Prospective repeated assessment of self-reported sleep quality and sleep disruptive factors in the intensive care unit: acceptability of daily assessment of sleep quality

Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review

Background: Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. Methods: PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Results: Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. Conclusions: While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects.

Effects of Nighttime Noise Management in Intensive Care Units on Hormone Levels and Sleep Quality in Conscious Patients

OBJECTIVE

This study aims to investigate the effects of nighttime noise management in intensive care units (ICU) on hormone levels and sleep quality in conscious patients.

METHODS

From March 2020 to March 2021, the routine noise management for conscious patients was implemented in the ICU of Wenzhou TCM Hospital of Zhejiang Chinese Medical University. During this time, 86 patients were selected as the study subjects; five patients who did not meet the inclusion criteria were excluded, and 81 patients were included in the reference group. From April 2021 to April 2022, nighttime noise management for conscious patients was conducted, during which 93 patients were selected as the research subjects; six patients who did not meet the inclusion criteria were excluded, and 87 patients were included in the observation group. The hormone indicators, Pittsburgh Sleep Quality Index (PSQI) scores, and Symptom Checklist-90 (SCL-90) scores were collected and compared.

RESULTS

After management, the observation group had significantly lower noise level and hormone indicators (P < 0.05), significantly lower PSQI score (P < 0.001) and significantly lower SCL-90 score than the reference group (P < 0.01).

CONCLUSION

Nighttime noise in the ICU has an adverse effect on conscious patients. Nighttime noise management improves the hormone levels and sleep quality of ICU patients.

Study on the Sleep Quality Classification and Influencing Factors of Adult ICU Awake Patients Based on Latent Profile Analysis: A Cross-Sectional Survey

Objective

To explore the potential category characteristics of sleep quality in conscious adult patients in the intensive care unit (ICU) and to analyze the differences in characteristics of different categories of conscious adult patients in the ICU.

Methods

From 5/4/2023 to 30/6/2023, we selected ICU patients of a Class iii Grade A hospital in Wuhan as subjects by simple random sampling. The general information questionnaire, Acute Physiology and Chronic Health Evaluation II, Numerical Rating Scale (NRS)/Critical Care Pain Observation Tool (CPOT) and Richards-Campbell Sleep Questionnaire (RCSQ) were used for investigation. To analyze the latent profile of sleep quality characteristics of adult ICU awake patients and to identify the influencing factors of the latent profile through univariate analysis and logistic regression analysis.

Results

A total of 298 awake ICU patients were investigated. There were three potential profiles of sleep quality characteristics, namely "low sleep quality" type (16.31%), "medium sleep quality" type (52.11%), and "high sleep quality" type (31.57%). Logistic regression analysis showed that age (36-60), disease type admitted to ICU, oxygen administration method, CPOT or NRS score, postoperative or not, use of analgesic drugs or not, and use of sleep-promoting drugs or not were the factors affecting the sleep quality of adult ICU awake patients (P < 0.05).

Conclusion

The sleep quality of adult ICU awake patients has obvious classification characteristics. Health professionals can carry out individualized interventions according to the influencing factors of different potential profiles to improve the sleep quality of adult ICU awake patients.

The Effects of Pain, Agitation, Delirium, Immobility, and Sleep Disruption Education on Novice Nurses in Adult Intensive Care Units

Intensive care unit (ICU) patients experience highly complex health problems, such as pain, agitation, delirium, immobility, and sleep disruption (PADIS), and require professional nursing care. The assessment of PADIS is critically important for ICU nurses, and therefore, PADIS education programs need to be conducted for these nurses to update and improve their caring knowledge, attitudes, and skills. The aims of this study are to bridge this gap by evaluating the effects of PADIS education programs on the knowledge, attitudes, and skills of these nurses, and compare the difference between novice and advanced nurses after receiving the PADIS education programs over a short period of time. In this quasi-experimental study, 112 nurses in ICUs were recruited by researchers and participated in the PADIS education programs. The PADIS education intervention was performed in a teaching hospital in Taipei. A demographic and self-developed PADIS care knowledge questionnaire was used. A baseline (T1) was measured before the interventions, followed by post-test (T2) immediately after the programs, and subsequently a follow-up (T3) test one month later. The results indicated that knowledge and skill scores between novice and advanced nurses varied significantly in T1 but not in T2 and T3. Thus, education programs can significantly assist novice ICU nurses to improve their short-term knowledge, attitudes, and skills, and PADIS education programs are strongly suggested for clinical nursing practice.

Assessing Discomfort in Critically Ill Patients: A Narrative Review of the Literature

BACKGROUND

The intensive care unit environment exposes patients to stressful conditions contributing to distressing symptoms. Discomfort is an infrequently and inconsistently described symptom experienced by intensive care unit patients.

OBJECTIVE

To complete a narrative literature review to summarize the currently available literature on discomfort assessment in critical care practice and identify knowledge gaps to direct future intervention research.

METHODS

A review of the currently available literature was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. No parameters were set for publication years or specific study designs. Inclusion criteria were patients aged at least 18 years, description of patient reports of discomfort in the intensive care unit, and English language.

RESULTS

This narrative review includes 10 studies that used 4 distinct self-reported, discomfort-related symptom assessment instruments. Two studies assessed overall discomfort. Only 1 assessment instrument, Inconforts des Patients de Reanimation, is validated for use in the intensive care unit.

CONCLUSION

The reviewed literature highlights the current gap in discomfort symptom assessment during the intensive care unit stay. An assessment instrument specific for intensive care unit-related discomfort, such as the Inconforts des Patients de Reanimation, would allow for prompt recognition and mitigation of intensive care unit-related patient discomfort.

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.

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

BACKGROUND

Sleep disturbance is common in intensive care patients. Understanding the accuracy of simple, feasible sleep measurement techniques is essential to informing their possible role in usual clinical care.

OBJECTIVE

The aim of the study was to investigate whether sleep monitoring techniques such as actigraphy (ACTG), behavioural assessments, and patient surveys are comparable with polysomnography (PSG) in accurately reporting sleep quantity and quality among conscious, intensive care patients.

METHODS

An observational study was conducted in 20 patients admitted to the intensive care unit (ICU) for a minimum duration of 24 h, who underwent concurrent sleep monitoring via PSG, ACTG, nursing-based observations, and self-reported assessment using the Richards-Campbell Sleep Questionnaire.

RESULTS

The reported total sleep time (TST) for the 20 participants measured by PSG was 328.2 min (±106 min) compared with ACTG (362.4 min [±62.1 min]; mean difference = 34.22 min [±129 min]). Bland-Altman analysis indicated that PSG and ACTG demonstrated clinical agreement and did not perform differently across a number of sleep variables including TST, awakening, sleep-onset latency, and sleep efficiency. Nursing observations overestimated sleep duration compared to PSG TST (mean difference = 9.95 ± 136.3 min, p > 0.05), and patient-reported TST was underestimated compared to PSG TST (mean difference = -51.81 ± 144.1 7, p > 0.05).

CONCLUSIONS

Amongst conscious patients treated in the ICU, sleep characteristics measured by ACTG were similar to those measured by PSG. ACTG may provide a clinically feasible and acceptable proxy approach to sleep monitoring in conscious ICU patients.

Noise reduction in the ICU: a best practice implementation project

INTRODUCTION

Sleep deprivation is a relevant problem among patients hospitalized in ICUs. Further, noise is the most critical disruptive factor according to patients.

OBJECTIVE

To implement scientific evidence-based best practices for noise control in an adult ICU.

METHODS

This was an evidence-based implementation project of best practices in noise control, conducted in a high-complexity hospital's adult ICU. The intervention consisted of three steps: baseline audit and identification of barriers, implementation of best practices, and a follow-up audit.

RESULTS

No compliance with best practices was detected in the baseline audit. After the implementation phase, the unit reached compliance levels of 78-88% for most of these criteria only one criterion related to noise level did not match the expected compliance.

CONCLUSION

Adherence to best practices regarding noise control was satisfactory, achieving more than 70% compliance in the six audit criteria. Only the noise level did not reach the threshold recommended by the WHO - a difficulty reported in other studies.

RELEVANCE TO CLINICAL PRACTICE

Best practices related to noise control are essential for managing sleep deprivation in ICUs and include changes in the behaviour of involved professionals.

The Effect of Earplugs and Eye Masks Usage in the Intensive Care Unit on Sleep Quality: Systematic Review

<b><i>Introduction:</i></b> Patients in the intensive care unit (ICU) have severe and complex disease characteristics and their sleep problems should not be ignored. Poor-quality sleep is associated with impaired immune function and associated susceptibility to disease and infection, decreased energy levels, delirium, delays in recovery. This study is conducted to examine the results of studies examining sleep quality using earplugs and eye masks in the ICU. <b><i>Methods:</i></b> PubMed, Science Direct, Google Scholar, and Medline databases were scanned using “Earplugs, Eye masks, Sleep quality, Intensive care units” as keywords. For the search strategy, a query in a patient-intervention-compare-result (PICO) format was used. P: Patients in intensive care; I: Earplugs and eye mask; C: Noise, Light, and Sleep Quality; O: Using earplugs and eye masks improves sleep quality. <b><i>Results:</i></b> We included the 17 most eligible studies meeting defined inclusion/exclusion criteria involving 1,372 participants. Randomized controlled trial was used mostly as study design. The interventions within the scope of the studies were earplugs, eye masks, relaxing music, and quiet time protocol. Richard Campbell Sleep Questionnaire and Verran and Snydern Halpern Sleep Scale were the most used scale. Most of the studies reviewed found that the use of non-pharmacological interventions showed a significant improvement in sleep quality. Earplugs and eye masks were found to have potential positive effects on sleep quality and delirium incidence in ICU patients. <b><i>Conclusion:</i></b> The use of earplugs and eye masks is a noninvasive, economical, and effective way to improve sleep quality in adult ICU patients.

Impact of sound levels on physiological and consciousness state of cardiovascular patients

BACKGROUND

Patients treated in intensive care units (ICUs) experience life-threatening medical conditions but some external factors in ICUs do not help or even adversely affect and complicate their evolution. Among others, such factors include noise pollution due to alarms and medical clinical equipment, as well as the activities of the health care personnel themselves.

AIM

This study aimed to evaluate the influence of elevated sound levels on physiological variables and the consciousness state of patients treated in a cardiovascular area in an ICU.

DESIGN

A longitudinal study with several observations was carried out during 1 month in the cardiovascular area of an ICU of a third-level hospital in southern Spain.

METHODS

Sound levels were monitored in different work shifts and patients' physiological data and consciousness status were recorded. Generalized additive mixed models (GAMMs) were developed to detect the variability of the sound levels together with the vital parameters of the patients in the ICU.

RESULTS

Thirty-eight patients were included. The mean sound level was 54.09 dBA. The GAMM sound levels analysis showed a significant increase in sound levels from 4:30 p.m. to 8:00 p.m. (1.83 dBA; P < .001) and 8:00 p.m. to 11:30 p.m. (3.06 dBA; P < .001). An increase in heart rate (3.66 bpm; P < .001), respiratory rate (2.62 rpm; P < .001) and the Glasgow Coma Scale (0.50 units; P = .002) was detected during the 4:30 p.m.-8:30 p.m.

PERIOD

CONCLUSIONS

Elevated sound levels in cardiovascular ICUs seem to influence positively the physiological and consciousness status of patients. Given the importance of the findings for patient safety, future intervention studies are recommended.

RELEVANCE TO CLINICAL PRACTICE

The finding of this study could translate into structural changes in ICU facilities, as well as the development of clinical practice guidelines that influence the behaviour of health care professionals.

Impact of a white noise app on sleep quality among critically ill patients

BACKGROUND

Sleep disturbance negatively affects recovery and survival of patients in intensive care units (ICUs).

AIMS AND OBJECTIVES

This study aimed to measure the noise levels and evaluate the impact of a white noise app on the sleep quality of critically ill patients.

DESIGN

A quasi-experimental time series pre-test-post-test control group design with repeated measures was adopted.

METHODS

The study was conducted in the high dependency unit (HDU) of a selected tertiary care hospital in Mangalore, Karnataka State, India. Conscious oriented patients with systolic blood pressure ranging from 100/70 to 140/90 mm Hg and hearing acuity of at most 20 dB in both ears were included in the study. Noise levels in the HDU were measured using calibrated sound level meter on weekdays/weekends in three different shifts and an average of 24 readings was obtained per shift. A 4-point Likert scale was used to assess the sleep quality. The intervention included administration of white noise app twice a day, for three consecutive days by using different masking sounds such as white noise on day 1 which resembles to a humming AC conditioner, pink noise on day 2 which resembles to the sound of ocean waves and brown noise on day 3 which resembles a steady rainfall. The app was used with the help of JBL earphones C10SI an excellent noise cancellation and noise isolating earphone.

RESULTS

Among the 54 subjects, the mean age of the patients was 40.28 years, majority 34 (63%) were males. The noise level in the ICU was more than 60 dB. There was a significant difference in the sleep quality after the application of the white noise app in the experimental group on Day 1 (Z = -3.996; P = .001), Day 2 (Z = -3.302; P = .001), and Day 3 (-2.822; P = .005) compared to the control group.

CONCLUSION

Adoption of technology driven noise reduction applications would enhance the quality of sleep among the ICU patients.

RELEVANCE TO CLINICAL PRACTICE

The use of a technology-driven application helps control noise levels which promotes improved sleep quality among critically ill patients in the intensive care units.

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

Background

A 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 ICU sleep using a commercially available activity tracker and evaluated agreement between tracker-derived sleep data and patient-perceived sleep quality.

Patients and methods

A prospective cohort study was performed in a 40-bed ICU at a community teaching hospital. An activity tracker (Fitbit Charge 2) was applied for up to 7 ICU days in English-speaking adults with an anticipated ICU stay ≥2 days and without mechanical ventilation, sleep apnoea, delirium, continuous sedation, contact isolation or recent anaesthesia. The Richards-Campbell Sleep Questionnaire (RCSQ) was administered each morning by a trained investigator.

Results

Available activity tracker-derived data for each ICU study night (20:00–09:00) (total sleep time (TST), number of awakenings (#AW), and time spent light sleep, deep sleep and rapid eye movement (REM) sleep) were downloaded and analysed. Across the 232 evaluated nights (76 patients), TST and RCSQ data were available for 232 (100%), #AW data for 180 (78%) and sleep stage data for 73 (31%). Agreement between TST (349±168 min) and RCSQ Score was moderate and significant (r=0.34; 95% CI 0.18 to 0.48). Agreement between #AW (median (IQR), 4 (2–9)) and RCSQ Score was negative and non-significant (r=−0.01; 95% CI −0.19 to 0.14). Agreement between time (min) spent in light (259 (182 to 328)), deep (43±29), and REM (47 (28–72)) sleep and RCSQ Score was moderate but non-significant (light (r=0.44, 95% CI −0.05 to 0.36); deep sleep (r=0.44, 95% CI −0.11 to 0.15) and REM sleep (r=0.44; 95% CI −0.21 to 0.21)).

Conclusions

A Fitbit Charge 2 when applied to non-intubated adults in an ICU consistently collects TST data but not #AW or sleep stage data at night. The TST moderately correlates with patient-perceived sleep quality; a correlation between either #AW or sleep stages and sleep quality was not found.

Intensive Care Unit Environment and Sleep

Patients undergoing treatment in intensive care unit are in an extremely vulnerable state and require a complex multidisciplinary approach. Adequate sleep is required to maintain physiologic functions of the human body. Good sleep quality plays a vital role in the process of recovery. Sleep disruption in intensive care settings is a well-known fact. The consequences of sleep deprivation can cause numerous complications including delayed mechanical ventilation wean, neurocognitive dysfunction, decreased immune function and increased mortality rates. This review describes how the intensive care unit environment impacts sleep architecture.

Reducing the dosing frequency of selective digestive tract decontamination to three times daily provides effective decontamination of Gram-negative bacteria

This study evaluated the effectiveness of selective digestive tract decontamination (SDD) application three times daily (t.i.d.) compared to the standard four times daily (q.i.d.). Retrospective equivalence (combined non-inferiority and non-superiority design) study with a before-and-after design on a tertiary ICU in which the SDD frequency was reduced from q.i.d. to t.i.d. All patients with ICU admissions ≥72h and with ≥2 surveillance cultures collected on different dates were included in this study. We compared successful decontamination of Gram-negative bacteria (GNB). Furthermore, time to decontamination, ICU-acquired GNB bacteraemia and 28-day mortality were compared between the two groups. In total 1958 ICU admissions (1236 q.i.d., 722 t.i.d). Decontamination was achieved during the first week of admission in 77% and 76% of patients receiving SDD q.i.d and t.i.d., respectively. Successful decontamination within 14 days (without consecutive acquisition of Gram-negative bacteria) was achieved in 69.3% of the admissions with q.i.d. versus 66.8% in t.i.d. SDD (p-value = 0.2519). The proportions of successful decontamination of GNB were equivalent in both groups (−0.025, 98% CI: −0.087; 0.037). There was no significant difference in time to decontamination between the two regimens (log-rank test p-value = 0.55). Incidence (episodes/1000 days) of ICU-acquired GNB bacteraemia was 0.9 in both groups, and OR for death at day 28 in the t.i.d. group compared to the q.i.d. group was 0.99 (95% confidence interval, 0.80–1.21). This study shows that a t.i.d. application regimen achieves similar outcomes to the standard q.i.d. regime, for both microbiological and clinical outcome measures.

Noise Level and Comfort in Healthy Subjects Undergoing High-Flow Helmet Continuous Positive Airway Pressure

AIM

The aim of this study was to assess the noisiness levels produced by different gas source systems, breathing circuits setup, and gas flow rates during continuous positive airway pressure (CPAP) delivered through helmet.

METHODS

This was a crossover design study. Ten healthy subjects received helmet CPAP at 5 cm H2O in random order with different gas flow rates (60 and 80 L/min), 3 diverse gas source systems (A: Venturi system, B: oxygen and air flowmeters, C: electronic Venturi system), and 3 different breathing circuit configurations. During every step of this study, a heat and moisture exchanger (HME) was placed on the helmet inlet gas port to measure the effects on noise production. Noise intensity level was recorded through a sound-level meter. Participants scored their noisiness perception on a visual analog scale.

RESULTS

The noise level inside the helmet ranged between 76 ± 4 and 117 ± 1 Decibel A. The gas source and the gas flow rate always affected the noise level inside and outside the helmet (P < .001). The different "breathing circuit setup" did not change the noise levels inside the helmet (P = .244), but affected the noise level outside, especially when a Venturi system was used (P < .001). An HME filter placed at the junction between the inspiratory limb of the breathing circuit and the helmet significantly decreased the noise intensity inside the helmet (mean dBA without HME, 99.56 ± 13.30 vs 92.26 ± 10.72 with HME; P < .001) and outside (mean dBA without HME, 68.16 ± 12.05 vs 64.97 ± 12.17 with HME; P < .001). The perception of noise inside the helmet was lower when an HME filter was placed on the inspiratory inlet gas port (median, 6 [interquartile range, 4-7] vs 7 [5-8]; P < .001).

CONCLUSIONS

When helmet CPAP is delivered through gas flow rates up to 50 L/min, an HME placed on the helmet inlet gas port should be used to reduce noise inside the helmet and to improve patients' comfort.

Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study

Sleep disruption is common in patients in the intensive care unit (ICU). The aim of the study was to measure sound levels during sleep-protected time in the ICU, determine sources of sound, assess the impact of sound levels and patient-related factors on duration and quality of patients' sleep. The study was performed between 2018 and 2019. A commercially available smartphone application was used to measure ambient sound levels. Sleep duration was measured using the Patient's Sleep Behaviour Observational Tool. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The study population comprised 18 (58%) men and 13 (42%) women. There were numerous sources of sound. The median duration of sleep was 5 (IQR 3.5–5.7) hours. The median score on the RCSQ was 49 (IQR 28–71) out of 100 points. Sound levels were negatively correlated with sleep duration. The cut-off peak sound level, above which sleep duration was shorter than mean sleep duration in the cohort, was 57.9 dB. Simple smartphone applications can be useful to estimate sound levels in the ICU. There are numerous sources of sound in the ICU. Individual units should identify and eliminate their own sources of sound. Sources of sound producing peak sound levels above 57.9 dB may lead to shorter sleep and should be eliminated from the ICU environment. The sound levels had no effect on sleep quality.

Factors associated with sleep quality among "left-behind women" in rural China: a cross-sectional study

OBJECTIVE

The present study aimed to assess the sleep quality of left-behind women in rural China and exploring the factors associated with sleep quality among rural women.

METHODS

A cross-sectional survey was conducted in Liaoning province, China. A total of 1591 participants were investigated. The sleep quality of rural women was measured by the Pittsburgh Sleep Quality Index scale (PSQI). The data collected included sociodemographic together with psychological factors including depression (CES-D), loneliness (UCLA), social support (PSSS), and resilience (CD-RISC).

RESULTS

The total prevalence rate of poor sleep quality for all participants was 34.54%, the detection rate of poor sleep quality in left-behind women was 51.6%, while it was only 24.3% in nonleft-behind women. The binary logistic regression indicated that the state of left behind was definitely a risk factor for sleep quality. In addition, physical exercise, social support, and resilience had significantly protective effects on sleep quality. Labor pressure, raising children, life events, depression, and loneliness served as risk factors were related to sleep quality.

CONCLUSION

The general sleep quality of rural left-behind women was not promising in rural China. Urgent attention should be payed to sleep quality of left-behind women. It is very necessary to promote sleep quality of left-behind women by developing public service and mental health system and to provide psychological intervention for those with poor mental health to promote the development of physical and mental health ultimately.

The effects of noise levels on pain, anxiety, and sleep in patients

BACKGROUND

Intensive care is a noisy environment for patients and one that affects pain, anxiety levels, and sleep quality.

AIMS AND OBJECTIVES

To determine the relationship between noise levels and pain, anxiety, and sleep levels in patients in intensive care units.

DESIGN

A descriptive and observational study design was used.

METHODS

This study was conducted between June and December 2018 in a public hospital and included 111 patients admitted to surgical critical care for at least 24 hours. Three Benetech Gm1351 manual sound level metres were used to measure noise. A Patient Information Form, a pain Visual Analog Scale (VAS), the Spielberger State-Trait Anxiety Inventory, and the Richards Campbell Sleep Questionnaire (RCSQ) were used for data collection.

RESULTS

The mean age of the patients was 57.29 years. The mean noise level detected in the intensive care unit was 66.52 dB (dB). Patients' mean pain VAS score was 3.79 ± 1.72, the mean State Anxiety Inventory score was 39.74 ± 2.98, and the mean total RCSQ score was 25.10 ± 13.17. Our findings show that patients in the intensive care unit are exposed to high noise levels and that, while this has no effect on pain, it significantly impacts anxiety and quality of sleep.

CONCLUSIONS

Noise levels in intensive care units significantly exceed recommended thresholds, and this adversely affects patients' anxiety levels and sleep quality. It is important for suitably restful conditions to be provided for patients, to be aware of the potential for anxiety, and for these factors to be borne in mind when planning nursing interventions.

RELEVANCE TO CLINICAL PRACTICE

Further studies on the effects of noise levels on pain, anxiety, and sleep levels in patients admitted to intensive care units are needed.

Music Therapy for Early Postoperative Pain, Anxiety, and Sleep in Patients after Mitral Valve Replacement

BACKGROUND

To investigate the effect of music therapy on early postoperative pain, anxiety, and sleep quality in patients after mechanical mitral valve replacement (MVR).

METHODS

A total of 222 patients undergoing mechanical MVR were divided into two groups: the music group and the control group. The patients in the music group received 30 minutes of music therapy every day, whereas the patients in the control group had 30 minutes of quiet time. The visual analogue scale (VAS) was used to evaluate the degree of pain, and the Self-Rating Anxiety Scale (SAS) was used to evaluate the degree of early postoperative anxiety. We also recorded the sleep duration of the patients and used the Verran and Snyder-Halpern (VSH) Sleep Scale to evaluate the sleep quality of the patients.

RESULTS

The VAS scores in the music group were significantly lower than those in the control group, and early postoperative anxiety in the music group was also significantly improved compared with that in the control group. The sleep duration in the music group was significantly greater than that in the control group. In the evaluation of sleep quality using the VSH Sleep Scale, the scores for sleep interruption, sleep length, sleep depth, degree of rest, and subjective sleep quality in the music group were significantly lower than those in the control group.

CONCLUSIONS

Music therapy can be an effective intervention to reduce early postoperative pain, relieve early postoperative anxiety, prolong sleep time, and improve the sleep quality of patients after mechanical MVR.

Impact of Light Intensity on Sleep of Patients in the Intensive Care Unit: A Prospective Observational Study

Aims and objectives

Sleep deprivation in the intensive care unit (ICU) has been linked to numerous complications. Light levels might impact the sleep of patients in the ICU. The aim of the study was to measure light levels during sleep-protected time in the ICU and to assess the impact of light intensity on sleep quantity/quality.

Materials and methods

This prospective, observational study was conducted in a 10-bed, mixed surgical/medical ICU. For measuring light levels, a commercially available smartphone application was used. The measurements were performed between 23:30 and 06:15 hours at 15-minute intervals. To assess sleep quantity, we used Patient's Sleep Observation Behavioral Tool and to assess sleep quality, we used Richards-Campbell Sleep Scale.

Results

The median number of time points at which patients were asleep was 20 (interquartile range, IQR 14-23) out of 25 (5 hours). The median self-reported quality of sleep (overall score) was 49 (IQR 28-71). The median values for individual questions are: question 1 (sleep depth)-54.0 (IQR 37-78), question 2 (sleep latency)-40.5 (IQR 6-90), question 3 (awakenings)-52.5 (IQR 28-76), question 4 (returning to sleep)-25.5 (IQR 11-78), and question 5 (sleep quality)-67.5 (IQR 5-76). No correlation was found between self-reported sleep quality and time spent asleep (p = 0.36). There was no correlation between average light levels during sleep-protected time and sleep quantity (p = 0.42)/sleep quality (p = 0.13). There was a correlation between average (13 ± 5 lux) light levels before sleep-protected time and sleep quality (p = 0.008).

Conclusion

Mean light levels of 11 ± 9 lux during sleep-protected time have no negative impact on quantity and quality of sleep in intensive care unit patients. Light levels up to 18 lux directly before falling asleep improve patients' self-reported quality of sleep in the ICU.

Clinical significance

Finding safe levels of light intensity during sleep-protected time in ICU.

How to cite this article

Czempik PF, Jarosińska A, Machlowska K, Pluta M. Impact of Light Intensity on Sleep of Patients in the Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2020;24(1):33-37.