The screening and management of sleep disturbances in people living with HIV: Delphi consensus.

Sleep disturbances in people living with HIV (PLHIV) are frequent but their management remains insufficient. In the absence of specific recommendations, a DELPHI consensus research project was conducted in France to establish best practice. A multidisciplinary Steering Committee (STC) undertook a literature review and used it with clinical expertise to create statements that were voted on. Two profiles of healthcare professionals with significant experience in monitoring PLHIV were selected for the voting: physicians and nurses/psychologists. Votes were collected electronically, independently, and anonymously. The STC created 27 statements covering six areas: Screening of sleep disturbances, Investigation, First-line management, Referral to a specialist, Antiretroviral treatment (ARV), and Prevention. Two rounds of votes included 42 physicians and 32 nurses/psychologists. Consensus was reached for 24 out of 27 statements (89%) including: to assess quantity and quality of sleep among PLHIV at least annually, ideally using a common methodology within the medical department; to consider the temporary addition of a hypnotic treatment in cases of acute insomnia not improved by the rules of sleep hygiene, with full awareness of potential drug-drug interactions and risk of dependence; to correct ferritinaemia if <100 ng/mL before referral to a specialist when restless legs syndrome is suspected; to consider changing the time of ARV administration or an ARV switch within the same class when sleep disturbances are caused by an ARV. This DELPHI Consensus provides best practice for screening and managing sleep disturbances in PLHIV and optimising their quality of life.

Prevalence of Anxiety and Depression Symptomatology in Adolescents Faced With the Hospitalization of a Loved One in the ICU.

OBJECTIVE: ICU experience is linked to anxiety and depression symptomatology in family members of patients. Minors may be forbidden from visiting. To bring practices in line with evidence, we determined the prevalence of anxiety and depression symptomatology in adolescents visiting a relative in the ICU. DESIGN: One-year prospective observational monocenter study. SETTING: Medical-surgical ICU, University Hospital of Martinique. PATIENTS: Forty-one patients intubated for more than 2 days; 53 adolescents (12-17 yr) first- to third-degree relatives in regular contact (minimum once a month) with patient before hospitalization. INTERVENTIONS: Adolescents with unrestricted ICU access completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluation (Hospital Anxiety and Depression Scale) before the patient's 15th day of hospitalization and extubation. MEASUREMENTS AND MAIN RESULTS: Forty adolescents (75.5%) visited their relative. Possible and probable anxiety and depression symptomatology prevalence was 35.9% and 18.9%, respectively, with no significant difference according to ICU visiting status. Most (80%) reported a lack of information, 40% insufficient consideration, and 27.5% misunderstood the reason for hospitalization. Two (5%) regretted visiting. Probable anxiety and depression symptomatology was associated with first-degree relationship (odds ratio, 9.1 [95% CI, 1.1-78.9]; p = 0.045), past exposure to a traumatic event (odds ratio, 8.7 [1.1-69.0]; p = 0.040) and past sense of threat (odds ratio, 10.4 [1.1-94.5]; p = 0.038). CONCLUSIONS: Anxiety and depression symptomatology is common in adolescent family members of ICU patients. An open visiting policy for adolescents is recommended, with visit planning, information meetings, and individual support from ICU staff.

Mental Health of Adolescent Relatives of Intensive Care Patients: Benefits of an Open Visitation Policy.

BACKGROUND: Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). OBJECTIVES: To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy. METHODS: One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale). RESULTS: Thirty-two patients intubated for >2 days and with a Simplified Acute Physiology Score II >30 were included. Forty-six adolescents with first- to third-degree relationships to the patient, and in regular contact (≥monthly) with the patient before hospitalization, were enrolled. The prevalence of PTSD among the adolescents was 33%. Adolescents who visited the ICU were less likely to report feelings of regret than those who did not visit the ICU (2% vs 9%, P = .01). A past sense of threat (odds ratio [95% CI], 19.4 [1.9-201.2]; P = .01) and anxiety and depression symptoms (odds ratio [95% CI], 9.6 [1.4-63.7]; P = .02) were independent factors associated with probable PTSD. CONCLUSIONS: A cautiously prepared open visiting policy should be maintained for adolescents with a relative in the ICU, because it could prevent feelings of regret and subsequent PTSD. Adolescents with risk factors should be screened and followed up.