Sleep and delirium in the intensive care: A prospective cohort study of nurses documentation and patients insights

Abstract

Sleep disruption is common in intensive care unit (ICU) patients, with reduced quality and quantity of sleep in many patients. Sleep in this setting may be related to the prevalence of delirium. The aim of this study was to describe ICU patients’ self-reported assessment of sleep, examine the relationship between patients’ self-reported sleep and associated nurses’ assessment of sleep and delirium status, and describe the sleep promotion strategies suggested by patients. A prospective cohort study was undertaken with communicative adult patients recruited in 2014–2015. Patients reported sleep using the Richards–Campbell Sleep Questionnaire (range 0–100; higher score indicates better sleep quality), with nursing assessment of sleep documented into categories. Delirium was assessed using the Confusion Assessment Method – ICU. Participants were asked daily to describe strategies that helped or hindered their sleep. Ethics approval for the study was gained. Descriptive statistics are provided as median (inter-quartile range); differences were assessed using the Kruskal–Wallis test (p < 0.05). Participants (n = 151) provided 355 reports of sleep [age: 60 (46–71) years; ICU length of stay 4 (2–9) days]. Average perceived sleep quality was 46 (26–65). Patients’ self-assessment of sleep varied widely across categories of sleep documented by nurses (see below table). Using the latest sleep assessment patients provided in ICU there was no difference in sleep for those who were delirious or not (p = 0.35). Strategies identified by patients to improve sleep included pain relief and sedation, peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs.