Prevalence, Risk Factors, and Intervention of Long-Term Sleep Disturbance After Intensive Care Unit Discharge: A Scoping Review.

Abstract

Sleep disturbance in the intensive care unit (ICU) is common and often persistent after discharge. Sleep disturbance after ICU discharge, often classified under post-intensive care syndrome (PICS), affects health-related quality of life (HRQOL). The aim of the current review was to map long-term sleep disturbance after ICU discharge, explore related factors, and suggest prevention and treatment measures, including those related to PICS. We searched the PubMed, CINAHL, and CENTRAL databases until June 12, 2024, using keywords related to ICU, sleep disturbance, and recovery. Inclusion criteria were the inclusion of adult patients, analysis of sleep disturbance after ICU, and evaluation of risk factors or interventions. Reviews, case reports, and non-original studies were excluded. A total of 1,786 studies on sleep disturbance after ICU discharge were initially identified, with 52 studies ultimately included after screening. Prevalence of sleep disturbance after ICU discharge was calculated from 42 studies, with rates of 55.0% at less than one month, 49.6% at 1-3 months, 39.2% at 4-6 months, 23.2% at 7-12 months, and 15.0% over one year. Risk factors for sleep disturbance included older age, female sex, pre-hospital sleep disturbance, ICU and hospital lengths of stay, duration of mechanical ventilation, duration of sedation or analgesia, pain, delirium, and poor sleep quality during hospital ward. Long-term sleep disturbance was associated with PICS. Sleep disturbance was associated with physical disability, cognitive impairment, mental dysfunction (especially depression, post-traumatic stress disorder, and anxiety), and HRQOL, assessed at 4-6 months after hospitalization. Two randomized controlled trials (RCTs) examined interventions for sleep disturbance. Psychological counseling and a 12-month nurse-led collaborative care intervention were found effective in improving long-term sleep disturbance. On the other hand, the use of sleep aids such as earplugs and eye masks in the ICU had no such effect. Sleep disturbance after ICU discharge is common, with over half of the patients being affected within one month, and a link to PICS symptoms exists, highlighting the need for further research on comprehensive interventions.