The objective of this study is to investigate the factors associated with postoperative severity of sleep-disordered breathing. Three hundred seventy-six patients completed polysomnography on preoperative and postoperative night 1. Preoperative apnea-hypopnea index (AHI) was 12 (4, 26) (median [25th, 75th percentile]) events per hour. Thirty-five patients had minor surgeries, 292 intermediate surgeries, and 49 major surgeries, with 210 general anesthesia and 166 regional anesthesia. The 72-h opioid dose was 55 (14, 85) mg intravenous morphine-equivalent dose.
Patients with a higher preoperative AHI were predicted to have a higher postoperative AHI. Preoperative AHI, age, and 72-h opioid dose were positively associated with postoperative AHI. Preoperative central apnea, male sex, and general anesthesia were associated with postoperative central apnea index.
Patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) may experience greater changes in these parameters than patients without OSA. Consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital. The primary and secondary outcome measurements were polysomnographic parameters of sleep-disordered breathing and sleep architecture.
AHI was increased after surgery in both OSA and non-OSA patients (P < 0.05), with peak increase on postoperative N3 (OSA vs. non-OSA, 29 [14, 57] vs. 8 [2, 18], median [25th, 75th percentile], P < 0.05). Hypopnea index accounted for 72% of the postoperative increase in AHI. The central apnea index was low (median = 0) but was significantly increased on postoperative N1 in only non-OSA patients. Sleep efficiency, rapid eye movement sleep, and slow-wave sleep were decreased on N1 in both groups, with gradual recovery.
Postoperatively, sleep architecture was disturbed and AHI was increased in both OSA and non-OSA patients. Although the disturbances in sleep architecture were greatest on postoperative N1, breathing disturbances during sleep were greatest on postoperative N3.
Actigraphy is overall a useful and valid means for estimating total sleep time and wakefulness after sleep onset in field and workplace studies, with some limitations in specificity.
The authors suggest that sleep acts “… as a key mediator at the connection between stress and BDNF. Whether sleep is maintained or disturbed might explain why some individuals are able to handle a certain stress load while others develop a mental disorder.”
“…we observed that sleep spindles consistently occurred in the hippocampus several minutes before sleep onset…. wakefulness and sleep are not mutually exclusive states, but rather part of a continuum resulting from the complex interaction between diffuse neuromodulatory systems and intrinsic properties of the different thalamocortical modules.”
The authors present a study that features an interesting and innovative approach of looking at the restorative properties of sleep. The restorative function of sleep may be a consequence of the enhanced removal of potentially neurotoxic waste products that accumulate in the awake central nervous system.
In this study, the authors evaluated if modification of the ICU sound environment in a way feasible could improve sleep. Study participants were healthy male volunteers who were exposed to originally recorded ICU noise and peak reduced ICU noise. These different noise exposures where evaluated for their impact on sleep. Using polysomnography over four nights, subjects were evaluated after exposure to two nights of different maximum sound levels. The authors discovered that during ICU exposure nights, sleep was more fragmented with less slow wave sleep, more arousals and more time awake. Unfortunately, the reduction of maximal A-weighted levels from 64 to 56 dB was not enough to have a clear improved effect on sleep quality in this study.
In the hustle and bustle on the intensive care unit, family members can often be stressed. Despite intensivist best efforts, family members can experience health problems related to a family member’s ICU experience. In this timely and important study, the authors remind us not to only be mindful of our patient’s sleep deprivation, but also their loved one’s (our other patients) sleep experience. In this study, the author’s state that one of the first ways families suffer is loss of sleep. Using the General Sleep Disturbance Scale (GSDS), Beck Anxiety Index (BAI) and Lee Fatigue Scale (NRS-F), the authors created a questionnaire to evaluate sleep fatigue and anxiety during the intensive care unit admission. 94 people responded to the survey, 43.6% of whom were children. 43.5% of the respondents stated sleep quality was poor to very poor. Only 15.2% stated sleep was good/very good. Anxiety, tension and fear were the biggest contributors to poor sleep. The most common suggestion to improve sleep was more information regarding the patient’s health and relaxation techniques. Hence, when thinking of sleep in the ICU, do not forget the patient’s family and their ICU related sleep disturbances.
While not looking at the ICU directly, evaluating non-pharmacologic interventions to improve the sleep of hospitalized patients is a discussion that could be of great benefit to the intensivist. In this review, the authors evaluated 13 studies, including four randomized controlled trials with over 1150 patients. As with many reviews of the literature, the authors found great heterogeneity in the trials with regards to interventions, patient populations, outcome measures and length of follow up. The authors found that daytime light exposure improved sleep quality 7–18%, improved sleep hygiene improved sleep 5% and relaxation techniques improved sleep 0–38%. These finding are interesting and may help the hospital physician determine where initial interventions to improve sleep can be made. However, the authors comment that there is insufficient evidence that any non-pharmacologic intervention improves sleep in general inpatients and further studies are needed.
In this prospective cohort study, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) treatment data was analyzed in 62 consecutive patients (age>2 years), where the majority had OSA (80%). Treatment was initiated in a specialized pediatric NIV unit followed up at home. Long-term CPAP/NIV adherence at home was extremely high (up to 9 hours), and no correlation was found between type of interface, age, type or duration of ventilation, or efficacy of nocturnal gas exchange. Thus highlighting the importance of close collaboration of the health care team, patient, family and trained pediatric homecare providers to increase adherence to therapy.