Sleep In Intensive Care Patients Research Articles

Night sleep in intensive care patients: An interpretive phenomenological study

Night sleep in intensive care patients: An interpretive phenomenological study

The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

BackgroundSleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring.MethodsProspective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time.ResultsWe recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated.ConclusionsActigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients.Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

Effect of the use of earplugs and eye mask on the quality of sleep in intensive care patients: a systematic review.

Intensive care unit (ICU) environment has a very strong and unavoidable negative impact on patients' sleep. Sleep deprivation in ICU patients has been already studied and negative effects on their outcome (prolonged ICU stay, decreased recovery) and complication rates (incidence of delirium, neuropsychological sequels of critical illness) discussed. Several interventions potentially improving the sleep disturbance in ICU (sleep-promotion strategies) have been assumed and tested for clinical practice. We present a review of recent literature focused on chosen types of non-pharmacological interventions (earplugs and eye mask) analysing their effect on sleep quality/quantity. From the total amount of 82 papers found in biomedical databases (CINAHL, PubMed and SCOPUS) we included the 19 most eligible studies meeting defined inclusion/exclusion criteria involving 1 379 participants. Both experimental and clinical trials, either ICU and non-ICU patient populations were analysed in the review. Most of the reviewed studies showed a significant improvement of subjective sleep quality when using described non-pharmacological interventions (objective parameters were not significantly validated). Measuring the sleep quality is a major concern limiting the objective comparison of the studies' results since non-standardised (and mainly individual) tools for sleep quality assessment were used. Despite the heterogeneity of analysed studies and some common methodological issues (sample size, design, outcome parameters choice and comparison) earplugs and eye mask showed potential positive effects on sleep quality and the incidence of delirium in ICU patients.

"Symptomatic Treatment of Delirium, Anxiety and Stress, and Protocol Based Analgesia, Sedation and Management of Sleep in Intensive Care Patients"

Critically ill patients suffer from anxiety, stress, pain, sleep disturbance and delirium. The updated version of the German evidence and consensus based guideline "Analgesia, Sedation and Delirium management in Intensive Care - DAS 2015" contributes an improved therapeutic management and is aimed to improve clinical outcome based on the current state of evidence. The task force members were representatives from 17 national medical societies therefore have consented following guiding principle in common: "Patients in intensive care shall be awake, alert and free of pain, anxiety and delirium, to be able to participate in the healing process actively."

The development of a clinical practice guideline to improve sleep in intensive care patients: A solution focused approach

Our objective was to develop a guideline to improve the opportunity for intensive care patients to rest and sleep. A pragmatic solution focused approach to guideline development and implementation was used in which data from international literature and original research from the study ICU were appraised in extensive consultation with intensive care staff. Audits were conducted early in the implementation phase to measure adoption rates. Over 320 suggestions were made for inclusion in a practice guideline. Information was integrated to create the guideline. A comprehensive 'rest and sleep for the intensive care patient' guideline was developed comprising two main themes: 'Optimise the environment' (for example, 'Quiet conversation') and 'Rest and sleep interventions' (for example, 'Provide optimal conditions for night-time sleep'). Audit data suggested that adoption of the guideline had begun but was not yet embedded in practice. The solution focused approach to addressing improvements ICU patients' sleep and the consideration of multiple sources of evidence resulted in the development of a comprehensive, context specific guideline. The process, based on a solution focus, may overcome difficulties faced by clinicians endeavouring to improve health care when there is a lack of high level evidence.