The Nature of Sleep in 10 Bedridden Elderly Patients With Disorders of Consciousness in a Japanese Hospital

Abstract

No previous study has satisfactorily clarified the nature of sleep in elderly bedridden people with disorders of consciousness (DOC). The objective of the present study was to clarify the sleep states of 10 elderly bedridden patients with DOC in a Japanese hospital to facilitate provision of evidence-based nursing care and appropriate adjustment of patients' environments. Nocturnal polysomnography recordings were analyzed according to the standard scoring criteria, and the patients' sleep stages and quality were investigated. Of the 10 patients, 9 showed slow wave sleep (SWS), 4 showed very high values for sleep efficiency (96-100%), and in 3 of these patients, the percentage of SWS was ≥ 20%. Furthermore, three of these four patients had 200 or more changes in sleep stage. Although the mechanism is unknown, the amount of SWS combined with the value of sleep efficiency suggests that the quality of sleep is poor in elderly bedridden patients with DOC. Further study is needed to determine better indicators of good sleep in this population.

24-h polysomnographic recordings and electrophysiological spectral analyses from a cohort of patients with chronic disorders of consciousness

“…In the previously discussed [23]. Similar findings have been demonstrated in previous investigations of patients with severe brain injuries [20,21,32]. Furthermore, slow wave sleep has been linked to learning and memory and is thought to have an important role in synaptic homeostasis [46,47].…”

“…Overall, patients diagnosed as being in a minimally conscious state tend to exhibit more preserved sleep architecture than patients diagnosed as being in a vegetative state (unresponsive wakefulness syndrome) [16][17][18][19]. Further, slow wave sleep correlates with more overt signs of awareness in most of these patients [20][21][22][23]. The circadian rhythms of patients with chronic disorders of consciousness are quite variable, with reports of periods ranging from 6 to 63 h in one study [24] and 23-26 h in another study [25].…”

The reliability of the Czech version of the Richards-Campbell Sleep Questionnaire

“…In our study, a statistically significant difference in age-related sleep quality was not confirmed (F = 0.1; p = 0.736). The impact of age was evaluated in the studies of the authors (Matsumoto et al, 2015;Sterniczuk et al, 2014), who, on the basis of the results, suggest that stages of sleep change in people aged 60 years and more, and there is a higher incidence of sleep-related respiratory disorders and abnormal movements related to sleep, and subjectively impaired sleep quality. The sociological analysis sought to examine the relationship between sleep quality perception in patients in ICU from the gender perspective.…”

Being wheelchair‐bound and being bedridden: Two concept analyses

“…Bedridden people are permanently bound to bed (Hirakawa et al, 2005;Matsumoto et al, 2015;Morimoto et al, 2006;Tanaka et al, 2013;Urasaki et al, 2011) and cannot sit up (Sugimoto et al, 2004) or get out of bed independently (Tseng et al, 2007).…”

“…• Sleep disturbances Matsumoto et al, 2015) • High risk of shoulder pain (Fullerton et al, 2003), and hand injury (e.g. carpal tunnel syndrome) (Wick & Zanni, 2007) due to using a manual wheelchair for locomotion • Infections (due to all microbes on wheelchair rims and tires with transfer from hand to face, eyes and nose) in particular in people with immune deficiencies (Wick & Zanni, 2007) • Shoulder and back pain (due to an inadequate proper skeletal and postural alignment in a wheelchair sitting position) (Veneman et al, 2017;Wick & Zanni, 2007) • High risk of pressure ulcer (Hampton, 2011;Urasaki et al, 2011;Wick & Zanni, 2007) • Respiratory changes (due to poor posture that the lungs may not fully expand) (Wick & Zanni, 2007) • High risk of falling (due to an inadequate proper skeletal and postural alignment) (Veneman et al, 2017) • Muscular atrophy (Wick & Zanni, 2007) • Dysphagia (due to a poor posture that disrupts normal swallowing) (Tamura et al, 2002;Wick & Zanni, 2007) • Fatigue (due to a poor position or seating that makes activities difficult) (Wick & Zanni, 2007) • Injuries (due to ill-fitting wheelchairs or a lack of wheelchair training) (Wick & Zanni, 2007) Physical consequences:…”