The accuracy of simple, feasible alternatives to polysomnography for assessing sleep in intensive care: An observational study

Night-time sleep of intensive care patients: A qualitative study

BACKGROUND

The quality of the sleep in the intensive care unit (ICU) is generally poor. It is known that several factors contribute to this situation.

AIMS AND OBJECTIVES

To describe the experiences of adult patients during night-time sleep in the ICU.

DESIGN

A qualitative study using a phenomenological approach was conducted from May to October 2021. Patients were intensive care patients (n = 10) who were treated for at least 24 h in tertiary ICUs.

METHODS

The data were obtained through semi-structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed.

RESULTS

The analysis resulted in three main themes: (a) inadequate sleep at night; (b) factors negatively affecting night-time sleep; and (c) patient expectations for improved night-time sleep. Night-time sleep of patients treated in intensive care were determined to generally have inadequate and be interrupted. Patients associated the cause of this situation with the physical environment conditions in the ICU, loud noises made by health employees and emotional reactions. It was stated that some physical environment changes that can be made in ICUs and psychological support will positively affect sleep.

CONCLUSIONS

Intensive care patients may not have quality night-time sleep because of multifactorial reasons. Noise in the ICU is a significant factor preventing patients from sleeping. In addition to reorganization of the physical environment to ensure adequate sleep, there is a need for an integrated approach dealing with patients' feelings and concerns.

RELEVANCE TO CLINICAL PRACTICE

Each patient has their own unique sleep pattern. To ensure effective management of sleep problems, health professionals should organize care and physical conditions in line with guidelines and create patient-specific night-time sleep management programmes.

Light, sleep and circadian rhythm in critical illness

PURPOSE OF REVIEW

Sleep and circadian disruption (SCD) are associated with worse outcomes in the ICU population. We discuss sleep, circadian physiology, the role of light in circadian entrainment and its possible role in treating SCD, with special attention to the use of light therapies and ICU design.

RECENT FINDINGS

The American Thoracic Society recently published an official research statement highlighting key areas required to define and treat ICU SCD. Recent literature has been predominantly observational, describing how both critical illness and the ICU environment might impair normal sleep and impact circadian rhythm. Emerging consensus guidance outlines the need for standardized light metrics in clinical trials investigating effects of light therapies. A recent proof-of-concept randomized controlled trial (RCT) showed improvement in delirium incidence and circadian alignment from ICU room redesign that included a dynamic lighting system (DLS).

SUMMARY

Further investigation is needed to define the optimal physical properties of light therapy in the ICU environment as well as timing and duration of light treatments. Work in this area will inform future circadian-promoting design, as well as multicomponent nonpharmacological protocols, to mitigate ICU SCD with the objective of improving patient outcomes.

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

BACKGROUND

Sleep 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.

OBJECTIVE

The 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.

METHODS

We 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.

RESULTS

A 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.

CONCLUSIONS

The 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.

Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review

RATIONALE/OBJECTIVES

Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU.

METHODS

A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified.

RESULTS

Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging.

CONCLUSIONS

This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.