Sleep Quality Associated with Motor Function among Older Adult Survivors of Critical Illness.
Sleep Quality Associated with Motor Function among Older Adult Survivors of Critical Illness.
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DOI：
10.1097/nnr.0000000000000418
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发表时间：
2020-01
期刊：
影响因子：
2.5
通讯作者：
Maya N. Elías;C. Munro;Zhan Liang
中科院分区：
文献类型：
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作者：
Maya N. Elías;C. Munro;Zhan Liang
背景睡眠不佳与老年人运动功能较差有关。睡眠可能会影响运动功能，特别是在从重症监护室（ICU）转移后从危重病中恢复的老年人中。描述老年ICU幸存者的运动功能（握力），并探讨ICU后早期过渡期睡眠与ICU获得性虚弱之间的关系。方法：我们招募了30名老年人，他们在住院前功能独立，在ICU中机械通气，并在ICU出院后24-48小时内。握力测定法评估ICU后运动功能（国立卫生研究院运动电池握力测试的完全校正T评分）。活动记录法估计了连续两个晚上从22：00 PM到06：00 AM的ICU后睡眠持续时间（总睡眠时间; TST）和碎片化（入睡后觉醒; WASO）。我们使用独立样本t检验确定了阻塞性睡眠呼吸暂停（OSA）病史在握力方面的差异。在调整临床相关协变量后，我们使用探索性多变量回归分析研究了睡眠时间和握力之间的关系。结果：这组ICU老年幸存者的握力几乎比健康老年人的正常值低两个标准差，表明相当大的ICU获得性虚弱。有OSA病史的受试者的握力低于无OSA的受试者。在调整OSA病史和匹兹堡睡眠质量指数总体评分后，TST越大，握力越差。此外，在调整急性生理学、年龄和慢性健康评估III评分和PSQI总体评分后，在男性亚组（n = 19）中，更大的TST与握力显著负相关。讨论促进睡眠可能是一个潜在的可改变的风险因素，以减轻老年ICU幸存者的ICU获得性虚弱。我们认为，在从危重病中恢复的整个过程中改善睡眠可能间接促进更好的结果，因为握力差与住院时间更长，出院处置的敏锐度更高以及老年人功能下降恶化有关。
BACKGROUND Poor sleep is associated with worse motor function in older adults. Sleep may affect motor function specifically among older adults recovering from critical illness after transfer out of an intensive care unit (ICU). OBJECTIVES Describe motor function (grip strength) of older ICU survivors, and explore relationships between sleep and ICU-acquired weakness in the early post-ICU transition period. METHODS We enrolled 30 older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24-48 hours post-ICU discharge. Handgrip dynamometry assessed post-ICU motor function (fully-corrected T score on the National Institutes of Health Motor Battery Grip Strength Test). Actigraphy estimated post-ICU sleep duration (total sleep time; TST) and fragmentation (wake after sleep onset; WASO) over two consecutive nights from 22:00 PM to 06:00 AM. We identified differences in grip strength by history of obstructive sleep apnea (OSA) using independent samples t-tests. We examined associations between sleep duration and grip strength using exploratory multivariate regression analyses, after adjustment for clinically relevant covariates. RESULTS Grip strength among this cohort of older ICU survivors was almost two standard deviations below the norm for healthy older adults, indicating considerable ICU-acquired weakness. Grip strength was lower among subjects with history of OSA than those without OSA. Greater TST was associated with worse grip strength, after adjusting for history of OSA and Pittsburgh Sleep Quality Index global score. Moreover, among the subset of males (n = 19), greater TST was significantly and negatively associated with grip strength, after adjusting for Acute Physiology, Age, and Chronic Health Evaluation III score and PSQI global score. DISCUSSION Sleep promotion may be a potentially modifiable risk factor to mitigate ICU-acquired weakness in older ICU survivors. We propose that improving sleep throughout recovery from critical illness may indirectly promote better outcomes, as poor grip strength is linked to longer length of hospital stay, higher acuity of discharge disposition, and worsened functional decline in older adults.