Mary Elizabeth Wilcox1, Mary Pat McAndrews2, Julie Van3, James C Jackson3, Ruxandra Pinto4, Sandra E Black5, Andrew S Lim6, Jan O Friedrich7, Gordon D Rubenfeld4. 1. Department of Medicine (Critical Care Medicine), University Health Network, Toronto, ON, Canada; Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: elizabeth.wilcox@mail.utoronto.ca. 2. Krembil Brain Institute, University Health Network and Department of Psychology, University of Toronto, Toronto, ON, Canada. 3. Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS Center), Nashville, TN; Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt Medical Center, Nashville, TN. 4. Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine (Critical Care Medicine), Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5. Department of Medicine (Critical Care Medicine), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada. 6. Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada. 7. Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
Abstract
BACKGROUND: ICU survivors can experience both cognitive dysfunction and persistent sleep disturbances after hospitalization. Sleep disturbances have been linked with cognitive impairment in various patient populations, and the apolipoprotein E (APOE) genotype has been linked to sleep-related impairments in cognition. RESEARCH QUESTION: Is there an association between sleep, long-term cognition, and APOE status in ICU survivors? STUDY DESIGN AND METHODS: We enrolled 150 patients from five centers who had been mechanically ventilated for at least 3 days; 102 patients survived to ICU discharge. Actigraphy and cognitive testing were undertaken at 7 days, 6 months, and 12 months after ICU discharge, and sleep duration, quality, and timing were estimated by actigraphy. APOE single nucleotide polymorphisms were assessed for each patient. RESULTS: Actigraphy-estimated sleep fragmentation, but not total sleep time or interdaily stability (estimate of circadian rhythmicity), was associated with worse cognitive impairment at 7 days of ICU discharge. No actigraphy-estimated variable of sleep estimation at 7 days post-ICU discharge predicted cognitive impairment or persistent sleep abnormalities at 6 and 12 months of follow-up in subsequently assessed survivors. Possessing the APOE ε4 allele was not significantly associated with sleep disturbances and its presence did not modify the risk of sleep-related cognitive impairment at follow-up. INTERPRETATION: Sleep fragmentation estimated by actigraphy was associated with worse cognitive performance in hospital, but not at later time intervals. Further research is needed to better delineate the relationship between persistent sleep disturbances and cognition in larger numbers of ICU survivors. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02086877; URL: www.clinicaltrials.gov.
BACKGROUND: ICU survivors can experience both cognitive dysfunction and persistent sleep disturbances after hospitalization. Sleep disturbances have been linked with cognitive impairment in various patient populations, and the apolipoprotein E (APOE) genotype has been linked to sleep-related impairments in cognition. RESEARCH QUESTION: Is there an association between sleep, long-term cognition, and APOE status in ICU survivors? STUDY DESIGN AND METHODS: We enrolled 150 patients from five centers who had been mechanically ventilated for at least 3 days; 102 patients survived to ICU discharge. Actigraphy and cognitive testing were undertaken at 7 days, 6 months, and 12 months after ICU discharge, and sleep duration, quality, and timing were estimated by actigraphy. APOE single nucleotide polymorphisms were assessed for each patient. RESULTS: Actigraphy-estimated sleep fragmentation, but not total sleep time or interdaily stability (estimate of circadian rhythmicity), was associated with worse cognitive impairment at 7 days of ICU discharge. No actigraphy-estimated variable of sleep estimation at 7 days post-ICU discharge predicted cognitive impairment or persistent sleep abnormalities at 6 and 12 months of follow-up in subsequently assessed survivors. Possessing the APOE ε4 allele was not significantly associated with sleep disturbances and its presence did not modify the risk of sleep-related cognitive impairment at follow-up. INTERPRETATION: Sleep fragmentation estimated by actigraphy was associated with worse cognitive performance in hospital, but not at later time intervals. Further research is needed to better delineate the relationship between persistent sleep disturbances and cognition in larger numbers of ICU survivors. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02086877; URL: www.clinicaltrials.gov.
Authors: Matthew B Maas; Bryan D Lizza; Minjee Kim; Maged Gendy; Eric M Liotta; Kathryn J Reid; Phyllis C Zee; James W Griffith Journal: Neurocrit Care Date: 2020-10-22 Impact factor: 3.210