Factors affecting sleep in the critically ill: An observational study (original) (raw)
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Sleep deprivation in the critically ill
2012
The sleep patterns of 9 critically ill subjects were studied in surgical and coronary intensive care units. Subjects had variable diagnoses and were studied for one night each, using EEG recordings. Visual, tactile, aural, emotional, somatic and cognitive stimuli perceivable by each subject were recorded. The mean sleep time for all subjects was 28.06 minutes (~ 28.24 minutes). Two subjects achieved no sleep and 1 subject achieved 1 minute of sleep. The longest amount of sleep achieved was 73 nonconsecutive minutes. Stage I sleep was achieved for a mean of 22.78 minutes (~ 26.09), and was the most commonly occurring stage of sleep. No REM sleep occurred. Fifty-eight different types of stimuli were recorded with a stimulus occurring an average of once every minute. The most frequently occurring group of stimuli was
Sleep quality and quantity in intensive care unit patients: A cross-sectional study
Indian Journal of Critical Care Medicine
IntroductIon Sleep is a naturally occurring periodic, reversible state of reduced consciousness, and response to external stimuli. Normal human sleep consists four to six 90-100 min blocks, during which nonrapid eye movement and rapid eye movement (REM) sleep alternate in a cyclical fashion accounting for a total sleep duration of 7-8 h/night. [1] Sleep is an indispensable physiological need often underestimated and disregarded especially in critically ill patients. [2-4] Sleep in them is highly fragmented; therefore, they lack deep restorative REM sleep. Around 38.5% of the patients who survived critical illness and were on mechanical ventilation (MV) for at least 48 h reported not being able to sleep well, 40% of the study group remembered frequent awakenings in the night, and 35% recalled having had difficulty falling asleep during their Intensive Care Unit (ICU) admission. [5] Sleep deprivation has been associated with the release of inflammatory cytokines, worse cardiovascular outcomes, poorer immunological response, etc. [6] Sleep disruption induces a catabolic state, impairs cellular and humoral immune response, [7] and causes respiratory dysfunction due to muscle fatigue and central respiratory. [8] Sleep disturbances are known to impair consolidation of memory and cognitive function. [9-13] Various factors implicated to cause sleep deprivation in ICU setting, such as delirium because of organic causes, underlying disease state, noise, and change in environment, MV and sedatives, unavailability of familial faces, etc. [3,10,14,15] Polysomnography (PSG) is the gold standard for measuring sleep; but in the ICU setting, it is cumbersome and impractical. [13,16] Actigraphy, which is a validated substitute Introduction: Lack of restorative sleep and altered sleep-wake cycle is a frequent problem among patients admitted to the Intensive Care Unit (ICU). This study was conducted to estimate the prevalence of poor sleep and patient's perspective of factors governing poor sleep in the ICU. Materials and Methods: A cross-sectional study was performed in medical ICU of a tertiary care hospital. A total of 32 patients admitted to the ICU for at least 24 h were recruited. A 72-h actigraphy was done followed by a subjective assessment of sleep quality by the Richards-Campbell Sleep Questionnaire (RCSQ). Patient's perspective of sleep quality and quantity and possible risk factors for poor sleep were recorded. Results: Poor sleep (defined as RCSQ <50, sensitivity 88% and specificity 87%) was found in 15 out of the 32 patients (47%). The prevalence of poor sleep was higher among patients on mechanical ventilation (n = 15) (66.7% vs. 33.3%, P < 0.05). Patients with poor sleep had higher age (median age [in years] 42.8 vs. 31.4, P = 0.008), acute physiology, and chronic health evaluation II score (mean 14 ± 5.15 vs. 9.3 ± 5.64, P = 0.02), SAPS 3 score (62.7 ± 8.9 vs. 45.6 ± 10.5, P ≤ 0.0001), and worse actigraphy parameters. Only 55.63% of total sleep time was in the night (2200-0600). All patients had discomfort from indwelling catheters and suctioning of endotracheal tubes. All patients suggested that there be a minimum interruption in the sleep for interventions or medications. Conclusion: There is a high prevalence of poor sleep among patients admitted to the ICU. There is a dire need to minimize untimely interventions and design nonpharmacological techniques to allow patients to sleep comfortably.
A Meta-analysis of Sleep-promoting Interventions During Critical Illness
The American Journal of Medicine, 2015
Background: Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients. Methods: We included RCTs that objectively measured sleep with electroencephalography or its derivatives and excluded observational studies and those that measured sleep by subjective reports. The research was performed according to PRISMA guidelines. Results: Of 6,022 studies identified, 13 studies met eligibility criteria involving 296 critically-ill patients. Eight trials looked at different modes of mechanical ventilation as sleep interventions, and the remaining five involved pharmacological, non-pharmacological, or environmental interventions. Meta-analysis of the studies revealed that sleep-promoting interventions improved sleep quantity (pooled standardized mean of differences [SMD] 0.37, 95%CI: 0.05, 0.69; P=0.02) and sleep quality through reduction in sleep fragmentation (SMD-0.31; 95%CI-0.60,-0.01; P=0.04). Subgroup analysis revealed that timed-modes of ventilation improved sleep quantity when compared to spontaneous-modes of ventilation (SMD 0.45, 95%CI 0.10, 0.81; P=0.01). Non-mechanical ventilation interventions tended to improve sleep quantity (SMD 0.65; 95%CI;-0.03, 1.33; P=0.06) and tended to reduce sleep fragmentation (SMD-0.29; 95% CI-0.61, 0.03; P=0.07). Conclusions: The synthesized evidence suggests that both mechanical ventilation and nonmechanical ventilation-based therapies improve sleep quantity and quality in critically ill patients but the clinical significance is unclear. In the future, adequately-powered multi-center RCTs involving pharmacological interventions to promote sleep in critically ill patients are warranted.
Sleep in Critically Ill Patients Requiring Mechanical Ventilation
Chest, 2000
Study objectives: To objectively measure sleep in critically ill patients requiring mechanical ventilation and to define selection criteria for future studies of sleep continuity in this population. Design: Prospective cohort analysis. Setting: University teaching hospital medical-surgical ICU. Patients: Twenty critically ill (APACHE II [acute physiology and chronic health evaluation II] acute physiology score [APS], 10 ؎ 5), mechanically ventilated adults (male 12, female 8, age 62 ؎ 15 years) with mild to moderate acute lung injury (lung injury score, 1.8 ؎ 0.9) 10 ؎ 7 days after admission to the ICU. Measurements and results: Patients were divided into three groups based on 24-h polysomnography (PSG) findings. No patient demonstrated normal sleep. In the "disrupted sleep" group (n ؍ 8), electrophysiologic sleep was identified and was distributed throughout the day (6:00 AM to 10:00 PM; 4.0 ؎ 2.9 h) and night (10:00 PM to 6:00 AM; 3.0 ؎ 1.9 h) with equivalent proportions of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Nocturnal sleep efficiency was severely reduced (38 ؎ 24%) with an increased proportion of stage 1 NREM sleep (40 ؎ 28% total sleep time [TST]) and a reduced proportion of REM sleep (10 ؎ 14% TST). Severe sleep fragmentation was reflected by a high frequency of arousals (20 ؎ 17/h) and awakenings (22 ؎ 25/h). Electrophysiologic sleep was not identifiable in the PSG recordings of the remaining patients. These were classified either as "atypical sleep" (n ؍ 5), characterized by transitions from stage 1 NREM to slow wave sleep with a virtual absence of stage 2 NREM and reduced stage REM sleep, or "coma" (n ؍ 7), characterized by > 50% delta or theta EEG activity with (n ؍ 5) and without (n ؍ 2) evidence of EEG activation either spontaneously or in response to deep painful stimuli. The combined atypical sleep and coma groups had a higher APS (13 ؎ 4 vs 6 ؎ 4) and higher doses of sedative medications than the disrupted sleep group. Conclusion: Sleep, as it is conventionally measured, was identified only in a subgroup of critically ill patients requiring mechanical ventilation and was severely disrupted. We have proposed specific criteria to select patients for future studies to evaluate potential causes of sleep disruption in this population.
Annals of Intensive Care, 2015
Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep.
Sleep disorders in critical care unit
2018
Sleep deprivation is common in critically ill patients in ICU. It is not surprising that sleep disturbances and fatigue are among the most common symptoms in critically ill adults. Many factors such as preexisting sleep disorders, pathophysiology of the underlying illness/injury, therapeutic interventions, medications, and ICU environment, play roles in sleep and fatigue symptoms during recovery from acute illness or injury. Sleep disruption is a significant stressor in the ICU that can negatively affect recovery and even survival.
Quality of Sleep Among Intensive Care Unit Patients
Critical care nursing quarterly, 2018
Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.
Critical Care, 2008
Introduction The aim of the present prospective multicenter cohort study was to examine the prevalence of sleep disturbance and its relation to the patient's reported healthrelated quality of life after intensive care. We also assessed the possible underlying causes of sleep disturbance, including factors related to the critical illness. Methods Between August 2000 and November 2003 we included 1,625 consecutive patients older than 17 years of age admitted for more than 24 hours to combined medical and surgical intensive care units (ICUs) at three hospitals in Sweden. Conventional intensive care variables were prospectively recorded in the unit database. Six months and 12 months after discharge from hospital, sleep disturbances and the healthrelated quality of life were evaluated using the Basic Nordic Sleep Questionnaire and the Medical Outcomes Study 36-item Short-form Health Survey, respectively. As a nonvalidated single-item assessment, the quality of sleep prior to the ICU period was measured. As a reference group, a random sample (n = 10,000) of the main intake area of the hospitals was used. Results The prevalence of self-reported quality of sleep did not change from the pre-ICU period to the post-ICU period. Intensive care patients reported significantly more sleep disturbances than the reference group (P < 0.01). At both 6 and 12 months, the main factor that affected sleep in the former hospitalised patients with an ICU stay was concurrent disease. No effects were related to the ICU period, such as the Acute Physiology and Chronic Health Evaluation score, the length of stay or the treatment diagnosis. There were minor correlations between the rate and extent of sleep disturbance and the healthrelated quality of life. Conclusion There is little change in the long-term quality of sleep patterns among hospitalised patients with an ICU stay. This applies both to the comparison before and after critical care as well as between 6 and 12 months after the ICU stay. Furthermore, sleep disturbances for this group are common. Concurrent disease was found to be most important as an underlying cause, which emphasises that it is essential to include assessment of concurrent disease in sleep-related research in this group of patients.