Post-ICU Insomnia Common in Patients Admitted for Acute Respiratory Failure

New research is shedding light on the prevalence of insomnia among patients admitted to the intensive care unit (ICU) with acute respiratory failure (ARF), highlighting frequent reports of sleep disturbances in this patient population.1

Study findings were presented at the American Thoracic Society (ATS) International Conference 2025 by Dexter Corlett, MD, MPH, Indiana University School of Medicine, and point to the role preexisting mental health diagnoses and a neurologic cause for ARF may play in increasing patients’ risk of post-ICU sleep dysfunction.1

“Patients admitted to the ICU frequently experience sleep disturbances. These disturbances can persist for months or even years following critical illness,” Corlett and colleagues wrote.1 “The prevalence of sleep disturbances in ARF ICU survivors is less well understood.”

The respiratory system facilitates gas exchange between the environment and the body, aiding the process of aerobic metabolism. Specifically, the respiratory system provides oxygen and removes carbon dioxide from the body – the inability to perform either or both of these tasks results in respiratory failure.2

Because it is caused by a multitude of pathological states, the epidemiology and prognosis of respiratory failure is difficult to ascertain. Affected patients frequently require emergency medical treatment in a hospital, posing important implications for their sleep health based on known associations between ICU stay and sleep disturbances.1,2

The data presented at ATS represent a secondary analysis of the mobile critical care recovery program (mCCRP) clinical trial, which included patients ≥ 18 years of age admitted with ARF requiring invasive ventilation at 4 Indiana hospital ICUs (n = 466). Demographics, comorbidities, and clinical characteristics were assessed using the electronic medical record during the index admission.1

Investigators assessed severity of illness using the Acute Physiology and Chronic Health Evaluation Score (APACHE-II). Additionally, sleep quality was assessed with the Insomnia Severity Index (ISI) at time of ICU discharge, with scores ranging from 0-28 and higher scores being indicative of worse insomnia.1

The present analysis included patients who completed an ISI at discharge (n = 362). Among the cohort, the mean age was 55.2 (standard deviation [SD], 14.0) years, 53.6% of patients were female, 37.6% identified as Black, and 17.7% had pre-existing sleep disorders.1

Participants’ mean APACHE-II score was 24.8 (SD, 8.8). Of the 362 patients, 31.2% reported clinical insomnia and 29.6% reported subthreshold insomnia. Investigators noted patients with clinical insomnia had significantly increased rates of anxiety (47%) compared with those with subthreshold insomnia (31%) or no insomnia (25%; P = .001). Those with clinical insomnia also had greater rates of depression (53%) compared with those with subthreshold insomnia (31%) or no insomnia (25%; P = .032).1

In a logistic regression model, patients with baseline anxiety had significantly increased odds of developing clinical insomnia (odds ratio [OR], 2.07; 95% CI, 1.17 - 3.65), as did those with a neurologic etiology of their ARF (OR, 3.12; 95% CI, 1.35 - 7.22).1

“Insomnia was highly prevalent in our cohort of ICU survivors with ARF, with over 60% of patients experiencing some degree of sleep disturbance. Preexisting mental health diagnoses and a neurologic cause for acute respiratory failure were significant risk factors for post-ICU sleep dysfunction,” investigators concluded.1 “Further study is needed to help determine interventions to reduce sleep disturbances both during ICU admission and after discharge.”

References

1. Corlett D, Perkins AJ, Koehler Z, et al. Insomnia Severity Following Intensive Care Unit Admission for Acute Respiratory Failure. Abstract presented at the American Thoracic Society (ATS) International Conference 2025 in San Francisco, CA, from May 18 - May 21, 2025.

2. Mirabile VS, Shebl E, Sankari A, et al. Respiratory Failure in Adults. StatPearls. June 11, 2023. Accessed May 18, 2025. https://www.ncbi.nlm.nih.gov/books/NBK526127/