Nighttime Sleep Duration Is Associated With Length of Stay Outcomes Among Older Adult Survivors of Critical Illness.
Maya N Elías, Cindy L Munro, Zhan Liang and 3 others
PMID 32251163WHAT IT FOUND
After ICU transfer, older survivors slept about 7.55 hours each night but woke for about 2.26 hours.
Longer sleep was associated with longer hospital stay: 18.78 days for 6 hours or more, versus 9.0 days for less.
Key findings
01Mean post-ICU nighttime total sleep time was 7.55 ± 2.52 hours, and mean wake after sleep onset was 2.26 ± 0.17 hours.
02Greater post-ICU total sleep time was significantly and positively associated with longer total hospital length of stay (β = 0.535, p < .001).
03Subjects who slept 6 hours or more had significantly longer prospective hospital stays (18.78 ± 15.02 days) than subjects who slept less than 6 hours (9.0 ± 3.87 days).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was small and used convenience sampling, with 30 subjects, so the associations may be unstable. The design was cross-sectional, so it cannot show that sleep duration caused longer hospital stay or that improving sleep would shorten stay. Longer sleep may reflect patients who were more inactive or bedridden, rather than restorative sleep driving a longer stay. Actigraphy was used instead of polysomnography, and the paper states it has not been validated within older ICU survivors. Actigraphy may score inactive or bedridden periods as sleep, and daytime sleep between 9:00 AM and 9:00 PM was not analyzed. One subject returned to the ICU after one night, but data from all 30 subjects were included, and only 29 completed both nights. The sample was limited to older adults who were functionally independent before admission and community-dwelling, so results may not apply to frailer or long-term care patients. Many subjects had obstructive sleep apnea, and only one was compliant with CPAP during the observation period, which may affect sleep and outcomes.
Declared interests
The authors report no conflicts of interest. The supplied text does not state a funding source.
The easy way to misread this
Do not conclude that longer sleep causes longer hospital stay or that sleep extension is harmful. This was a small cross-sectional study, and the association may reflect sicker, less mobile, or more sedated patients.