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Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
Department of Anaesthesia and Intensive Care, Intensiv Care Unit, Ryhov Hospital, 551 85 Jönköping, Sweden.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
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2008 (English)In: Critical care (London, England), ISSN 1466-609X, Vol. 12, no 4, R97- p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The aim of the present prospective multicenter cohort study was to examine the prevalence of sleep disturbance and its relation to the patient's reported health-related quality of life after intensive care. We also assessed the possible underlying causes of sleep disturbance, including factors related to the critical illness.

METHODS: Between August 2000 and November 2003 we included 1,625 consecutive patients older than 17 years of age admitted for more than 24 hours to combined medical and surgical intensive care units (ICUs) at three hospitals in Sweden. Conventional intensive care variables were prospectively recorded in the unit database. Six months and 12 months after discharge from hospital, sleep disturbances and the health-related quality of life were evaluated using the Basic Nordic Sleep Questionnaire and the Medical Outcomes Study 36-item Short-form Health Survey, respectively. As a nonvalidated single-item assessment, the quality of sleep prior to the ICU period was measured. As a reference group, a random sample (n = 10,000) of the main intake area of the hospitals was used.

RESULTS: The prevalence of self-reported quality of sleep did not change from the pre-ICU period to the post-ICU period. Intensive care patients reported significantly more sleep disturbances than the reference group (P < 0.01). At both 6 and 12 months, the main factor that affected sleep in the former hospitalised patients with an ICU stay was concurrent disease. No effects were related to the ICU period, such as the Acute Physiology and Chronic Health Evaluation score, the length of stay or the treatment diagnosis. There were minor correlations between the rate and extent of sleep disturbance and the health-related quality of life.

CONCLUSION: There is little change in the long-term quality of sleep patterns among hospitalised patients with an ICU stay. This applies both to the comparison before and after critical care as well as between 6 and 12 months after the ICU stay. Furthermore, sleep disturbances for this group are common. Concurrent disease was found to be most important as an underlying cause, which emphasises that it is essential to include assessment of concurrent disease in sleep-related research in this group of patients.

Place, publisher, year, edition, pages
2008. Vol. 12, no 4, R97- p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17825DOI: 10.1186/cc6973PubMedID: 18673569OAI: oai:DiVA.org:liu-17825DiVA: diva2:212376
Note

Original Publication: Lotti Orvelius, Anders Nordlund, Peter Nordlund, Ulla Edéll-Gustafsson and Folke Sjöberg, Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care: a prospective multicenter cohort study, 2008, Critical care (London, England), (12), 4, R97. http://dx.doi.org/10.1186/cc6973 Licencee: BioMed Central http://www.biomedcentral.com/

Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2014-01-10Bibliographically approved
In thesis
1. Health related quality of life in adult former intensive care unit patients
Open this publication in new window or tab >>Health related quality of life in adult former intensive care unit patients
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health‐related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients.

Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical‐surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5‐Dimensions (EQ‐5D) and Medical Outcome Short Form (SF‐36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre‐existing diseases was collected by self‐reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group.

Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ‐5D and in SF‐ 36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre‐existing diseases were found to be the factor that had the largest influence on HRQoL in both the short‐ and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC ‐related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay.

Conclusions: This multicenter study shows that pre‐existing diseases influence the HRQoL short‐ and long‐term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre‐existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1117
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17829 (URN)978‐91‐7393‐651‐4 (ISBN)
Public defence
2009-05-08, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
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Supervisors
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2012-01-26Bibliographically approved

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Orwelius, LottiNordlund, AndersEdéll-Gustafsson, UllaSjöberg, Folke

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