Sleep and Circadian Health of Critical Survivors in the Long-Term: Good or Bad?

Dr. Adriano D. S. Targa

Dr. Adriano D. S. Targa

Miguel Servet fellow, Translational Research in Respiratory Medicine (TRRM) group, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain. CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.

Dr. Adriano Targa obtained his Bachelor’s Degree in Biological Sciences (2011), followed by a Master’s Degree in Physiology (2014), and a PhD in Pharmacology (2018) from the Federal University of Paraná (Brazil). Currently, he holds the position of Miguel Servet fellow as the Principal Investigator of the Sleep Medicine and Chronobiology research line within the Translational Research in Respiratory Medicine (TRRM) group at the Biomedical Research Institute of Lleida (IRBLleida), Spain. Dr. Targa’s research focuses on investigating sleep and circadian health from distinct perspectives, including critical illness, Alzheimer’s disease, and obstructive sleep apnea.

Sleep and circadian health of critical survivors: A 12-month follow-up study

Critical patients often experience sleep and circadian alterations both during their stay in the intensive care unit and shortly after being discharged from the hospital. Studies suggest that as many as 64.3% of survivors report poor sleep quality one to three months post-discharge, accompanied by significant fragmentation of the circadian rest-activity rhythm. Even after six months, while there may be a slight improvement in sleep quality, the fragmentation of the rhythm persists.

Potential causative factors for such outcomes include the night-time patient care interventions, excessive exposure to artificial light at inappropriate times, and noise from alarms and staff conversations. Additionally, other critical illness-related events such as the presence of pain, increased inflammatory processes, sleep-altering medication intake, and the use of invasive mechanical ventilation can be relevant contributors to this scenario.

With this study, we aimed to shed some light on the state of sleep and circadian health in the long-term, addressing the notable gap of evidence in this area, despite the significant prevalence of patients still experiencing poor sleep quality and rhythm fragmentation in the mid-term. We also found it compelling to explore this topic, particularly considering that the effects of potential causative factors were expected to have diminished by this point.

Leveraging the natural research opportunity provided by the SARS-CoV-2 pandemic, we followed critical COVID-19 patients recruited during the intensive care unit stay. We assessed various parameters including sleep, circadian rest-activity rhythm, mental health, quality of life, cognitive function, aerobic capacity, and respiratory function at three-, six-, and 12-months post-hospital discharge.

The findings

Our findings revealed compromised sleep and circadian health among critical survivors 12 months after hospital discharge. While sleep quality displayed a slight improvement, the overall circadian function showed the same pattern throughout the follow-up.

Our additional analyses, to gain deeper insights into this context, demonstrated that the disease severity, as indicated by the use of invasive mechanical ventilation, had an additional impact on the fragmentation of the circadian rest-activity rhythm in the short and mid-term, although this effect was partially mitigated by the 12-month follow-up. Furthermore, other markers associated with disease severity, such as hospitalization duration, predicted higher rhythm fragmentation in the long-term. Lastly, we observed a close relationship between sleep quality and mental health at this time-point, while rhythm fragmentation was mostly associated with respiratory function.

Overall, our findings underscore the need for strategies aimed at preventing and/or reversing sleep and circadian alterations following the intensive care unit stay. Such interventions could potentially enhance quality of life, facilitate patient recovery, and mitigate other conditions associated with sleep and circadian disturbances.

Infographic created by:
Marta Molinero García

Article and infographic based on:
Henríquez-Beltrán et al. (2024). Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study. Crit Care Med.

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