Role of sleep on respiratory failure after extubation in the ICU

Abstract

Background Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others. Results Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23). Conclusions Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation.

Correlation Between Sleep Continuity and Patient-Reported Sleep Quality in Conscious Critically Ill Patients at High Risk of Reintubation: A Pilot Study

“…This article reports on a new analysis of a previously published cohort ( 6 ). The study was performed between January 2016 and January 2019 at the medical ICU of the University Hospital of Poitiers in France to investigate the role of sleep quality on respiratory failure after extubation ( 6 ). Patients at high risk of extubation failure (> 65 yr, or with any underlying cardiac or lung disease, or intubated > 7 d) were included.…”

“…Among the 52 patients who had polysomnography recording after midnight, 12 (23%) developed postextubation respiratory failure and 8 (15%) required reintubation. Median [interquartile range] duration of mechanical ventilation before extubation was 9 days [4][5][6][7][8][9][10][11][12][13][14][15][16] and median duration of sedation before polysomnography was 3 days [2][3][4][5][6][7][8][9]. All patients were maintained in the ICU for ongoing critical illness; no patients were kept in the ICU per protocol.…”

Causes, Consequences, and Treatments of Sleep and Circadian Disruption in the ICU: An Official American Thoracic Society Research Statement

“…These atypical features can make conventional scoring rules unreliable. Atypical EEG patterns have been associated with poor outcomes in many studies ( 27 , 28 , 73 , 90 – 95 ) but not in all studies ( 86 , 96 ). Alternative rules have been proposed to improve the rigor and reproducibility of PSG scoring in ICU patients but have not been widely adopted ( 28 , 29 ).…”

Sleep and critical illness: a review

“…When TST is preserved, this is due to a large percentage (up to 41%) of sleep occurring in the daytime hours ( 41 , 51 ). While loss of deep sleep and REM stages is also associated with medications frequently administered in the ICU (such as sedatives, analgesics, and pressors), these findings persist in those who have been off sedation for an average of 3 days ( 52 ). Even patients without extreme illness (Acute Physiologic and Chronic Health Evaluation Score II of nine or less), who are sedative naïve ( 53 ), and non-ventilated requiring ICU care are noted to have decreased sleep efficiency with frequent cortical arousals, relatively increased stage 1 sleep, decreased N2 and N3, and absence of REM sleep ( 54 ).…”