Actigraphic measures of sleep on the wards after ICU discharge.

BACKGROUND: The purpose of this study was to use an objective measure to evaluate sleep quality on the ward after ICU discharge in survivors of critical illness. MATERIALS AND METHODS: This was a prospective cohort study of 94 patients admitted to a multidisciplinary intensive care unit (ICU) between December 2013 and June 2017. Adult patients received ≥3 days of mechanical ventilation. Sleep quality was measured using multi-night sleep actigraphy. Baseline sleep quality (i.e. sleep prior to hospitalization) was evaluated using the Pittsburgh Sleep Quality Index. RESULTS: A total of 65% of patients had poor sleep quality measured with the PSQI. The average (SD) sleep time and sleep efficiency was 6.03 h (3.70 h) and 44% (27%), respectively. An admission diagnosis of sepsis was associated with shorter total sleep time (TST; p = .03) and reduced sleep efficiency (SE; p = .04) as were severity of illness and duration of sedative exposure (p = .12 and 0.03; p = .09 and < 0.01; respectively for TST and SE). Weak correlations were seen between pro-inflammatory biomarkers and sleep quality. CONCLUSIONS: This study highlights the important role that future interventions might have in patients at high-risk of sleep disorders after critical illness.

A study protocol for an observational cohort investigating COGnitive outcomes and WELLness in survivors of critical illness: the COGWELL study.

INTRODUCTION: Up to 9 out of 10 intensive care unit (ICU) survivors will suffer some degree of cognitive impairment at hospital discharge and approximately half will have decrements that persist for years. The mechanisms for this newly acquired brain injury are poorly understood. The purpose of this study is to describe the prevalence of sleep abnormalities and their association with cognitive impairment, examine a well-known genetic risk factor for dementia (Apolipoprotein E ε4) that may allow for genetic risk stratification of ICU survivors at greatest risk of cognitive impairment and determine if electroencephalography (EEG) is an independent predictor of long-term cognitive impairment and possibly a candidate intermediate end point for future clinical trials. METHODS AND ANALYSIS: This is a multisite, prospective, observational cohort study. The setting for this trial will be medical and surgical ICUs of five large tertiary care referral centres. The participants will be adult patients admitted to a study ICU and invasively ventilated for ≥3 days . Participants will undergo follow-up within 7 days of ICU discharge, 6 months and 1 year. At each time point, patients will have an EEG, blood work (biomarkers; gene studies), sleep study (actigraphy), complete a number of questionnaires as well as undergo neuropsychological testing. The primary outcome of this study will be long-term cognitive function at 12 months follow-up as measured by the Repeatable Battery for the Assessment of Neuropsychological Status and Trails Making Test B. ETHICS AND DISSEMINATION: The study has received the following approvals: University Health Network Research Ethics Committee (13-6425-BE), Sunnybrook Health Centre Research Ethics Committee (365-2013), Mount Sinai Research Ethics Committee (14-0194-E) and St. Michael's Hospital Research Ethics Committee (14-295). Results will be made available to critical care survivors, their caregivers, the funders, the critical care societies and other researchers. TRIAL REGISTRATION NUMBER: NCT02086877; Pre-results.