Effect of sleep quality on weaning from mechanical ventilation: A scoping review
Article Category: Review
Published Online: Jan 31, 2025
Page range: 23 - 32
Received: Jul 08, 2024
Accepted: Oct 30, 2024
DOI: https://doi.org/10.2478/jccm-2024-0043
Keywords
© 2025 Hana Locihová et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Study characteristics – effect of hospitalized patient’ sleep quality (objectively measured) on weaning from mechanical ventilation
| To assess sleep quality in tracheotomized patients undergoing prolonged weaning |
A cross-sectional study of 19 patients undergoing prolonged weaning at a specialized weaning unit of a pneumology department Groups: |
Gas exchange monitoring |
7 patients (36.8%) Days on MV: 39 (SD 22) |
No significant difference in sleep quality between the A decreased amount of REM sleep: 9.1 (SD 6.3) vs. 5 (SD 8.4), respectively |
No significant difference in nocturnal gas exchange between the groups | There was no difference between |
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| To determine whether abnormal sleep or wakefulness is associated with SBT outcome |
A prospective multicenter study of 44 (enrolled; 37 with adequate signals) intubated mechanically ventilated patients with an SBT planned for the next day at 3 ICUs Groups: |
EEG markers (ORP index + hemispheric correlation [ICC R/L ORP]) |
11 patients (30%) Days on MV: 10.4 (SD 8.6) |
No significant difference in sleep architecture between the groups shown by PSG Abnormal sleep patterns are present but not significant More time with ORP > 2.0 and > 2.2 in the Differences in R/L ORP ICC: 0.80 (SD 0.16) |
SOFA score: 7 (SD 3) Delirium: 3 (27%) |
Although abnormal sleep patterns were noted, there was no association between sleep architecture changes and weaning. However, a detailed analysis of derived EEG markers (ORP, R/L ORP ICC) identified these parameters helpful in predicting SBT success. | |||
| To assess the impact of sleep alterations on weaning duration |
A prospective single-center study of 45 intubated patients with at least one SBT failure at a medical ICU Groups: |
EEG reactivity at eyes opening during wakefulness assessed by a neurologist |
27 patients (60%) Days on MV (median, IQR): 8 (4–13) |
Weaning duration is significantly longer in patients with atypical sleep compared with those with normal sleep (median, IQR): 5 (2–8) vs. 2 (1–2); p < 0.001 and independently associated with prolonged weaning: OR = 13.9, 95% CI 3.2–85.7; p = 0.001 Weaning duration is significantly longer in patients with no REM sleep compared with the others (median, IQR): 4 (2–7) vs. 2 (1–2); p = 0.03 |
Delirium: 10 (37%) ICU-AW: 9 (33%) |
Patients with atypical sleep or no REM sleep had markedly longer weaning duration than those with normal sleep. Atypical sleep was associated with prolonged weaning (a strong predictor). | |||
| To assess whether sleep alterations after extubation are associated with an increased risk of reintubation |
A prospective observational single-center study of 52 extubated patients at a medical ICU Groups: |
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44 patients (85%) Days on MV (median, IQR): 3 (2–7) |
Reintubation rates 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep, difference −16% (95% CI −33% to 6%); p=0.23 No statistically significant changes in the other PSG sleep parameters between the groups |
SOFA score (median, IQR): 3 (2–4) Delirium: 4 (10%) |
Absence of REM sleep influenced the risk of reintubation in the ICU. | |||
| To assess the impact of delirium during weaning and associated alterations in the circadian rhythm |
An observational multicenter study of 70 patients intubated for over 24 hours in an ICU Groups: |
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43 patients (61.4%) Days on MV (median, IQR): 4.1 (2.6–7.4) |
Reduced excretion of 6-SMT (ng) in patients with delirium (median, IQR): 20.212 (23.207–39.920) vs. 18.880 (11.462–27.325); Interaction between delirium and 6-SMT secretion: F statistic = 2.65; p = 0.019 |
SOFA score (median, IQR): 8.0 (6.0–11.0) More complications during weaning in patients with delirium: 40 (93%) vs. 15 (63%); p = 0.02 (OR 5.95, 95% CI 1.26–28.13; p = 0.021) Successful extubation is less likely in patients with delirium: HR 0.54, 95% CI 0.30–0.95; p = 0.02 Alcohol abuse (median, IQR): 11 (25.6%) |
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Study characteristics – effect of hospitalized patient' sleep quality (subjectively evaluated) on weaning from mechanical ventilation
| To investigate the predictors of sleep quality and successful weaning |
A cross-sectional study of 94 patients in the process of weaning from MV at 3 respiratory care centers Groups: |
The first two parts of a questionnaire: demographic (age, gender) and clinical (co-existing chronic illnesses, alcohol drinking, use of hypnotics, tracheotomy, albumin, days on MV) information Third part: disease severity (APACHE II and GCS scores) Fourth part: sleep (VSH score) |
YES |
53 patients (56.4%) Days on MV: 37.9 (SD 17.8) |
Sleep quality was better in the Sleep quality negatively influenced by disease severity (APACHE II score: b = −1.323, 95% CI −2.052 to −0.593; p < 0.001), use of hypnotics (b = −10.707, 95% CI −16.718 to −4.696; p < 0.001), and 3–4 co-existing illnesses (b = −9.905, 95% CI −17.734 to −2.077; p < 0.14 |
The Other factors identified as independent predictors of weaning (based on regression analysis): APACHE II score (OR = 1.644, 95% CI 1.150–2.351; p < 0.06), GCS score (OR = 0.810, 95% CI 0.695–0.944; p < 0.07), and alcohol use (OR = 0.208, 95% CI 0.063–0.689; p < 0.09) |
Sleep quality was identified as a significant predictor of successful weaning from MV. | |
| Huttmann |
To assess sleep quality in tracheotomized patients undergoing prolonged weaning |
A cross-sectional study of 19 patients undergoing prolonged weaning at a specialized weaning unit of a pneumology department Groups: |
PSG (10 pm – 6 am) Gas exchange monitoring |
NO |
7 patients (36.8%) Days on MV: 39 (SD 22) |
No significant difference in sleep quality or any items of the questionnaire between the groups | No difference was identified in sleep quality or questionnaire items between the successful and |
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