Psychiatric symptoms and their association with sleep disturbances in intensive care unit survivors

Abstract

Sophia Wang,1–3 Jared W Meeker,4 Anthony J Perkins,5 Sujuan Gao,5 Sikandar H Khan,4,6 Ninotchka L Sigua,4,7 Shalini Manchanda,4,7 Malaz A Boustani,2,3,6,8 Babar A Khan3,4,6,8 1Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202 USA; 2Center for Health Innovation and Implementation Science, Clinical and Translational Science Institute, Indianapolis, IN, USA; 3Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN, USA; 4Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 5Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA; 6IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, USA; 7Indiana University Health Sleep Disorders Center, Indiana University School of Medicine, Indianapolis, IN, USA; 8Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA Background: Sleep disturbances in critically ill patients are associated with poorer long-term clinical outcomes and quality of life. Studies are needed to better characterize associations and risk factors for persistent sleep disturbances after intensive care unit (ICU) discharge. Psychiatric disorders are frequently associated with sleep disturbances, but the role of psychiatric symptoms in sleep disturbances in ICU survivors has not been well-studied. Objective: To examine the association between psychiatric symptoms and sleep disturbances in ICU survivors. Methods: 112 adult ICU survivors seen from July 2011 to August 2016 in the Critical Care Recovery Center, an ICU survivor clinic at the Eskenazi Hospital in Indianapolis, IN, USA, were assessed for sleep disturbances (insomnia, hypersomnia, difficulty with sleep onset, difficulty with sleep maintenance, and excessive daytime sleepiness) and psychiatric symptoms (trauma-related symptoms and moderate to severe depressive symptoms) 3 months after ICU discharge. A multivariate logistic regression model was performed to examine the association between psychiatric symptoms and sleep disturbances. Analyses were controlled for age, hypertension, history of depression, and respiratory failure. Results: ICU survivors with both trauma-related and depression symptoms (OR 16.66, 95% CI 2.89–96.00) and trauma-related symptoms alone (OR 4.59, 95% CI 1.11–18.88) had a higher likelihood of sleep disturbances. Depression symptoms alone were no longer significantly associated with sleep disturbances when analysis was controlled for trauma-related symptoms. Conclusion: Trauma-related symptoms and trauma-related plus moderate to severe depressive symptoms were associated with a higher likelihood of sleep disturbances. Future studies are needed to determine whether psychiatric symptoms are associated with objective changes on polysomnography and actigraphy and whether adequate treatment of psychiatric symptoms can improve sleep disturbances. Keywords: sleep disturbance, post-traumatic stress disorder, depression, ICU survivor, psychiatric disorders, post-intensive care syndrome

Keywords

• Sleep disturbance
• post-traumatic stress disorder
• depression
• ICU survivor