COVID-19, Critical Illness, and Sleep*

Abstract

While acute respiratory distress syndrome has been the most-reported severe complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there is mounting evidence that this infection can affect the nervous system. This includes excessive daytime sleepiness, anxiety, depression, fatigue, muscle weakness, and elevated scores on the Pittsburgh Sleep Quality Index (PSQI). Sleep problems affect between 30% and 60% of COVID-19 patients (1).In an international survey of over 25,000 people that compared pre-pandemic sleep to intra-pandemic sleep, the prevalence of disrupted sleep increased from 14% to 28%. For those patients with self-reported COVID infection (800 patients), it was increased from 14% to 32%. Excessive sleepiness increased to 40% from 18% in post-infection patients (2).As most practicing intensivists already know, critically ill patients have significant sleep disruptions that contribute to ICU delirium. While many zeitgebers and interventions like vital sign checks, noise, procedures, and sedation have been implicated, invasive mechanical ventilation has a disproportionate contribution (3). These disruptions have been shown to persist up to a week after ICU discharge. While they do improve over time, they do not appear return to normal, even after 12 months (4). The natural question then arises, is there an additive effect of critical illness, mechanical ventilation, and SARS-COV-2 infection? COVID-19 CRITICAL ILLNESS DISRUPTS SLEEP AND CIRCADIAN RHYTHMIn this issue of Critical Care Medicine, Benítez et al ( 5) followed 172 consecutive patients admitted to their ICU in Spain with COVID-19 infection. No experimental interventions were made. The usual demographic and clinical data were obtained (e.g., age, ventilator days, ICU length of stay [LOS], etc.). Studyspecific data were collected during a research visit with surviving patients at day 90: PSQI (seven category subsets of 19 questions); Epworth Sleepiness Scale; Satisfaction Alertness Timing Efficiency Duration (sleep quality survey); actigraphy (7 d with total sleep time [TST], intradaily variability [IV] for sleep fragmentation, and interdaily stability [IS] for circadian rhythm); carbon monoxide diffusion coefficient; chest CT scan; Hospital Anxiety and Depression Scale (HADS); and 6-minute walk test for distance (6MWD). The statistical analysis was appropriate.

Social support as a mediator between anxiety and quality of sleep among Chinese parents of special children

“…So, previous studies have found that anxiety, social support, coping style and sleep quality are related to each other. In addition, many studies have shown that the COVID-19 epidemic will affect individual sleep, anxiety and other mental health (Stanton et al, 2020;Qiu et al, 2021;Chatterjee, 2022). Studies have explored the psychometric relationship among these related variables, but the mediating role of social support and coping style between anxiety and sleep quality has been explored very rarely.…”