psychiatric disorders, with sleep disturbance and increased medical utilization.

Methods

We analyzed data from the Israel National Health Survey (INHS) conducted in 2003-2004 on a representative sample (N=4859) of the adult Israeli population. Data were collected in face-to-face interviews using the Composite International Diagnostic Interview. Statistical analyses were performed using multinomial logistic regression models.

Results

Past year chronic pain was reported by 29.9% of all study participants (n=1453). Psychiatric disorders were more common among participants with chronic pain; adjusted odds ratios were 2.23 (95% CI 1.49-3.36) for depressive disorders and 2.94 (95% CI 2.08-4.17) for anxiety disorders. Associations of chronic pain and psychiatric disorders were stronger in men. Chronic pain was associated with both sleep problems and increased health care utilization even for individuals with no psychiatric comorbidity. Sleep difficulties but not health care utilization rates were more pronounced in the comorbid group compared to the chronic pain only group.

Conclusion

Chronic pain was associated with sleep problems and increased health care utilization in this sample, independent of psychiatric comorbidity. Sleep problems were significantly greater in the comorbid vs. non-comorbid group. In contrast, associations of pain with health care utilization were largely independent of psychiatric comorbidity.     

Sleep bruxism and oromandibular myoclonus in rapid eye movement sleep behavior disorder: a preliminary report

Objective

We aimed to compare rhythmic masticatory muscle activity typical of sleep bruxism and oromandibular myoclonus (OMM) during rapid eye movement (REM) sleep in patients with idiopathic REM sleep behavior disorder (iRBD) and in Parkinson disease (PD) patients with RBD (PD-RBD).

Methods

Sleep polygraphic data were collected from 9 age-matched controls and 28 patients (mean ± standard error of the mean, 66.0 ± 1.7 y) with a clinical and sleep laboratory diagnosis of RBD. Patients were divided into two groups: 13 patients with iRBD and 15 patients with PD-RBD. Rhythmic masticatory muscle activity, a marker of sleep bruxism, and OMM were scored blind to subject’s diagnosis from jaw electromyographic recordings during sleep.

Results

The rhythmic masticatory muscle activity index was significantly higher during REM sleep in iRBD subjects compared to controls (P < .01) and was significantly higher during non-REM (NREM) sleep in both subject groups compared to controls (P ? .03). A positive sleep laboratory diagnosis of sleep bruxism was made in 25% of all patients. In iRBD, patients had more OMM during REM sleep than controls (2.4 times higher; P = .01).

Conclusion

In the presence of a high frequency of rhythmic masticatory muscle activity during REM sleep, RBD may be suspected and further neurologic assessment is recommended.     

Polysomnographic abnormalities in patients with vascular cognitive impairment-no dementia

Objectives

We aimed to investigate subjective sleep quality and polysomnographic sleep structure features in patients with vascular cognitive impairment-no dementia (VCIND).

Methods

Fifty-six patients with VCIND, 48 patients with simple stroke (without cognitive impairment), and 48 control subjects were included. The Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to analyze their sleep characteristics. The Montreal Cognitive Assessment (MoCA) was conducted to assess mental state.

Results

Patients with VCIND had higher PSQI scores compared with control subjects and simple stroke patients (P < .01). PSG revealed that patients with VCIND or stroke were more likely to experience prolonged sleep latency (SL), decreased sleep efficiency (SE), increased arousal, and reduced deep sleep and rapid eye movement (REM) sleep than controls. Patients with VCIND had significantly longer SL, increased periodic leg movements in sleep (PLMS), decreased SE, and increased arousal and sleep fragmentation compared to patients with simple stroke (P < .05). In VCIND patients, a significant positive correlation was found between SE and MoCA scores (r = 0.632; P < .001), though PSQI, SL, and arousal index were significantly negatively associated with MoCA scores (r = −0.787, −0.740, −0.772, respectively; P < .001 for all).

Conclusions

VCIND patients had different abnormal sleep features, including decreased SE, increased PLMS, and prolonged SL and sleep fragmentation. Abnormal sleep in VCIND may be associated with cognitive impairment.     

Primary sleep disorders can cause long-term sleep disturbance in patients with autoimmune mediated limbic encephalitis

Objectives

Antibody mediated limbic encephalitis causes a sub acute encephalopathy with an amnestic syndrome, seizures and often an affective prodrome. Sleep disturbance including abnormal dream sleep and insomnia are described in a percentage of long-term survivors but there are very few detailed assessments of sleep disturbance in patients beyond the acute phase of illness. The objectives of this study were to understand the causes of sleep disturbance in the long-term survivors of antibody mediated limbic encephalitis.

Patients and methods

We screened twelve patients under long-term follow up with sleep questionnaires and went on to perform detailed sleep studies (polysomnography) in those who reported sleep disturbance.

Results

Two were found to have persistent, severe central and obstructive sleep apnoea and two others to have restless legs and periodic limb movements of sleep.

Conclusions

This highlights the need to investigate sleep disturbance in this group of patients. Effective treatments may be available to improve quality of life and daytime function.     

Relationships between sleep disturbances and gastroesophageal reflux disease in Asian sleep clinic referrals

Objective

Studies on the association between gastroesophageal reflux disease (GERD) and sleep apnea syndrome (SAS) have reported conflicting results, and attention has not been paid to the relationship between GERD and other sleep disorders. The aim of the study was to evaluate the relationship between GERD and various aspects of sleep disturbances.

Methods

A total of 564 subjects who were referred to a sleep laboratory were enrolled in the study. They underwent nocturnal polysomnography (NPSG), and they were asked to complete a GERD questionnaire. The questionnaire consisted of 14 items, and included questions on seven reflux symptoms, namely, heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, coughing and epigastric soreness. Subjects reporting heartburn or acid regurgitation at least once a week were classified as having GERD.

Results

Among 564 participants, 51 subjects (9.0%) were diagnosed as having GERD. GERD patients had higher scores in Beck depression inventory (p < .01), Epworth sleepiness scale (p = .03), Pittsburg sleep quality index (p < .01), more spontaneous arousals in NPSG, and more alcohol consumption than non-GERD patients. There was no association between presence of GERD, SAS-related variables, and body mass index (BMI). GERD was significantly associated with poor sleep quality (adjusted OR, 3.5; 95% CI, 1.3–9.3) and depressed mood (adjusted OR, 2.8; 95% CI, 1.5–5.3).

Conclusion

Poor subjective sleep and depressive symptoms are associated with the presence of GERD with no association between SAS, BMI and GERD. In managing patients with GERD, psychiatric and sleep symptoms need to be evaluated and appropriately treated.     

Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome

Objective

To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS).

Methods

Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography + multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders.

Results

Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8 years (SD 10.3)].A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease.In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder.

Conclusions

A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.     

Effects of different sleep deprivation protocols on sleep perception in healthy volunteers

Objectives

To investigate whether different protocols of sleep deprivation modify sleep perception.

Methods

The effects of total sleep deprivation (TD) and selective rapid eye movement (REM) sleep deprivation (RD) on sleep perception were analyzed in normal volunteers. Thirty-one healthy males with normal sleep were randomized to one of three conditions: (i) normal uninterrupted sleep; (ii) four nights of RD; or (iii) two nights of TD. Morning perception of total sleep time was evaluated for each condition. Sleep perception was estimated using total sleep time (in hours) as perceived by the volunteer divided by the total sleep time (in hours) measured by polysomnography (PSG). The final value of this calculation was defined as the perception index (PI).

Results

There were no significant differences among the three groups of volunteers in the total sleep time measured by PSG or in the perception of total sleep time at baseline condition. Volunteers submitted to RD exhibited lower sleep PI scores as compared with controls during the sleep deprivation period (P < 0.05). Both RD and TD groups showed PI similar to controls during the recovery period.

Conclusion

Selective REM sleep deprivation reduced the ability of healthy young volunteers to perceive their total sleep time when compared with time measured by PSG. The data reinforce the influence of sleep deprivation on sleep perception.     

The psychiatric sequelae of burn injury

Objective

To examine factors predicting psychiatric morbidity, taking into account the full range of psychiatric disorders before and after burn injury.

Methods

A cohort of 107 patients consecutively admitted to a Swedish national burn center was examined for lifetime psychiatric morbidity, as well as 94 patients at 1 year postinjury. Sixty-seven individuals, some from that same cohort, were interviewed at 2 to 7 years postinjury. The predictive effects of psychiatric history, personality and other risk factors for psychiatric morbidity following burn were evaluated with multiple regression analyses.

Results

The prevalence of having a psychiatric disorder preburn was 57%. One year postinjury 19% had minor or major depression and 23% had subsyndromal or full posttraumatic stress disorder. At 2 to 7 years, 31% fulfilled the criteria for a psychiatric disorder. The strongest contributing factors were a history of psychiatric morbidity and neuroticism.

Conclusions

Two-thirds of the patients had a lifetime psychiatric disorder, and one-third had a psychiatric diagnosis 2 to 7 years postburn. Mental health problems can have a major impact on daily life and functional abilities. Thus, identification and treatment of a range of psychiatric disorders, taking into account preburn psychiatric disorders and personality, is important for optimal adjustment after burn.     

Influence of psychiatric disorders on surgical outcomes and care resource use in Japan

Objective

The aim of this study was to quantify the effects of psychiatric disorders on major surgery outcomes and care resource use.

Methods

This study adopted a retrospective cohort study design. The samples consisted of hospital stays. Subjects were patients who had undergone major surgery. We used multilevel regression analysis to quantify the influence of psychiatric disorders on major surgery outcomes and care resource use.

Results

The total number of hospital stays included in the study was 5569, of which 250 were patients with psychiatric disorders. Compared with those without psychiatric disorders, those with schizophrenia had a significantly higher risk of complications, and those with neurotic disorder tended to have fewer complications. Total cost was significantly higher for those with schizophrenia and mood disorder and significantly lower in those with neurotic disorder. Lengths of stay were significantly longer for those with schizophrenia and mood disorder but not for those with neurotic disorder. Post-surgical mortality was equivalent among those with any psychiatric disorder and among those without a psychiatric disorder.

Conclusion

The study revealed that surgical outcomes and care resource use are differentiated by psychiatric disorders.     

Night diapers use and sleep in children with enuresis

Objective

We aimed to assess the association between night diapers use and sleep quality of school-aged children with enuresis.

Methods

The sleep patterns of 72 school-aged children (ages 6–9 y) with enuresis referred to a clinic specializing in bladder disorders and 63 healthy control children were assessed. Sleep measures were derived from four to five monitoring nights of actigraphy and daily logs.

Results

In comparison to controls, children with enuresis who did not wear night diapers had poorer sleep quality as reflected by both actigraphic measures (more activity during sleep and shorter periods of continuous sleep) and one reported measure (lower sleep quality). However, no differences were found on any of the sleep measures between children with enuresis wearing night diapers and controls. The reported sleep quality of all children with enuresis with and without night diapers was lower than controls.

Conclusions

Our results suggest that sleep patterns of school-aged children with enuresis who do not wear night diapers are impaired, and the sleep quality of children using night diapers is similar to those of healthy children. Thus, clinicians and healthcare providers should consider recommending sleeping with night diapers for untreated children with enuresis, based on its positive impact on sleep.     

Is interictal EEG activity a biomarker for mood disorders in temporal lobe epilepsy?

Objective

Psychiatric comorbidities are frequent in temporal lobe epilepsy (TLE), and symptoms of these comorbidities may be related to epilepsy activity. Here we evaluated interictal EEG activity in TLE patients with or without psychiatric comorbidities.

Methods

A cohort study of 78 patients with TLE, with evaluation of wake/sleep interictal scalp EEG. All subjects were submitted to a psychiatric structured clinical interview (SCID) for the diagnosis of lifetime psychiatric comorbidities. Three major diagnostic categories were studied: mood disorders, anxiety disorders, and psychosis. We then evaluated differences in interictal EEG activity between patients with and without these psychiatric comorbidities.

Results

Infrequent EEG interictal spikes, defined as less than one event per minute, were significantly associated with mood disorders in TLE (p = 0.02).

Conclusions

Low intensity seizure disorder has been associated with a decrease in interictal EEG discharges and with an increase in psychiatric symptoms in TLE, a phenomenon known as forced normalization. In our study, we observed a low interictal spike frequency on EEG in TLE patients with mood disorders.

Significance

A low spike index might be a neurophysiological marker for depression in temporal lobe epilepsy.     

Sleep architecture in infants with spinal muscular atrophy type 1

Objective

Few reports on sleep patterns of patients with spinal muscular atrophy type 1 (SMA1) have been published and none on sleep microstructure. The aim of this study was to analyze sleep architecture and microstructure in a group of infants with SMA1, compared with age- and sex-matched controls.

Methods

Twelve SMA1 patients (six males, mean age 5.9 months) and 10 controls (five males, mean age 4.8 months) underwent full polysomnography to evaluate their sleep architecture and microstructure by means of the cyclic alternating pattern (CAP).

Results

Compared with control children, SMA1 patients showed increased sleep latency and apnea/hypopnea index. CAP analysis revealed a significant increase in the percentage of A1 CAP subtypes, a reduction of that of A3 subtypes and of A2 and A3 indexes (number/h), indicating a dysfunction of the arousal system in these patients.

Conclusion

The results indicate the presence of an abnormality of sleep microstructure in SMA1 patients, characterized by a reduction of A2 and A3 CAP subtypes. We hypothesize that SMA1 patients have reduced arousability during non-rapid eye movement sleep, which could be interpreted as additional evidence of central nervous system involvement in this disease.     

Safety behaviors and sleep effort predict sleep disturbance and fatigue in an outpatient sample with anxiety and depressive disorders

Objective

Theoretical and empirical support for the role of dysfunctional beliefs, safety behaviors, and increased sleep effort in the maintenance of insomnia has begun to accumulate. It is not yet known how these factors predict sleep disturbance and fatigue occurring in the context of anxiety and mood disorders. It was hypothesized that these three insomnia-specific cognitive–behavioral factors would be uniquely associated with insomnia and fatigue among patients with emotional disorders after adjusting for current symptoms of anxiety and depression and trait levels of neuroticism and extraversion.

Methods

Outpatients with a current anxiety or mood disorder (N = 63) completed self-report measures including the Dysfunctional Beliefs About Sleep Scale (DBAS), Sleep-Related Safety Behaviors Questionnaire (SRBQ), Glasgow Sleep Effort Scale (GSES), Pittsburgh Sleep Quality Index (PSQI), NEO Five-Factor Inventory (FFI), and the 21-item Depression Anxiety and Stress Scale (DASS). Multivariate path analysis was used to evaluate study hypotheses.

Results

SRBQ (B = .60, p < .001, 95% CI [.34, .86]) and GSES (B = .31, p < .01, 95% CI [.07, .55]) were both significantly associated with PSQI. There was a significant interaction between SRBQ and DBAS (B = .25, p < .05, 95% CI [.04, .47]) such that the relationship between safety behaviors and fatigue was strongest among individuals with greater levels of dysfunctional beliefs.

Conclusion

Findings are consistent with cognitive behavioral models of insomnia and suggest that sleep-specific factors might be important treatment targets among patients with anxiety and depressive disorders with disturbed sleep.     

Treatment of sleep disorders may improve fatigue in multiple sclerosis

Objective

In a previous polysomnographic cross-sectional study we found a significant relationship between sleep disorders and multiple sclerosis (MS) related fatigue. The purpose of this open follow-up observation was to compare the impact of treatment of sleep disorders on MS related fatigue measured with the Modified Fatigue Impact Scale (MFIS).

Methods

Non-randomized follow-up observation: treated versus untreated patients, subgroups according to compliance with sleep medical treatment recommendations (univariate, multivariate analysis, multiple logistic regression). 66 MS patients were followed after polysomnography, 49 patients with relevant sleep disorders and 17 without.

Results

Mean MFIS scores decreased from 41.2 to 26.2 (p = 0.025) in patients with good compliance (GC; n = 18), from 42.4 to 32.1 (p = 0.12) in patients with moderate compliance (MC; n = 12), and from 41.6 to 35.5 (p = 0.17) in non-compliant patients (NC; n = 17). Mean MFIS values increased in patients without sleep disorders from 22.9 to 25.4 (NSD; n = 12, p = 0.56). In multiple logistic regression, treatment of sleep disorders predicted decrease of MFIS-values (GC versus NSD odds ratio 13.4; p = 0.015; 95% confidence interval (CI) 1.7–107.2, MC versus NSD odds ratio 13.8; p = 0.028; 95% CI 1.3–143.3).

Conclusions

Sleep medical treatment may improve MS related fatigue when patients adhere to treatment recommendations.     

Los ictus y su relación con el sueño y los trastornos del sueño

Introduction

In the current population, strokes are one of the most important causes of morbidity and mortality, to which new risk factors are increasingly being attributed. Of late, there is increased interest in the relationship between sleep disorders and strokes as regards risk and prognosis.

Development

This article presents the changes in sleep architecture and brain activity in stroke patients, as well as the interaction between stroke and sleep disorders, including those which may also influence the outcome and recovery from strokes. The different treatments discussed in the literature are also reviewed, as correct treatment of such sleep disorders may not only improve quality of life and reduce after-effects, but can also increase life expectancy.

Conclusions

Sleep disorders are becoming increasingly associated with stroke. In addition to being a risk factor, they can also interfere in the outcome and recovery of stroke patients.This article aims to present an exhaustive and current review on strokes and their relationship with sleep alterations and sleep disorders.     

Parasomnia overlap disorder: a distinct pathophysiologic entity or a variant of rapid eye movement sleep behavior disorder? A case series

Background

Parasomnia overlap disorder (POD) currently is classified by the International Classification of Sleep Disorders, Second Edition (ICSD-2) as a variant of rapid eye movement (REM) sleep behavior disorder (RBD), and therefore its diagnosis also implies counseling the patients on the increased risk for developing neurodegenerative disorders. POD pathophysiology is not clear to date.

Methods

The authors report 5 cases of POD, review the literature, and analyze previously published cases of POD.

Results

In all 5 reported cases sleep-related activity was clearly demonstrated, though the RBD component was mild or incidentally discovered. None of the patients had Parkinsonian clinical features. Based on ICSD-2 criteria, there are 139 more POD cases reported in the literature and 69. 2% are idiopathic. The POD patients had an earlier age of onset than the patients with RBD. The RBD component was milder than the disorder of arousal (DOA) in most cases. Recently an updated classification was published, which included new categories of POD. The features mentioned above and the revised classification suggests that POD is not just a subtype of RBD.

Conclusions

We propose that POD is a distinct pathophysiologic parasomnia. Further research to identify the underlying mechanism is needed. Proper counseling is necessary for patients presenting with POD at a young age of onset.     

Sleep and psychological health during early recovery from critical illness: An observational study

Introduction

Intensive care patients often report sleep disruption in ICU and during recovery from critical illness.

Objectives

To assess: (i) patients' self-reported sleep quality in ICU, on the hospital ward after transfer from ICU and two and six months after hospital discharge; (ii) whether patients who report sleep disruption in ICU continue to report sleep disruption in recovery and (iii) whether prehospital insomnia, experiences in intensive care, quality of life and psychological health are associated with sleep disruption six months after hospital discharge.

Methods

Patients completed self-report measures on sleep quality at five time points: prior to hospitalization, in ICU, the hospital ward, two months and six months after hospital discharge, their intensive care experiences two months after discharge and psychological health and quality of life six months after discharge.

Results

Patients (n = 222) were aged (mean ± SD) 57.2 ± 17.2 years, 35% female, had mean ICU stay of 5 ± 6 days and BMI of 26 ± 5. Over half the participants (57%) reported poor sleep at six months; for 10% this was at all time points after ICU admission. Prehospitalization insomnia (p = .0005), sleep quality on the ward (p = .006), anxiety (p = .002), and mental (p = .0005) and physical health (p = .0005) were independently associated with poorer sleep quality in survivors six months after ICU treatment.

Conclusions

Sleep is a significant issue for more than half of survivors 6 months after ICU treatment. Some influencing factors, such as hospital sleep quality, anxiety, physical health and mental health, are potentially modifiable and should be targeted in recovery programs.