Sleep Quality and Delirium Occurrence in Intensive Care Unit Patients: A Prospective Observational Study.
Jiyeon Kang, Hyeonjin Cho, Soogyeong Kim and 1 others
PMID 41823621WHAT IT FOUND
ICU patients who slept less and woke more often on their first night were more likely to develop delirium the next day.
By day three, illness severity and prior delirium outweighed sleep quality. Early sleep protection may matter most in the first 24 hours.
Key findings
01Shorter sleep time and higher wake after sleep onset percentage on the first night were independently associated with delirium on Day 2.
02On Day 3, sleep parameters from the previous night were not significantly associated with delirium; disease severity and prior delirium status were the significant predictors.
03Non-opioid analgesic use was also an independent predictor of Day 2 delirium in the multivariable models.
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 likely underpowered to detect smaller effects because the observed daily delirium incidence (9.3% and 14.9%) was lower than the 20% assumed in the sample size calculation. Delirium assessments were not conducted during the sleep window (11:00 PM to 7:00 AM), so it is impossible to know if delirium started overnight or the next morning. Sleep stage data were missing in nearly one-third of cases due to device limitations, preventing analysis of sleep architecture. The study excluded patients with pre-existing cognitive disorders, delirium at admission, or those at the end of life, limiting generalisability to these groups. Pain intensity was not measured, so the association with non-opioid analgesics could be confounded by untreated pain.
Declared interests
The study was funded by the National Research Foundation of Korea. The funding source had no role in the study design, analysis, or decision to publish. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the association between non-opioid analgesics and delirium as evidence that these drugs cause delirium. The study did not measure pain intensity, so the finding may reflect that patients with more severe pain (who require more analgesia) are at higher risk of delirium, rather than the medication itself being the cause.