Endoscope-guided nasoenteric feeding improves sleep quality in ICU patients: a retrospective study

Poor sleep and circadian disruption are pervasive in critically ill adults receiving enteral nutrition. Whether feeding-tube placement technique influences these physiological outcomes is unknown. Disposable endoscope-guided tubes provide real-time visualization and might improve both procedural performance and downstream sleep–circadian biology. In this single-centre retrospective cohort study, we analysed 32 adults requiring nasoenteric feeding, 16 managed with a disposable endoscopic visual tube and 16 with conventional blind tubes. Baseline demographic, clinical, nutritional, and laboratory characteristics were comparable. The primary endpoint was first-attempt catheterization success confirmed by radiography. Secondary endpoints included overall success, catheterization time, operator ratings, 48-h safety, polysomnography- and actigraphy-derived sleep metrics, and circadian markers (including dim-light melatonin onset DLMO, relative amplitude, and interdaily stability). Endoscopic guidance improved first-attempt success (15/16 93.8% vs. 10/16 62.5%; p = 0.03) and shortened catheterization time (6.2 ± 1.3 vs. 8.5 ± 2.1 min; p = 0.004). Operators rated intubation smoother (4.6 ± 0.5 vs. 3.9 ± 0.7; p = 0.002) and more convenient (4.7 ± 0.5 vs. 4.0 ± 0.6; p = 0.003). Vital signs, haemoglobin, creatinine, adverse events, and device defects did not differ significantly (p > 0.05). Sleep–circadian outcomes showed higher sleep efficiency (82.0 ± 6.7% vs. 69.0 ± 9.7%), shorter sleep latency (12.8 ± 8.6 vs. 30.0 ± 15.8 min), fewer awakenings (5.2 ± 1.6 vs. 10.3 ± 3.6)/arousals (12.8 ± 3.2 vs. 20.0 ± 4.1 events per hour), higher per cent of N3 sleep (18.2 ± 4.0% vs. 10.9 ± 4.8%) and REM sleep (29.7 ± 4.8% vs. 15.8 ± 6.5%), higher RCSQ scores (71.0 ± 8.2 vs. 43.7 ± 12.7 mm), and more favourable circadian markers (including DLMO (19.3 ± 0.9 vs. 21.6 ± 1.0 h), relative amplitude (0.8 ± 0.1 vs. 0.5 ± 0.1), interdaily stability (0.7 ± 0.1 vs. 0.4 ± 0.1, p < 0.001), and intradaily variability (0.8 ± 0.2 vs.1.3 ± 0.3) in the endoscope-guided group (all p < 0.05). Disposable endoscope-guided nasoenteric tube placement was associated with higher first-attempt success and shorter placement time compared with blind placement; compared with blind placement, endoscopic guidance showed directionally favourable sleep efficiency and circadian rhythmicity across complementary endpoints (nominal two-sided p-values).