Sleep Deprivation from the Perspective of a Patient Hospitalized in the Intensive Care Unit-Qualitative 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.

AIM

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.

Effects of Ward Night Noise Management in the Context of Enhanced Recovery After Surgery on Postoperative Sleep Quality, Anxiety, and Hormone Levels of Thoracic Surgery Patients with Lung Cancer

OBJECTIVE

This study aimed to analyze the effects of ward night noise management in the context of enhanced recovery after surgery (ERAS) on postoperative sleep quality and anxiety of thoracic surgery patients with lung cancer.

METHODS

This retrospective analysis included 118 patients with lung cancer who underwent thoracic surgery (from January 2020 to December 2021). The patients were categorized into the control and observation groups, which comprised 63 and 55 cases, respectively, on the basis of perioperative management plans. The two groups were compared in terms of their score in Athens Insomnia Scale (AIS), the State-Trait Anxiety Inventory (STAI) and Self-Rating Depression Scale (SDS), salivary cortisol (SC), thyroid hormone (TSH), and angiotensin II (Ang II) levels, and noise measurements at various timepoints.

RESULTS

The observation group exhibited a significantly lower noise level than the control group (P < 0.001). No statistically significant difference was found in the AIS, STAI, and SDS scores and Ang II, TSH and SC levels between the two groups before their surgery (P > 0.05). Compared with the control group, the observation group achieved significantly lower AIS scores at 1, 3 and 7 days after surgery (P < 0.05) and significantly lower STAI scores at 1 and 3 days postsurgery (P < 0.05). Significantly lower Ang II, TSH and SC indices were observed in the observation group after management than the control group (P < 0.05).

CONCLUSION

Night noise management in the context of ERAS can improve sleep quality and adverse moods of patients who underwent thoracic surgery for lung cancer, which helps in the promotion of prognosis.

Parents' Experiences and Perspectives of Their Child's Sleep Quality During Hospitalization

Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements.

Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model

BACKGROUND

Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes.

AIM

This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM).

STUDY DESIGN

A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM.

RESULTS

The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain).

CONCLUSIONS

The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated.

RELEVANCE TO CLINICAL PRACTICE

Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.

The efficacy of earplugs and eye masks for delirium severity and sleep quality in patients undergoing coronary artery bypass grafting in cardiac intensive care units: A single-blind, randomised controlled trial

BACKGROUND AND PURPOSE

Delirium is a neuropsychiatric syndrome with a wide range of possible causes and multiple complications in patients admitted to intensive care units. It is, therefore, necessary to seek appropriate and safe strategies to prevent and manage delirium. This study is intended to examine the efficacy of eye masks and earplugs for delirium severity and sleep quality in patients with coronary artery bypass grafting in a cardiac intensive care unit.

MATERIALS AND METHODS

This single-blind, randomised controlled trial was conducted on 114 patients who were consecutively enrolled and randomly assigned to either the experimental group or the control group. The experimental group received routine care plus eye masks and earplugs, and the control group received only routine care. The delirium severity and sleep quality were measured with the Neelon and Champagne confusion scale and the Verran and Snyder-Halpern sleep scale.

RESULTS

The mean delirium severity score differed significantly between the two groups on the second, third, and fourth postoperative days (p < 0.001). Although the trend of changes in the mean delirium severity score from the first postoperative day (before the intervention) to the second, third, and fourth postoperative days was downward in the two groups (trending towards higher delirium severity), the control group experienced greater changes than the experimental group. An intragroup analysis of delirium severity detected a statistically significant difference in both the experimental and control groups (p < 0.001). The sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) showed a statistically significant difference between the two groups across the three intervention days (p < 0.001).

CONCLUSION

The overnight use of eye masks and earplugs were found to have positive effects on sleep quality domains (sleep disturbance, sleep effectiveness, sleep supplementation) and delirium severity in coronary artery bypass grafting patients admitted to the cardiac intensive care unit for several days. It was also found that a significant interaction effect between the sleep disturbance subscale and delirium severity exists.

CLINICAL TRIAL REGISTRATION NUMBER

(https://en.irct.ir): IRCT20210523051370N2.

Sleep in cardiac arrest survivors

BACKGROUND

Insomnia, sleep apnoea and sleep loss are risk factors for the development of cardiovascular diseases. Most research on sleep disturbances includes patients with heart failure, while the role of sleep in sudden cardiac arrest survivors (SCA) has been only partially investigated and understood. Sleep-related breathing disorders and obstructive sleep apnoea increase illness and mortality in the aftermath of SCA. Also, post-traumatic stress is evident in SCA survivors, where sleep disruptions are some of the main symptoms of the condition. Consequently, it is important to identify sleep problems in SCA survivors at an early stage to avoid unnecessary suffering.

AIM

The aim of this study was to investigate registered nurses' perceptions of SCA survivors' sleep, both in hospital and after discharge.

STUDY DESIGN

This was an explorative interview study with a phenomenographic approach. Nineteen registered nurses (RNs) varying in age, sex and years in the profession participated.

FINDINGS

The nurses' perceptions of SCA survivors' sleep were categorized as: "The observer - noticing behaviours, emotions and habits of the patient that affect sleep", "The oblivious witness - attitudes that hinder the ability to recognise sleep behaviours", and "The practitioner - advising and medicating for sleep". The outcome space showed that the nurses detected both obvious and subtle signs relating to patients' sleep. However, attitudes hindering the recognition of sleep behaviours were independent of acting as an observer or practitioner. If nothing unforeseen was observed, or if the patient did not spontaneously raise the subject, sleep was considered less important than other health problems in SCA survivors.

CONCLUSIONS

Although the nurses knew that SCA survivors suffered from poor sleep, they failed to reflect on the consequences for the patient. Nurses' feelings of insufficient knowledge about sleep, as well as their omittance of sleep in the follow-up documentation could leave sleep issues unaddressed and cause unnecessary patient suffering.

RELEVANCE TO CLINICAL PRACTICE

Nurses need increased knowledge and training to enable them to detect subtle signs of sleep problems in SCA survivors.

Hydrogen Gas Treatment Improves Postoperative Delirium and Cognitive Dysfunction in Elderly Noncardiac Patients

Purpose: Postoperative delirium is a state of acute brain dysfunction characterized by fluctuating mental status that affects millions of patients each year. We used prophylactic inhalation of hydrogen gas in elderly patients undergoing elective surgery to compare their occurrence of postoperative delirium with that of controls. Methods: A total of 184 patients aged ≥ 65 years were enrolled and randomized into either a control group or a hydrogen inhalation group. The quality of sleep was assessed 1 day before and 1, 3, and 7 days after surgery at 8 A.M. The Confusion Assessment Method (CAM) was used as a screening tool for delirium and assessed the patients’ state of consciousness 1−7 days after surgery. Results: Postoperative delirium occurred in 17 (24%) of 70 patients without hydrogen inhalation and in 10 (12%) of 83 patients after hydrogen inhalation. The incidence of delirium was decreased in the hydrogen group. No significant differences were found between length of stay in hospital after surgery and sleep quality at 1, 3, and 7 days postoperatively between the two groups. The numerical rating scale (NRS) pain scores were higher in the hydrogen group (4.08 ± 1.77) than the control group (3.54 ± 1.77) on day 1 (p < 0.05); however, the mean difference between the two groups was small (1 to 1.6). There were no significant differences on day 3 and 7. The postoperative C-reactive protein level was significantly lower in the hydrogen group than the control group. Conclusions: This study suggests that hydrogen inhalation can prevent postoperative delirium in elderly noncardiac patients by reducing the inflammatory response.

Effects of an earplug placement intervention on sleep quality in patients in a medical intensive care unit: A randomized controlled trial

AIMS

This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non-ventilated intensive care unit patients.

METHODS

A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6-sulfatoxymelatonin levels, relaxation responses measured using the Richards-Campbell Sleep Questionnaire, liquid chromatography-mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am.

RESULTS

Overall, 28.03% of participants showed virtually no 6-sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6-sulfatoxymelatonin and vital signs.

CONCLUSIONS

The effects of using earplugs alone on sleep quality, urinary 6-sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality.

Sleep disturbance: The overlooked side after open heart surgery in adults

BACKGROUND

Sleep is essential for full mental and physical renewal. Cardiac surgery improves the life expectancy and quality. But unfortunately, some patients lacked that merit as they suffered sleep disturbance. We used validated questionnaire applied to 153 cardiac surgery patients to assess the sleep disturbances after surgery.

RESULTS

About 70 (45.8%) had valve procedure, 55 (36%) had revascularization, 19 (12.4%) had both procedures and 9 (5.8%) had other procedures. The majority had no post-operative bleeding nor infection. About 78% had sleeping difficulty for one month. About 50% used different medications to fall asleep, mostly analgesics. About 76% slept after 2-6 h irrespective of sleep quality. Some patients had poor sleep quality in the form of nightmares and night terrors.

CONCLUSION

Sleep quality was disturbed immediately following cardiac surgery. There was a reduction of night sleep compensated by increased daytime sleepiness. These changes almost reverted one month after surgery.

Occurrence of Delirium during ECMO Therapy in a Critical Care Unit in Poland-A Cross-Sectional Pilot Study

BACKGROUND

The problem of delirium during extracorporeal membrane oxygenation (ECMO) therapy, which has rarely been studied, is an important issue since it is necessary to ensure patient safety during therapy. This study aimed to show the incidence of delirium in patients after extracorporeal membrane oxygenation therapy and factors affecting the occurrence of delirium in this group of patients.

DESIGN

A cross-sectional study was conducted.

METHOD

The study involved a group of patients from an intensive cardiac care unit who received extracorporeal membrane oxygenation therapy. The study lasted for more than two years, in the period from 2018 until 2020. The Nursing Delirium Screening Scale (NuDESC) and the Delirium Observation Screening Scale (DOSS) were applied. Additionally, the patients were examined using Numeric Rating Scale (NRS), the Insomnia Severity Index (ISI), the Richmond Agitation Sedation Scale (RASS), the Ramsay Sedation Scale (RSS), and a thirst intensity scale; ultimately, relationships between these factors and delirium were examined.

RESULTS

In patients who underwent ExtraCorporeal Membrane Oxygenation (ECMO) therapy, delirium was confirmed by the NuDESC in 68.75% of patients in the evening hours, while it was measured by the DOSS scale in 84.38% of patients in the morning. The study found that ECMO delirium was not associated with hyperactivity, sleep disturbance, sedation, pain, or thirst.

CONCLUSION

Delirium in patients undergoing ECMO therapy was confirmed by both the NuDESC and DOSS. Factors such as thirst and sleep disturbance after ECMO therapy were shown to influence the occurrence of delirium. The diagnosis of delirium using standardized scales is possible provided that more tests are carried out. Research should be conducted to determine whether the NuDESC is equivalent to the DOSS.