Sleep and Activity Patterns Are Altered During Early Critical Illness in Mechanically Ventilated Adults

Sleep of Intensive Care Patients: A Qualitative Study Based on Experiences of Nurses

BACKGROUND

Intensive care patients experience a high rate of poor sleep quality. As the sleep quality is improved with nursing practices, patients' recovery and the length of stay in the intensive care unit (ICU) may be positively influenced, and patients may benefit from treatment and care at the highest level. Therefore, it is important to explore the experiences and evaluation of nurses working in ICUs.

OBJECTIVES

This study was carried out to explore the experiences and evaluations of ICU nurses about patients' sleep.

METHODS

The study is a qualitative study conducted in a descriptive phenomenological design. The data were collected using the individual in-depth interview method with the semistructured interview form. Thematic analysis was performed to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used.

RESULTS

The analysis revealed 4 main themes, which are (1) importance of sleep, (2) evaluation of sleep, (3) reasons for poor sleep, and (4) sleep promotion interventions.

CONCLUSIONS

This study revealed that nurses are aware of the importance of sleep; however, they do not evaluate sleep and try to improve sleep quality only based on their own knowledge and experience rather than on evidence-based approaches. However, their interventions are not sufficient and they are restricted because of physical conditions and intensive care procedures.

Sleep assessment in critically ill adults: A systematic review and meta-analysis

PURPOSE

To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients.

MATERIALS AND METHODS

We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible.

RESULTS

132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ).

CONCLUSIONS

Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.