Sleep In Intensive Care Unit Research Articles

Effect of Eye Masks and Ear Plugs on Quality of Sleep of Patients in Intensive Care Unit

Sleep has physiologic importance and adequate sleep is necessary for the maintenance of good health and well-being of all patients especially the critically ill. The study aimed to test the effect of eye masks and ear plugs on the quality of sleep among patients admitted to Intensive Care Units (ICU) and to identify the factors affecting the quality of sleep in ICU. An experimental cross-over design was adopted. Fourty subjects were selected using consecutive sampling from the Cardiac ICU, Neuro ICU, and Surgical ICU of the hospital. The tools used were the Richard Campbell Sleep Questionnaire (RCSQ) to assess the quality of sleep and the Visual Analogue Scale to measure factors causing sleep disturbance in the ICU. Results showed that eye mask and ear plug were effective in improving sleep among patients in ICU. While sleeping without interventions all of the subjects in ICU reported poor sleep. After using the eye mask and ear plugs 27.5 percent of subjects reported very good sleep 65 percent of subjects reported good sleep and only 7.5 percent had poor sleep. The mean score and standard deviation of quality of sleep of patients in ICU increased from 17.90 ±3.90 to 36.87±4.09 while sleeping with eye mask and ear plugs. This increase was significant at a 0.05 level of significance with a p value of 0.000. Eye masks and ear plugs were effective in improving sleep among patients in ICU. The most important factor affecting the quality of sleep of patients in ICU was light followed by anxiety, pain and alarms. The study concluded that Intensive care nurses have to use eye mask and ear plug for ICU patients to promote sleep which will help in reducing the use of sedatives. Nurses should take measures to reduce light and sound in ICU during night time and take measures to reduce anxiety and pain effectively for promoting sleep.

Psychometric properties and structural validity of traditional Chinese version of the Richards–Campbell Sleep Questionnaire in intensive care unit patients without physical restraint

BackgroundSleep assessment in the intensive care unit (ICU) is difficult and often unreliable. The most commonly used questionnaire for assessing ICU sleep, the Richards–Campbell Sleep Scale (RCSQ), has not been tested for reliability and construct validity in the Mandarin–Taiwanese speaking population. ObjectiveThe objective of this study was to test the construct validity and criterion validity of the traditional Chinese version of RCSQ (TC-RCSQ) in critically ill patients without physical restraint. MethodsWe adopted a cross-sectional study design. Adults aged 20 years and above were recruited from a plastic surgery ICU of a medical center. The Cronbach's alpha was used to test internal consistency; the validity testing included content validity, criterion validity, and construct validity. Criterion validity was analysed by testing the association of TC-RCSQ with the Chinese version of Verran and Snyder-Halpern Sleep Questionnaire and sleep parameter of actigraphy using the Pearson correlation coefficient; construct validity was analysed using exploratory factor analysis. ResultsA total of 100 patients were included with a mean age of 49.78 years. Internal consistency reliability suggested Cronbach's alpha of 0.93. Moderate to strong correlations of TC-RCSQ with Verran–Snyder-Halpern Sleep Questionnaire were identified (r = 0.36 to 0.80, P < 0.05). We found significant correlations of actigraphic sleep efficiency with difficulty of falling sleep, awakening times, sleep quality, and total score of the TC-RCSQ (r = 0.23, 0.23, 0.20, and 0.23, P < 0.05). One factor (named as overall sleep quality) was extracted by exploratory factor analysis with a total variance explained of 78.40 %, which had good construction validity. ConclusionsThe TC-RCSQ yields satisfactory reliability and validity in critically ill patients. Actigraphic sleep efficiency may be a single index for objectively sleep assessment of sleep quality in patients without physical restraint. Both the TC-RCSQ and actigraphy can aid nurses to evaluate the sleep quality in critically ill patients without physical restraint.

A Rapid Systematic Review of Pharmacologic Sleep Promotion Modalities in the Intensive Care Unit.

Background: The Society of Critical Care Medicine Clinical Practice Guidelines for Management of Pain, Agitation, Delirium, Immobility, and Sleep recommend protocolized non-pharmacologic sleep improvement. Pharmacologic interventions are frequently initiated to promote sleep but the evidence supporting these strategies remains controversial. Purpose: To systematically search and synthesize evidence evaluating pharmacologic sleep promotion modalities in critically ill adults. Methods: A rapid systematic review protocol was used to search Medline, Cochrane Library, and Embase for reports published through October 2022. We included randomized controlled trials (RCTs) and before-and-after cohort studies evaluating pharmacologic modalities intended to improve sleep in adult intensive care unit (ICU) patients. Sleep-related endpoints were the primary outcome of interest. Study and patient characteristics and relevant safety and non-sleep outcome data were also collected. The Cochrane Collaboration Risk of Bias or Risk of Bias in Non-Randomized Studies of Interventions were used to assess the risk of bias for all included studies. Results: Sixteen studies (75% RCTs) enrolling 2573 patients were included; 1207 patients were allocated to the pharmacologic sleep intervention. Most studies utilized dexmedetomidine (7/16; total n = 505 patients) or a melatonin agonist (6/16; total n = 592 patients). Only half of the studies incorporated a sleep promotion protocol as standard of care. Most (11/16, 68.8%) studies demonstrated a significant improvement in ≥1 sleep endpoint (n = 5 dexmedetomidine, n = 3 melatonin agonists, n = 2 propofol/benzodiazepines). Risk of bias was generally low for RCTs and moderate-severe for cohort studies. Conclusions: Dexmedetomidine and melatonin agonists are the most studied pharmacologic sleep promotion modalities, but current evidence does not support their routine administration in the ICU to improve sleep. Future RCTs evaluating pharmacologic modalities for ICU sleep should consider patients' baseline and ICU risks for disrupted sleep, incorporate a non-pharmacologic sleep improvement protocol, and evaluate the effect of these medication interventions on circadian rhythm, physiologic sleep, patient-perceived sleep quality, and delirium.

789: IMPACT OF A PHARMACIST-DRIVEN SLEEP-PROMOTING PROTOCOL ON DELIRIUM IN THE CRITICALLY ILL

Introduction: Sleep deprivation is reported in nearly 80% of patients in the intensive care unit (ICU) and is associated with delirium. Guidelines recommend implementing a multicomponent sleep-promoting protocol in critically ill patients. ICU sleep protocols may increase the quantity and quality of sleep and may decrease delirium. Our objective was to develop and implement a pharmacist-led interdisciplinary sleep-promoting protocol and analyze its impact on delirium in intubated and non-intubated ICU patients. Methods: The study involved pre-implementation education and protocol development, and post-implementation analysis. ICU pharmacists completed prospective patient chart reviews to reduce exposure to deliriogenic medications and assess the patient’s need for a pharmacological sleep aid. The primary outcome was to assess the difference in the incidence of delirium and delirium-free days pre- and post-implementation. Secondary outcomes included ICU length of stay, incidence and duration of mechanical ventilation (MV), documented pharmacist medication interventions, and patients receiving a pharmacologic sleep agent (%), Results: Post-protocol patients (n=185) had a higher incidence of delirium compared to pre-protocol patients (n=237) (51.3% vs 39.0%; p=0.01). Post-protocol patients had a higher average APACHE III score (p=< 0.001). Delirium-free days were not significantly different between groups (p=0.97). Difference in ICU length of stay was not significant (p=0.80). More patients received MV post-protocol implementation (55.7% vs 36.1%; p< 0.001). MV days were similar between groups (p=0.053). Pharmacists documented a total of 113 medication interventions. Half of the study patients did not receive an insomnia agent during their ICU admission. Conclusions: A pharmacist-led, ICU sleep-promoting protocol was successfully implemented at our institution. The protocol did not reduce the incidence of delirium or the administration of insomnia agents in our ICUs. Post-protocol patients had a higher disease severity and were more likely to receive mechanical ventilation which may have impacted our results. The incidence of delirium in our patients was consistent with the national reported prevalence of ICU delirium. ICU pharmacists on all shifts had an active role in optimizing sleep in the critically ill.

P107 Patient self-reported sleep quality, noise and light levels in a tertiary ICU: a prospective observational study

Abstract Introduction Sleep is poor in intensive care units (ICU). However, there is limited research examining the causes from the patient perspective, especially in an Australian population. The current study investigated the factors that patients perceive as affecting their sleep in a major Australian tertiary ICU. Methods Patients (n=138, 51F; aged 58.1±16.8 years) completed a survey assessing sleep before and during their ICU stay, factors contributing to poor sleep, and factors that may have improved their sleep in the ICU. Night-time sound (16 nights) and light (28 nights) levels in rooms were also measured. Results Most patients reported good (38%) to very good (25%) sleep quality before their ICU stay, and poor (28%) to very poor (32%) sleep quality in the ICU. Over half (56%) reported an abnormal sleep-wake cycle and most (60%) felt as though they did not obtain sufficient sleep. Noise (54%), pain (50%) and lights (48%) were the top reasons for self-reported poor sleep. Patients felt as though their sleep would have been improved with dimmed lights (64%), a sleeping pill (57%) and closing door/blinds at night (46%). Median (IQR) overnight noise and light levels were 52.8 (51.4–54.6) dB and 39.9 (8.2–90.9) lux respectively. Discussion Of the top three factors that patients perceive to be the primary reasons for poor sleep, two are modifiable (noise and lights). Night-time sound levels exceed standard recommendations and light levels, while mostly low, were higher than indicated for a healthy sleep environment, suggesting that these could be modified to improve patients sleep.

Sleep-Promotion Bundle Development, Implementation, and Evaluation in Critically Ill Adults: Roles for Pharmacists.

To review evidence for intensive care unit (ICU) sleep improvement bundle use, identify preferred sleep bundle components and implementation strategies, and highlight the role for pharmacists in developing and evaluating bundle efforts. Multiple databases were searched from January 1, 1990, to September 1, 2021, using the MeSH terms sleep, intensive care or critical care, protocol or bundle to identify comparative studies evaluating ICU sleep bundle implementation. Study screening, data extraction, and risk-of-bias evaluation were conducted in tandem. The ICU quality improvement literature and Institute for Healthcare Improvement bundle improvement guidance were also reviewed to identify recommended strategies for successful sleep bundle use. Nine studies (3 randomized, 1 quasi-experimental, 5 before-and-after) were identified. Bundle elements varied and were primarily focused on nonpharmacological interventions designed to be performed during either the day or night; only 2 studies included a medication-based strategy. Five studies were associated with reduced delirium; 2 studies were associated with improved total sleep time and 2 with improved patient-perceived sleep. Pharmacists were involved directly in 4 studies. Sleep improvement bundles are recommended for use in all critically ill adults; specific bundle elements and ICU team member roles should be individualized at the institution/ICU level. Pharmacists can help lead bundle development efforts and routinely deliver key elements. Pharmacists can play an important role in the development and implementation of ICU sleep bundles. Further research regarding the relative benefit of individual bundle elements on relevant patient outcomes is needed.

Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality.

Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation. To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception. Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non-mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures. Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; P = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; P = 0.0003) compared with before implementation. A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.

Characterisation of ICU sleep by a commercially available activity tracker and its agreement with patient-perceived sleep quality

BackgroundA low-cost, quantitative method to evaluate sleep in the intensive care unit (ICU) that is both feasible for routine clinical practice and reliable does not yet exist. We characterised nocturnal...

Factors affecting Quality of Sleep in Intensive Care Unit

Background: The etiology of sleep disruption in intensive care unit is poorly known and often ignored complication. It is caused by the environmental factors especially pain, noise, diagnostic testing and human interventions that cause sleep disruption. Light, medications and activities related to patient care interfere with patient’s ability to have good sleep. There are multi-factorial environmental etiologies for disruption of sleep in ICU.&#x0D; Objective: The objective of this study was to evaluate the factors disturbing the sleep quality in intensive care unit (ICU) admitted patients.&#x0D; Methodology: A cross sectional study was designed involving 150 patients admitted in intensive care unit and high dependency unit of Gulab Devi Chest Hospital. The duration of study was from September 2015 to March 2016. The questionnaire was made and filled with the help of patients. The data was analyzed using SPSS version 16.00.&#x0D; Results: Mean age of patients was 50.46+10.96 with maximum age of 65 and minimum age of 30 years. There was 53.33% male patients and 46.67% females participating in this study. The sleep quality was significantly poor in ICU than at home. After analysis, 54.67% patients were with poor quality of sleep due to pain and 48.67% were due to noise of environmental stimuli. The other factors were alarms, light and loud talking.&#x0D; Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable.&#x0D; Conclusion: Current study shows that reduced sleep quality is a common problem in ICU with multi-factorial etiologies. Patient reported the poor sleep quality in ICU due to environmental issues that are potentially modifiable.

Circadian Biology and Its Importance to Intensive Care Unit Care and Outcomes.

Circadian rhythms are an integral part of life on earth. Circadian rhythms play a fundamental role in homeostasis as they ensure coordination between the environment and an organism's behavior and physiology. This coordination is called entrainment. Entrainment depends on environmental cues known as zeitgebers. Human zeitgebers include light (primary zeitgeber), sleep, eating, exercise, and activity. Circadian rhythms are disrupted in critically-ill patients due to both critical illness and current intensive care unit (ICU) practices. Disruptions in circadian rhythms are tightly linked with ICU sleep disruption. Together these entities potentiate numerous adverse outcomes including delirium, metabolic derangements, cardiovascular instability, and immune compromise. Herein, we will highlight potential areas for care improvement via chronobundles. We suggest bright light during the day, maintaining darkness, and protecting sleep at night, intermittent rather than continuous feeds, and activity via mobilization during the day. Optimizing circadian rhythms is a low-risk intervention that is underutilized in current ICU practice. This optimization could be a powerful tool in helping to improve outcomes in the critically-ill patient.

Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review.

Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem. A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed. Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low. Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.

Causes of sleep disorders in patients treated in the Intensive Care Unit and strategies to minimize them

AbstractIntroduction: Sleep plays an important part in human wellbeing. Sleep deprivation has serious deleterious effects on any subject of life. The most obvious and well documented adverse consequences are focused on the immune system, cardiopulmonary function and cognitive function. Sleep in critical ill patients is characterized by frequent disruptions and poor quality along with a reduction in the depth and restorative stages. In critical ill patients the prevalence of sleep disturbance has been shown to be more than 50%. Sleep disturbances seems to be due to environmental factors related to the intensive care unit (ICU) itself (light, noise level) patient’s condition and medical treatment.The aim of the presented study was to present the cause of sleep disorders in patients treated in the intensive care unit and to present activities that would improve the sleep quality of patients.Material and methods: The work is of an illustrative nature. For the needs of the work, the Polish and English-language literature available in medical databases over the last 15 years has been analyzed.Results: Analysis of the collected literature has shown that pharmaceuticals used in the treatment of patients in the intensive care unit can potentially affect sleep disorders. Respiratotherapy is one of the main factors disturbing ICU sleep. Factors such as noise and care activities have been classically recognized as the main causes of sleep disorder in critically ill patients.Conclusions: Nursing staff who have constant contact with the patient plays a key role in minimizing factors that disrupt the patient’s sleep. Therefore, it is important to raise the awareness of nursing staff about possible activities that can minimize sleep disorders.

Survey of clinical pharmacist perceptions and practices in promoting sleep in intensive care unit patients

ObjectivesSleep deprivation is associated with significant patient morbidity in the intensive care unit (ICU) and must be addressed through a systematic, interdisciplinary approach. The objectives of this study were to describe pharmacists' perceptions and practices regarding sleep in the ICU. We also assessed the prevalence and characteristics of systematic processes to promote sleep in ICU patients.MethodsWe administered an international, cross‐sectional survey to 1723 pharmacists via a member distribution list through the American College of Clinical Pharmacy Critical Care Practice and Research Network. The survey included questions about pharmacists' demographics, practice sites, and individual and site‐specific perceptions of sleep promotion practices.ResultsTwo hundred fifty‐five (15%) pharmacists initiated the survey and 195 were completed and included for analysis. Respondents most commonly had less than 5 years of experience in ICU practice, completed a Critical Care Pharmacy Residency, and worked in a Medical or Surgical ICU. All participants responded that the assessment of sleep quality is important in the ICU. Most respondents reported that they recommend both non‐pharmacological (81%) and pharmacological (93%) interventions to optimize sleep in their ICU patients. Pharmacists reported most commonly recommending to adjust non‐sleep‐related medications to avoid nighttime administration (41.4%) and initiating melatonin receptor agonists (33.7%). A low number of respondents (9%) reported the presence of a sleep protocol in their ICU. Within this subset, 59% reported that less than half of their ICU patients actually receive the protocol and 41% indicated low protocol compliance.ConclusionsCritical care pharmacists value sleep, and most recommend interventions to optimize sleep in their patients. However, sleep protocols in ICUs are uncommon, and overall protocol use and compliance are perceived to be low. Pharmacists can improve protocol use and compliance and potentially impact sleep, delirium incidence, or other ICU patient outcomes. This impact should be evaluated in future studies.

Sleep on the ward in intensive care unit survivors: a case series of polysomnography.

Few studies have investigated sleep in patients after intensive care despite the possibility that inadequate sleep might further complicate an acute illness impeding recovery. To assess the quality and quantity of a patient's sleep on the ward by polysomnography (PSG) within a week of intensive care unit (ICU) discharge and to explore the prevalence of key in-ICU risk factors for persistent sleep fragmentation. We enrolled 20 patients after they have been mechanically ventilated for at least 3 days and survived to ICU discharge. We included all patients over the age of 16 years and excluded patients with advanced cognitive impairment or who were unable to follow simple commands before their acute illness, primary admission diagnosis of neurological injury, uncontrolled psychiatric illness or not fluent in English. Twenty patients underwent an overnight PSG recording on day 7 after ICU discharge (SD, 1 day). ICU survivors provided 292.8 h of PSG recording time with median recording times of 16.8 h (Interquartile range (IQR), 15.0-17.2 h). The median total sleep time per patient was 5.3 h (IQR, 2.6-6.3 h). In a multivariable regression model, postoperative admission diagnosis (P = 0.04) and patient report of poor ICU sleep (P = 0.001) were associated with less slow-wave (restorative) sleep on the wards after ICU discharge. Patients reported poor sleep while in the ICU, and a postoperative admission diagnosis may identify a high-risk subgroup of patients who may derive greater benefit from interventions to improve sleep hygiene.

Sleep in critically ill, mechanically ventilated patients with severe sepsis or COPD.

The standard method for scoring polysomnographic (PSG) sleep is insufficient in the intensive care unit (ICU). A modified classification has been proposed, but has not been tested in specific groups of ICU patients. We aimed firstly to (1) use the modified classification to describe sleep in two groups of ICU patients: a severe sepsis group and a chronic obstructive pulmonary disease (COPD) group, and (2) to compare sleep stage distribution in the groups; secondly to compare the PSG findings with nurses' sleep evaluation. Non-sedated mechanically ventilated patients with severe sepsis or COPD completed up to 20-hours PSG recording in each patient. A modified classification for scoring sleep in ICU was used for scoring the PSGs. Sleep assessment by nurses was done at 15minutes intervals. We included 16 patients with severe sepsis and 17 patients with COPD. Half of the patients in the severe sepsis group and 59% in the COPD group had atypical sleep. We found significantly different sleep stage distribution in the two groups, with the COPD group having a higher proportion of atypical sleep (54.4% vs 48.7%, P<.0001). No correlation between nurse sleep assessment and PSG was found in cases of atypical sleep (P<.0001). Normal PSG sleep characteristics as defined by standard classification are absent in many conscious, non-sedated critically ill patients on mechanical ventilation. Nurse sleep evaluation does not correlate with PSG if atypical sleep is present in the PSG, which limits the reliability of subjective sleep assessment in this patient population.

Creating Naptime: An Overnight, Nonpharmacologic Intensive Care Unit Sleep Promotion Protocol.

Introduction:Patients in the intensive care unit (ICU) have significantly disrupted sleep. Sleep disruption is believed to contribute to ICU delirium, and ICU delirium is associated with increased mortality. Experts recommend sleep promotion as a means of preventing or shortening the duration of delirium. ICU Sleep promotion protocols are highly complex and difficult to implement. Our objective is to describe the development, pilot implementation, and revision of a medical ICU sleep promotion protocol.Methods:Naptime is a clustered-care intervention that provides a rest period between 00:00 and 04:00. We used literature review, medical chart review, and stakeholder interviews to identify sources of overnight patient disturbance. With stakeholder input, we developed an initial protocol that we piloted on a small scale. Then, using protocol monitoring and stakeholder feedback, we revised Naptime and adapted it for unitwide implementation.Results:We identified sound, patient care, and patient anxiety as important sources of overnight disturbance. The pilot protocol altered the timing of routine care with a focus on medications and laboratory draws. During the pilot, there were frequent protocol violations for laboratory draws and for urgent care. Stakeholder feedback supported revision of the protocol with a focus on providing 60- to 120-minute rest periods interrupted by brief clusters of care between 00:00 and 04:00.Discussion:Four-hour blocks of rest may not be possible for all medical ICU patients, but interruptions can be minimized to a significant degree. Involvement of all stakeholders and frequent protocol reevaluation are needed for successful adoption of an overnight rest period.

Posttraumatic stress symptoms in intensive care patients: An exploration of associated factors.

To explore demographic, clinical, and psychological factors in intensive care unit (ICU), including self-reported sleep quality and experiences that were associated with posttraumatic stress (PTS) symptoms 6 months after discharge from hospital. A prospective survey was conducted (N = 222). On the day of transfer to the hospital ward, ICU patients reported pain and state-anxiety levels, as well as ICU and prehospital sleep quality. Two months after hospital discharge, they reported sleep quality at home and experiences in ICU. Six months after hospital discharge, sleep quality, PTS symptoms (measured with the Posttraumatic Stress Disorder Checklist-Specific; PCL-S; VA National Center for PTSD, 2014) and psychological well-being (using Depression, Anxiety and Stress Scales-21; DASS-21; Ware, Kosinski, & Keller, 1994) were reported. Descriptive data analyses were performed and factors associated with PTS symptoms were explored with multiple linear regression. The sample was predominately male (65%), with a mean age 57 years. At baseline, pain intensity was low (M ± SD; 2.25 ± 1.14) and state-anxiety levels were moderate (2.50 ± 2.90). At 6 months, 30% of the sample demonstrated depression, and 13.5% (mean PCL-S score: 26.54 ± 10.52) reported symptoms reflective of PTS. The regression model explained 68.2% of the variance in the PCL-S score. Higher PTS scores were independently associated with frightening experiences in ICU, higher stress and depression scores, pain intensity at baseline, and sleep quality at 6 months. Continuing symptoms of PTS were evident in 14% of the cohort. Screening for prevention and treatment of delirium while a patient is in ICU is essential, and psychological screening and follow-up during recovery would therefore also be beneficial for many patients. (PsycINFO Database Record

Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation?

IntroductionSleep deprivation is common in critically ill patients in the intensive care unit (ICU). Noise and light in the ICU and the reduction in plasma melatonin play the essential roles. The aim of this study was to determine the effect of simulated ICU noise and light on nocturnal sleep quality, and compare the effectiveness of melatonin and earplugs and eye masks on sleep quality in these conditions in healthy subjects.MethodsThis study was conducted in two parts. In part one, 40 healthy subjects slept under baseline night and simulated ICU noise and light (NL) by a cross-over design. In part two, 40 subjects were randomly assigned to four groups: NL, NL plus placebo (NLP), NL plus use of earplugs and eye masks (NLEE) and NL plus melatonin (NLM). 1 mg of oral melatonin or placebo was administered at 21:00 on four consecutive days in NLM and NLP. Earplugs and eye masks were made available in NLEE. The objective sleep quality was measured by polysomnography. Serum was analyzed for melatonin levels. Subjects rated their perceived sleep quality and anxiety levels.ResultsSubjects had shorter total sleep time (TST) and rapid eye movement (REM) sleep, longer sleep onset latency, more light sleep and awakening, poorer subjective sleep quality, higher anxiety level and lower serum melatonin level in NL night (P <0.05). NLEE had less awakenings and shorter sleep onset latency (P <0.05). NLM had longer TST and REM and shorter sleep onset latency (P <0.05). Compared with NLEE, NLM had fewer awakenings (P = 0.004). Both NLM and NLEE improved perceived sleep quality and anxiety level (P = 0.000), and NLM showed better than NLEE in perceived sleep quality (P = 0.01). Compared to baseline night, the serum melatonin levels were lower in NL night at every time point, and the average maximal serum melatonin concentration in NLM group was significantly greater than other groups (P <0.001).ConclusionsCompared with earplugs and eye masks, melatonin improves sleep quality and serum melatonin levels better in healthy subjects exposed to simulated ICU noise and light.Trial registrationChinese Clinical Trial Registry ChiCTR-IPR-14005458. Registered 10 November 2014.

Sleep quality in Intensive Care Unit

Introduction Critically-ill patients who require hospitalization are admitted to the Intensive Care Unit (ICU). Although sleep quality could be an important factor in the recovery of these patients, the ICU environment is not conducive to sleep (1). Since few studies have evaluated this matter, the objective of this study was to assess the quantity and quality of sleep in ICU patients. Materials and methods Polysomnography for consecutive hours (from 10 p.m. to 8 a.m) were performed in conscious adult patients connected to artificial ventilation by an orotracheal tube or tracheostomy. All patients were not receiving sedation from 24 h prior to the study. Light and noise levels were measured. Results are presented as medians and percentiles (25th and 75th). Results To date, 13 polysomnography studies have been performed. Three studies were interrupted due to clinical deterioration of the patient. Of the remaining 10 patients, 4 tracings (40%) could not be scored by standard AASM criteria because characteristic graphoelements to define sleep staging were absent. In the other 6 patients, total sleep time was 182 min (130–228) with a sleep efficiency of 31% (22–38). Sleep time was as follows: N1, 56 min (39–75); N2, 112 min (68–132); and N3, 6 min (1–34). Only two patients presented REM sleep. During the 10-hour study, median light and noise levels were 19 lux (17–22) and 49 decibels (48–50), respectively. Conclusion In a non-negligible percentage of patients admitted to an ICU, polysomnography data did not fulfill the standard criteria for scoring. In those patients where standard criteria could be applied, quantity and quality of sleep were highly abnormal, with short N3 and REM sleep stages. The present results fall in the line with previous studies which suggest the need of a new classification for sleep analysis in critically ill patients (2, 3). Moreover, further studies are necessary in order to evaluate the consequences of these sleep findings on patient outcomes. Acknowledgements Drouot X, Cabello B, d’Ortho MP, Brochard L. Sleep in the intensive care unit. Sleep Med Rev. 2008 Oct;12(5):391–403. Drouot X, Roche-Campo F, Thille AW, Cabello B, Galia F, Margarit L, d’Ortho MP, Brochard L. A new classification for sleep analysis in critically ill patients. Sleep Med. 2012 Jan;13(1):7–14. Watson PL, Pandharipande P, Gehlbach B et al., Atypical Sleep in Ventilated Patients: Empirical Electroencephalography Findings and the Path Toward Revised ICU Sleep Scoring Criteria. Critical Care Medicine 2013 August; 14(8):1–1.

Developing, Implementing, and Evaluating a Multifaceted Quality Improvement Intervention to Promote Sleep in an ICU

Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). To supplement previously published results of this QI intervention, the present article describes the specific QI framework used to develop and implement this intervention, which consists of 4 steps: (a) summarizing the evidence to create a list of sleep-promoting interventions, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education and regular project evaluation. Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives.