收稿日期: 2025-01-13
网络出版日期: 2025-08-12
基金资助
浙江省自然科学基金探索项目(LTGY24H090006)
Influencing factors of sleep disorders in post-ICU patients：a systematic review and meta-analysis
目的 系统评价和Meta分析ICU转出患者睡眠障碍的影响因素。方法 检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、CINAHL、Cochrane Library、Web of Science数据库中有关ICU转出患者睡眠障碍影响因素的文献。检索时限为建库至2024年8月31日。采用Stata 18.0软件进行数据分析。结果 共纳入9篇文献，包括6 558例患者，共提取出19项影响因素。将9项影响因素进行Meta合并，有意义的危险因素包括ICU入住时长（OR=1.136）、共病（OR=2.257）、抑郁（OR=1.497）、疼痛（OR=1.121）；有意义的保护因素包括生理健康（OR=0.897；MD=7.483）、心理健康（OR=0.845；MD=7.993）。剩余无法合并的影响因素进行系统评价，危险因素包括急性生理与慢性健康状况Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）评分、气管切开、创伤后应激障碍（post-traumatic stress disorder，PTSD）、ICU感染、血清大麻素水平、药物滥用；保护因素包括ICU转出时侵入性管路移除数量、血清褪黑素水平、年龄、病房睡眠质量。结论 ICU转出患者睡眠障碍受多种因素影响，涉及治疗、生理、心理方面。医护人员应尽早、全面、动态评估ICU转出患者的睡眠状况，给予个体化和精准化的预防及干预措施。同时，鉴于纳入文献数量和质量限制，上述部分研究结果需要未来更多高质量研究进一步验证。
姜伟林 , 王莉 , 黄真真 , 燕然 , 易佳 , 庄一渝 . ICU转出患者睡眠障碍影响因素的系统评价和Meta分析[J]. 中华急危重症护理杂志, 2025 , 6(8) : 945 -952 . DOI: 10.3761/j.issn.2096-7446.2025.08.007
Objective To systematically review and meta-analyze the influencing factors of sleep disorders in post-ICU patients. Methods We searched related literature on influencing factors of sleep disorders in post-ICU patients in CNKI，Weipu Database，Wanfang Database，SinoMed，PubMed，Embase，CINAHL，Cochrane Library，and Web of Science，the retrieval time was from inception of the database to August 31，2024. All analyses were performed using Stata version 18.0. Results A total of 9 studies，involving 6 558 patients and 19 influencing factors，met the inclusion criteria. Nine influencing factors were pooled for meta-analysis. The identified significant risk factors included length of ICU stay（OR=1.136），comorbidity（OR=2.257），depression（OR=1.497），and pain（OR=1.121）. Significant protective factors included physical health（OR=0.897；MD=7.483），and mental health （OR=0.845；MD=7.993）. The remaining influencing factors，which could not be pooled，were systematically reviewed. The risk factors included Acute Physiology and Chronic Health Evaluation（APACHE） Ⅱ score，tracheotomy，post-traumatic stress disorder（PTSD），ICU infections，serum cannabinoid levels，and drug abuse. Protective factors included the number of invasive tube removals at ICU discharge，serum melatonin levels，age，and ward sleep quality. Conclusion Sleep disorders in post-ICU patients are influenced by various factors，including therapeutic，physiological，and psychological aspects. Doctors and nurses should evaluate the sleep status of post-ICU patients as early as possible，comprehensively，and dynamically，providing individualized and precise prevention and intervention measures. However，due to limitations in the quantity and quality of the included studies，some findings require further verification through higher-quality research in the future.
| [1] | Pase MP, Harrison S, Misialek JR, et al. Sleep architecture,obstructive sleep apnea,and cognitive function in adults[J]. JAMA Netw Open, 2023, 6(7):e2325152. |
| [2] | Lim DC, Najafi A, Afifi L, et al. The need to promote sleep health in public health agendas across the globe[J]. Lancet Public Health, 2023, 8(10):e820-e826. |
| [3] | Gravante F, Trotta F, Latina S, et al. Quality of life in ICU survivors and their relatives with post-intensive care syndrome:a systematic review[J]. Nurs Crit Care, 2024, 29(4):807-823. |
| [4] | King J, O’Neill B, Ramsay P, et al. Identifying patients’ support needs following critical illness:a scoping review of the qualitative literature[J]. Crit Care, 2019, 23(1):187. |
| [5] | 崔大磊, 徐思梦, 张霞, 等. 心脏外科手术患者转出ICU前后睡眠轨迹潜在类别及影响因素研究[J]. 中华急危重症护理杂志, 2025, 6(1):50-56. |
| Cui DL, Xu SM, Zhang X, et al. Research on the latent classes and influencing factors of sleep trajectories in cardiac surgery patients before and after transfer out of ICU[J]. Chin J Emerg Crit Care Nurs, 2025, 6(1):50-56. | |
| [6] | Renner C, Jeitziner MM, Albert M, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome[J]. Crit Care, 2023, 27(1):301. |
| [7] | Gauld C, Wakefield JC, Micoulaud-Franchi JA. Proposing a definition for sleep disorders:an epistemological review[J]. Sleep Med Rev, 2025, 79:102028. |
| [8] | 宋秀秀, 吴娟, 王逸楠. ICU转出患者睡眠障碍发生率的系统评价[J]. 中华护理杂志, 2023, 58(6):743-750. |
| Song XX, Wu J, Wang YN. Prevalence of sleep disorders in post-ICU patients:a systematic review[J]. Chin J Nurs, 2023, 58(6):743-750. | |
| [9] | 孙英明, 孙娜, 张敏, 等. ICU转出患者睡眠障碍及其评估工具的研究进展[J]. 中国护理管理, 2020, 20(6):950-955. |
| Sun YM, Sun N, Zhang M, et al. Research progress on sleep disorder in post-ICU patients and relevant assessment tools[J]. Chin Nurs Manag, 2020, 20(6):950-955. | |
| [10] | 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具[J]. 中国循证心血管医学杂志, 2012, 4(4):297-299. |
| Zeng XT, Liu H, Chen X, et al. Meta-analysis series IV:quality assessment tools for observational studies[J]. Chin J Evid Based Cardiovasc Med, 2012, 4(4):297-299. | |
| [11] | Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J]. Eur J Epidemiol, 2010, 25(9):603-605. |
| [12] | 彭仁梅, 钱荣, 李亚军, 等. ICU转出患者睡眠障碍风险列线图预测模型的构建与验证[J]. 护理学报, 2023, 30(15):16-22. |
| Peng RM, Qian R, Li YJ, et al. Construction and validation of nomogram to predict sleep disorder risk in patients transferred from ICU[J]. J Nurs China, 2023, 30(15):16-22. | |
| [13] | 王丽竹, 李茜, 朱祎容, 等. 蛛网膜下腔出血患者出院后睡眠障碍影响因素研究[J]. 护理与康复, 2022, 21(9):5-9. |
| Wang LZ, Li Q, Zhu YR, et al. Study on influencing factors of sleep disorders for discharged patients with subarachnoid hemorrhage[J]. J Nurs Rehabil, 2022, 21(9):5-9. | |
| [14] | Oh TK, Park HY, Song IA. Occurrence and long-term prognosis of insomnia disorder among survivors of acute respiratory distress syndrome in south Korea[J]. Ann Am Thorac Soc, 2022, 19(6):1022-1029. |
| [15] | Altman MT, Knauert MP, Murphy TE, et al. Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness:an observational cohort study[J]. Ann Intensive Care, 2018, 8(1):63. |
| [16] | Caruana N, McKinley S, Elliott R, et al. Sleep quality during and after cardiothoracic intensive care and psychological health during recovery[J]. J Cardiovasc Nurs, 2018, 33(4):E40-E49. |
| [17] | Parsons EC, Hough CL, Vitiello MV, et al. Insomnia is associated with quality of life impairment in medical-surgical intensive care unit survivors[J]. Heart Lung, 2015, 44(2):89-94. |
| [18] | McKinley S, Fien M, Elliott R, et al. Sleep and psychological health during early recovery from critical illness:an observational study[J]. J Psychosom Res, 2013, 75(6):539-545. |
| [19] | Parsons EC, Kross EK, Caldwell ES, et al. Post-discharge insomnia symptoms are associated with quality of life impairment among survivors of acute lung injury[J]. Sleep Med, 2012, 13(8):1106-1109. |
| [20] | Orwelius L, Nordlund A, Nordlund P, et al. Prevalence of sleep disturbances and long-term reduced health-related quality of life after critical care:a prospective multicenter cohort study[J]. Crit Care, 2008, 12(4):R97. |
| [21] | Tronstad O, Flaws D, Patterson S, et al. Evaluation of the sensory environment in a large tertiary ICU[J]. Crit Care, 2023, 27(1):461. |
| [22] | Seifen C, Huppertz T, Matthias C, et al. Obstructive sleep apnea in patients with head and neck cancer-more than just a comorbidity?[J]. Medicina, 2021, 57(11):1174. |
| [23] | Babson KA, Sottile J, Morabito D. Cannabis,cannabinoids,and sleep:a review of the literature[J]. Curr Psychiatry Rep, 2017, 19(4):23. |
| [24] | Jia SH, Guo XT, Chen ZX, et al. The roles of the circadian hormone melatonin in drug addiction[J]. Pharmacol Res, 2022, 183:106371. |
| [25] | Mouchati C, Katzan I, Munoz LM, et al. Prevalence of obstructive sleep apnea and insomnia in neurological populations (P9-9.006)[J]. Neurology, 2024, 102(7_supplement_1):3365. |
| [26] | Li SY, Zheng W, Wang X, et al. The impact of obstructive sleep apnea and comorbidity status on cardiovascular outcomes in patients with acute coronary syndrome[J]. Nutr Metab Cardiovasc Dis, 2023, 33(12):2372-2383. |
| [27] | Yin JH, Gong RP, Zhang M, et al. Associations between sleep disturbance,inflammatory markers and depressive symptoms:Mediation analyses in a large NHANES community sample[J]. Prog Neuropsychopharmacol Biol Psychiatry, 2023, 126:110786. |
| [28] | Jiang Y, Gong X, Yu M, et al. Relationships between orofacial pain and sleep:analysis of UK biobank and genome-wide association studies data[J]. J Dent Sci, 2025, 20(1):529-538. |
| [29] | 尹金瑜, 陈香萍, 劳月文, 等. ICU转出患者慢性疼痛评估与预测工具的研究进展及启示[J]. 中华急危重症护理杂志, 2024, 5(10):926-931. |
| Yin JY, Chen XP, Lao YW, et al. Research progress and enlightenment of evaluation and prediction tools for chronic ICU-related pain[J]. Chin J Emerg Crit Care Nurs, 2024, 5(10):926-931. | |
| [30] | Meth EMS, N?ga DA, Dubol M, et al. The impact of pharmacotherapy for premenstrual dysphoric disorder on sleep[J]. Sleep Med Rev, 2025, 80:102069. |
| [31] | Mander BA, Winer JR, Walker MP. Sleep and human aging[J]. Neuron, 2017, 94(1):19-36. |
| [32] | de Leeuw M, Verhoeve SI, van der Wee NJA, et al. The role of the circadian system in the etiology of depression[J]. Neurosci Biobehav Rev, 2023, 153:105383. |
| [33] | Slavish DC, Briggs M, Fentem A, et al. Bidirectional associations between daily PTSD symptoms and sleep disturbances:a systematic review[J]. Sleep Med Rev, 2022, 63:101623. |
/
| 〈 |
|
〉 |