Insomnia disorder and long‐term mortality in adult patients treated with extracorporeal membrane oxygenation in South Korea

• Published in: Journal of sleep research Vol. 31; no. 2; pp. e13454 - n/a
• Main Authors: Park, Hye Yoon, Song, In‐Ae, Cho, Hyoung‐Won, Oh, Tak Kyu
• Format: Journal Article
• Language: English
• Published: England 01.04.2022
• Subjects: critical care; extracorporeal membrane oxygenation; intensive care unit; sleep initiation and maintenance disorders; critical care; sleep initiation and maintenance disorders; extracorporeal membrane oxygenation; intensive care unit
• ISSN: 0962-1105; 1365-2869
• DOI: 10.1111/jsr.13454

Summary We investigated the prevalence of insomnia in extracorporeal membrane oxygenation (ECMO)‐treated patients and examined the association between post‐ECMO insomnia disorder and long‐term mortality. In the present population‐based cohort study, we used data from the National Health Insurance Claims database in South Korea. All adult patients who underwent ECMO between 2006 and 2014 were included, and ECMO‐treated patients were defined as those who survived >365 days after ECMO. Insomnia disorder was identified using the International Classification of Diseases 10th Revision codes G47.0 and F51.0. Overall, 3,055 ECMO‐treated patients were included in the final analysis: 431 (14.1%) had pre‐ECMO insomnia disorder, while 148 (4.8%) were newly diagnosed with insomnia disorder up to 1 year after ECMO. In multivariable Cox regression model, patients with post‐ECMO insomnia disorder had higher 5‐year all‐cause mortality (ACM) than controls (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.21–2.42; p = 0.003); however, those with pre‐ECMO insomnia disorder did not (p = 0.655). In sensitivity analysis, post‐ECMO insomnia disorder with underlying psychiatric illness was associated with a 2.39‐fold higher 5‐year ACM in ECMO‐treated patients (HR 2.39, 95% CI 1.52–3.75; p < 0.001). In conclusion, at 1‐year after ECMO, 4.8% of ECMO‐treated patients were newly diagnosed with insomnia disorder, and post‐ECMO insomnia disorder was associated with higher 5‐year ACM, especially in those with underlying psychiatric illness. Our present results suggest that the development of insomnia disorder might be related to poorer long‐term survival in ECMO‐treated patients, especially in case of underlying psychiatric illness.