Sleep quality and risk of oropharyngeal dysphagia in older people in intensive care units

Lira, Isabela Cristina Monteiro de; Martins, Natália de Castro e Silva; Oliveira Filho, Luciano Pedrosa de; Silva, Bianca Emmanuely Clemente da; Studart-Pereira, Luciana Moraes

doi:10.1590/2317-1782/e20250183en

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Original Article • CoDAS 38 (4) • 2026 • https://doi.org/10.1590/2317-1782/e20250183en linkcopy

Sleep quality and risk of oropharyngeal dysphagia in older people in intensive care units

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To associate the risk of oropharyngeal dysphagia with poor sleep quality in older adults in intensive care units.

Methods Analytical, observational, cross-sectional study carried out in intensive care units with purposive sampling. A screening form was completed daily for patients admitted during the research period, totaling 221 participants. The inclusion criteria were older individuals (> 60 years old) with preserved cognitive status, communication skills, and physical and emotional stability; based on these criteria, the sample comprised 66 participants. The study used the Richards-Campbell Sleep Questionnaire to assess sleep quality, item 4 of the Sleep in ICU Questionnaire to assess daytime sleepiness, and the Oropharyngeal Dysphagia Screening in Hospitalized Older Adults to assess the risk of dysphagia.

Results There was a predominance of females (65.2%) and of the age group of 60-70 years (66.7%). Of these, 30.3% were hospitalized due to respiratory problems. Most of the sample (62.1%) reported good sleep quality, while 37.9% had poor sleep. Sleep depth and time to sleep lowest scores, reflecting increased sleep latency and reduced sleep depth. Also, 16.7% scored at risk for oropharyngeal dysphagia during hospitalization, with choking (24.2%) and respiratory incoordination (22.7%) being the most prevalent risk signs in the study population. The risk of oropharyngeal dysphagia was not significantly associated with poor sleep quality (p > 0.05).

Conclusion Sleep quality was not associated with the risk of dysphagia in older adults admitted to intensive care units.

Keywords:
Deglutition Disorders; Intensive Care Units; Sleepiness; Sleep Quality; Aged

Variables	n	%
Age (years)
60 – 70	44	66.7
71 – 80	16	24.2
81 – 90	6	9.1
Sex
Males	23	34.8
Females	43	65.2
Reason for admission
Respiratory changes	20	30.4
Oncological	10	15.3
Respiratory changes and cardiovascular changes	7	10.6
Clinical Multimorbidity^*	29	43.7

RCSQ items ^*	Mean ± SD	Median (Q₁; Q₃)	Minimum – Maximum
Sleep depth	43.8 ± 37.2	50.0 (0.0; 80.0)	0.0 – 100.0
Time to sleep	47.9 ± 33.4	50.0 (20.0; 72.5)	0.0 – 100.0
Awakenings	54.4 ± 31.3	60.0 (30.0; 80.0)	0.0 – 100.0
Return to sleep	53.8 ± 35.2	60.0 (20.0; 82.5)	0.0 – 100.0
Sleep quality	55.6 ± 35.6	60.0 (20.0; 80.0)	0.0 – 100.0
Noise	71.1 ± 32.0	80.0 (60.0; 100.0)	0.0 – 100.0
Please rate your overall level of daytime sleepiness during your ICU stay (SICUQ).	6.2 ± 2.7	6.0 (4.0; 8.0)	1.0 – 10.0

Variables	Please rate your overall level of daytime sleepiness during your ICU stay	p-value
Variables	Median (Q₁; Q₃)	p-value
Age (years)
60 – 70	6.0 (4.3; 8.0)	0.711 ^*
71 – 80	6.0 (4.0; 10.0)
81 – 90	5.0 (4.5; 8.5)
Sex
Males	5.0 (4.0; 7.0)	0.164 ^**
Females	7.0 (5.0; 9.0)
RCSQ
Poor	5.0 (3.0; 8.0)	0.039 **
Good	7.0 (5.0; 9.0)
RADI-H
At risk	5.0 (4.0; 9.0)	0.584 **
No risk	6.0 (5.0; 8.0)

Variables	RCSQ		p-value
	Poor	Good
	n (%)	n (%)
RADI-H
At risk	4 (36.4)	7 (63.6)	1.000 ^*
No risk	21 (38.2)	34 (61.8)

Variables	RCSQ		p-value	RADI-H		p-value
	Poor	Good		At risk	No risk
	n (%)	n (%)		n (%)	n (%)
Age (years)
60 – 70	17 (38.6)	27 (61.4)	0.725 ^*	7 (15.9)	37 (84.1)	0.453 *
71 – 80	5 (31.3)	11 (68.7)		2 (12.5)	14 (87.5)
81 – 90	3 (50.0)	3 (50.0)		2 (33.3)	4 (66.7)
Sex
Males	8 (34.8)	15 (65.2)	0.705 ^**	5 (21.7)	18 (78.3)	0.495 *
Females	17 (39.5)	26 (60.5)		6 (14.0)	37 (86.0)

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[1] (*) Cases involving the coexistence of two or more relevant clinical conditions, as respiratory and oncological changes; renal/hepatic changes and sepsis; cardiovascular changes, drug intoxication and CT; respiratory changes and renal/hepatic changes; respiratory changes and grade III obesity; cardiovascular changes; renal/hepatic changes; cardiovascular and oncological changes; gastrointestinal changes, renal and oncological changes; sepsis; respiratory, renal and oncological changes; renal changes, sepsis and oncological changes; gastrointestinal and oncological changes; cardiovascular changes and gastrointestinal changes; oncological + postoperative.