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Title Ποιότητα του ύπνου των ασθενών μετά τη νοσηλεία τους σε Μονάδα Εντατικής Θεραπείας / Μπολάκη Μαρία.
Alternative Title Sleep quality in survivors of critical illiness
Author Μπολάκη, Μαρία
Thesis advisor Γεωργόπουλος, Δημήτριος
Reviewer Κονδύλη, Ευμορφία
Σιδηροπούλος, Πρόδρομος
Μήτσιας, Παναγιώτης
Τζανάκης, Νικόλαος
Σχίζα, Σοφία
Βαπορίδη, Αικατερίνη
Abstract Purpose: There is limited data regarding the sleep quality in survivors of critical illness, while the time course of the sleep abnormalities observed after ICU discharge is not known. The aim of this study was to assess sleep quality and the time course of sleep abnormalities in survivors of critical illness. Methods: Eligible survivors of critical illness without hypercapnia and hypoxemia were evaluated within 10 days (1st evaluation, n = 36) and at 6 months after hospital discharge (2nd evaluation, n = 29). At each visit, all patients underwent an overnight full polysomnography and completed healthrelated quality of life questionnaires (HRQL). Lung function and electro-diagnostic tests (ED) were performed in 24 and 11 patients, respectively. Results: At 1st evaluation, sleep quality and HRQL were poor. Sleep was characterised by high percentages of N1, low of N3 and REM stages, and high apnea–hypopnea index (AHI, events/h). Twenty-two out of 36 patients (61%) exhibited AHI ≥ 15 (21 obstructive, 1 central). None of the patients’ characteristics, including HRQL and lung function, predicted the occurrence of AHI ≥ 15. At 6 months, although sleep quality remained poor (high percentages of N1 and low of REM), sleep architecture had improved as indicated by the significant increase in N3 [4.2% (0–12.5) vs. 9.8% (3.0– 20.4)] and decrease in AHI [21.5 (6.5– 29.4) vs. 12.8 (4.7–20.4)]. HRQL improved slightly but significantly at 6 months. Neither the changes in HRQL nor in lung function tests were related to these of sleep architecture. Six out of eight patients with abnormal ED at 1st evaluation continued to exhibit abnormal results at 6 months. Discussion: Our study resulted in the following findings: (1) in survivors of critical illness without gas exchange abnormalities, within 10 days of hospital discharge, sleep quality was poor characterised by severe disruption of sleep architecture and excessive sleep-disordered breathing, mainly of the obstructive type. (2) at 6 months after hospital discharge sleep quality remained relatively poor, in comparison to the 1st sleep study, however significant improvement in N3 stage and AHI was observed, resulting in significantly more patients being classified as normal or with mild SDB. (3) quality of life improved at 6 months, however continued to be abnormal. (4) the change in quality of life and that of sleep disturbances had no relationship between each other. The demonstration of obstructive events could be explained by four pathophysiologic mechanisms which are the following: (1) increased upper airway collapsibility, (2) high chemical loop gain, (3) low arousal threshold and (4) poor responsiveness of pharyngeal dilators (mainly the genioglossus muscle) to negative pharyngeal pressure. Although our study has some limitations, it is to our knowledge the first one to prospectively collect data regarding the sleep quality of survivors of critical illness at hospital discharge and 6 months later Conclusions: Survivors of critical illness exhibited a high prevalence of obstructive sleep-disordered breathing and poor sleep architecture at hospital discharge, which slightly improved 6 months later, indicating that reversible factors are partly responsible for these abnormalities.
Language Greek
Subject Hospital discharge
Intensive care unit
Mechanical ventilation
Quality of life
Sleep architecture
Issue date 2019-07-17
Collection   Faculty/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Doctoral theses
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