Sleep Quality in ICU Subjects Receiving Noninvasive Respiratory Support: A Prospective Observational Study

Background: Sleep deprivation is common in critically ill patients because of disease severity and ICU conditions, yet sleep quality in those requiring noninvasive respiratory support remains understudied. Methods: This prospective observational study in a teaching hospital ICU enrolled subjects on noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC) who could tolerate overnight polysomnography (PSG). Sleep was assessed using standard PSG from 22:00 in the evening until 08:00 the following morning. The primary outcome was to evaluate sleep quantity and quality. Results: A total of 72 subjects (43 NIV and 29 HFNC) were included in the study. Compared with healthy adults, subjects receiving noninvasive respiratory support exhibited significantly shorter total sleep time (median 396.0 vs 279.5 min), lower sleep efficiency (85.7% vs 45.9%), longer wake after sleep onset (48.2 vs 297.1 min), higher stage 1 of non-rapid-eye movement (non-REM) sleep (N1, 7.9% vs 37.8%), lower stage 3 of non-REM sleep (N3, 20.4% vs 4.9%), lower REM sleep (19.0% vs 9.4%), longer REM latency (97.4 vs 171.7 min), and a higher arousal index (AI, 12.6 vs 39.2 per hour; all P < .01). No significant differences were found between NIV and HFNC subgroups. However, clinically improved subjects ( n = 60) had lower N1 (35.6% vs 50.0%, P < .01) and higher REM sleep (10.3% vs 4.9%, P = .02) than this without clinical improvement ( n = 12). Conclusions: In the ICU setting, noninvasive respiratory support subjects experienced poor sleep quality, with no modality difference (NIV vs HFNC). However, subjects with clinical improvement demonstrated relatively better sleep quality than those without improvement.