Abstract
Sleep disturbances are common in critically ill patients and have been characterised by numerous studies using polysomnography. Issues regarding patient populations, monitoring duration and timing (nocturnal versus continuous), as well as practical problems encountered in critical care studies using polysomnography are considered with regard to future interventional studies on sleep. Polysomnography is the gold standard in objectively measuring the quality and quantity of sleep. However, it is difficult to undertake, particularly in patients recovering from critical illness in an acute-care area. Therefore, other objective (actigraphy and bispectral index) and subjective (nurse or patient assessment) methods have been used in other critical care studies. Each of these techniques has its own particular advantages and disadvantages. We use data from an interventional study to compare agreement between four of these alternative techniques in the measurement of nocturnal sleep quantity. Recommendations for further developments in sleep monitoring techniques for research and clinical application are made. Also, methodological problems in studies validating various sleep measurement techniques are explored.Current Controlled Trials ISRCTN47578325.
Highlights
Sleep disturbances are common in critically ill patients and they contribute to patient morbidity
Study comparing different sleep measurement techniques In the context of a small randomised trial on the effect of melatonin on sleep in critical care patients, we investigated nocturnal sleep in 24 patients studied over the span of 4 nights who were being weaned from mechanical ventilation
Objective techniques include polysomnography, processed electroencephalograms (EEGs), and actigraphy, whereas subjective assessment usually relies on methods of nurse observation or patient self-report
Summary
Sleep disturbances are common in critically ill patients and they contribute to patient morbidity. Inter- and intra-patient variability occurs; this is not surprising given the multiple causes of sleep disruption in this patient group. These include environmental factors [3,4], medication [5], ventilator [6], stress response, inflammatory response, and circadian rhythm disturbance factors [2]. To control for these co-variables, studies should involve relatively large patient numbers and be conducted over multiple days and nights. The guidelines recommend patient self-report, but if this is not possible nurse observation could be used
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