Is there an association between subjective sleep quality and daily delirium occurrence in critically ill adults? A post hoc analysis of a randomised controlled trial

Aug 28, 2020BMJ open respiratory research

Links between how well critically ill adults sleep and daily delirium episodes

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Abstract

Sleep quality, measured by the Leeds Sleep Evaluation Questionnaire, is not associated with occurrence in ICU patients.

A total of 100 ICU patients were monitored over 1115 24-hour periods.
Delirium was observed in 10.2% of these periods, while 78.1% had no delirium.
In a retrospective analysis, sleep quality scores showed no significant relationship to previous delirium occurrences.
The predictive analysis also indicated that sleep quality scores did not predict future delirium occurrences.
Both analyses suggest that perceived sleep quality in ICU patients does not influence delirium.

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OBJECTIVES: Whether and how and sleep quality in the intensive care unit (ICU) are linked remains unclear. A recent randomised trial reported nocturnal low-dose dexmedetomidine (DEX) significantly reduces incident ICU delirium. Leeds Sleep Evaluation Questionnaire () scores were similar between intervention (DEX; n=50) and control (placebo (PLA); n=50) groups. We measured the association between morning LSEQ and delirium occurrence in the prior 24 hours (retrospective analysis) and the association between morning LSEQ and delirium occurrence in the following 24 hours (predictive analysis).

DESIGN: Post hoc analysis of randomised controlled trial data.

PARTICIPANTS: Adult ICU patients (n=100) underwent delirium screening twice a day using the Intensive Care Delirium Screening Checklist (ICDSC) if Richmond Agitation Sedation Scale (RASS) was ≥-3 and patient-reported sleep quality evaluations at 09:00 daily with the LSEQ if RASS was ≥-1.

OUTCOMES: The analysis included all 24-hour study periods with LSEQ documentation and matched delirium screening in coma-free patients. Separate logistic regression models controlling for age, baseline Acute Physiology and Chronic Health Evaluation II score and DEX/PLA allocation evaluated the association between morning LSEQ and delirium occurrence for both retrospective and predictive analyses.

RESULTS: The 100 patients spent 1115 24-hour periods in the ICU. Coma, delirium and no delirium occurred in 130 (11.7%), 114 (10.2%) and 871 (78.1%), respectively. In the retrospective analysis, when an LSEQ result was preceded by an ICDSC result (439/985 (44.6%) 24-hour periods), delirium occurred during 41/439 (9.3%) periods. On regression analysis, the LSEQ score had no relationship to prior delirium occurrence (OR (per every 1 point average LSEQ change) 0.97, 95% CI 0.72 to 1.31). For the predictive analysis, among the 387/985 (39.1%) 24-hour periods where an LSEQ result was followed by an ICDSC result, delirium occurred during 56/387 (14.5%) periods. On regression analysis, the LSEQ score did not predict subsequent delirium occurrence (OR (per 1 point LSEQ change) 1.02, 95% CI 0.99 to 1.05).

CONCLUSIONS: The sleep quality ICU patients perceive neither affects nor predicts delirium occurrence.

TRIAL REGISTRATION NUMBER: NCT01791296.

Key numbers

114 of 985

Occurrence

Number of ICU periods with out of total evaluated periods.

1.01

Odds Ratio for Prior

Odds ratio per 1 point average change in retrospective analysis.

1.20

Odds Ratio for Subsequent

Odds ratio per 1 point average change in predictive analysis.

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Is there an association between subjective sleep quality and daily delirium occurrence in critically ill adults? A post hoc analysis of a randomised controlled trial

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