Sleep Deprivation in the Intensive Care Patient

Parents' perceptions of factors influencing sleep in pediatric intensive care units: A qualitative study

PURPOSE

The purpose of this study is to explore factors influencing sleep in pediatric intensive care units as perceived by parents of critically ill children.

DESIGN AND METHODS

This descriptive qualitative study used individual semistructured interviews. Parents were recruited through purposive sampling from two pediatric intensive care units at two locations in one university hospital in Norway. Ten parents were interviewed. The interviews were analyzed using a six-phase reflexive thematic analysis.

FINDINGS

The analysis produced 17 subthemes under four main themes: environmental factors in the pediatric intensive care unit disturb children's sleep, children need trust and safety to sleep, nurses' cooperation with parents influences children's sleep, and nurses' structuring of their practices is fundamental to sleep promotion.

CONCLUSION

The parents found that the environment disturbed their children's sleep, and environmental factors were easier to control in single rooms than in multibed rooms. Children slept better when they felt safe and trusted the nurses, and parents desired more cooperation in promoting sleep for their children, which may be an essential and overlooked part of sleep promotion. Nurses varied considerably in how they prioritized sleep and structured their practices to promote sleep.

PRACTICE IMPLICATIONS

Nurses should take parents' experiences into account to better promote sleep for patients. By limiting environmental disturbances, building relationships with children to make them feel safe, including parents in sleep promotion, and prioritizing sleep in their practices, nurses could improve sleep quality and limit the consequences of sleep disturbance.

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.

The Impact of a Pharmacist-Driven Multicomponent Sleep-Promoting Protocol on Delirium in Critically Ill Patients

Background: Sleep deprivation is reported in 80% of patients in the intensive care unit (ICU) and is associated with delirium. Guidelines recommend implementing a sleep-promoting protocol in critically ill patients which may increase the quantity and quality of sleep and may decrease delirium. Our objective was to implement a pharmacist-led interdisciplinary sleep-promoting protocol and analyze its impact on delirium in ICU patients receiving mechanical ventilation (MV). Methods: The study involved pre-implementation education, protocol development, and post-implementation analysis. ICU pharmacists completed prospective patient chart reviews to reduce exposure to deliriogenic medications and assess the need for a pharmacologic sleep aid. The primary outcome was the incidence of delirium and delirium-free days. Secondary outcomes included ICU length of stay (LOS), incidence of MV, and pharmacist medication interventions. 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 = .01). Post-protocol patients had a higher average APACHE III score (P = <.001). Delirium-free days were not significantly different between groups (P = .97). Difference in ICU LOS was not significant (P = .80). More patients received MV post-protocol implementation (55.7% vs 36.1%; P < .001). Pharmacists documented a total of 113 medication interventions. Conclusion and Relevance: A pharmacist-led, ICU sleep-promoting protocol was successfully implemented but did not reduce the incidence of delirium or the administration of insomnia agents. Post-protocol patients had higher disease severity and were more likely to receive MV. Incidence of delirium was consistent with the national reported prevalence of ICU delirium. ICU pharmacists on all shifts had an active role in optimizing sleep.

Environmental Comfort in Promoting Sleep in Critically Ill Patients: A Scoping Review

INTRODUCTION

It is important to understand the concept of comfort as a whole to build an assistance intervention plan that meets the person's needs. Therefore, it is necessary to monitor and assess the person's sleep by considering the surrounding environment, to provide a comfortable environment that is quiet and provides privacy, especially in contexts of difficult management of environmental factors in the approach to the person in critical condition.

OBJECTIVES

The aims of this study were to map the nursing interventions that promote sleep-promoting environmental comfort in critically ill people and identify the instruments to assess sleep in critically ill people.

METHODS

This is a scoping review based on the methodological strategy of the Joanna Briggs Institute for Scoping Reviews. The search was conducted on February 17 and 18, 2022, in the databases CINAHL, Cochrane Library Plus, PubMed, JBI Evidence Synthesis, SciELO, DANS Easy Archive, RCAAP, and DART-Europe using the Boolean phrase search strategy: "Hospital Emergency Service" OR "Critical Care" AND "Sleep" NOT "Children" AND Nurs*. We included all studies, conducted in any contextual setting, in Portuguese, English, or Spanish, on adult patients with acute and/or critical illness in intensive care and/or emergency units, which addressed nursing interventions that contribute to environmental comfort and promote sleep. Studies on pregnant or puerperal women, persons with psychiatric disorders, and those at the end of life or in palliative care were excluded.

RESULTS

Twenty-one articles were included in this scoping review. Three categories of nursing interventions emerged: person centered (14 interventions), environment centered (37 interventions), and nurse role centered (45 interventions). Three categories of instruments for sleep assessment emerged, in particular: quality of sleep (12 instruments), environmental effects on a night's sleep (2 instruments), and influence on sleep practices in the intensive care unit (1 instrument).

DISCUSSION

The use of instruments to monitor comfort and sleep allows for an accurate assessment of the impact of nurses' intervention focusing on sleep-promoting interventions aimed at comfort, for an improvement of sleep in critically ill patients.

CONCLUSION

The interpretation of the content makes it clear that how critically ill patients in different contexts experience the environmental context positively or negatively conditions their comfort. In this sense, it is essential to reflect on these measures as a team so that everyone can apply them.

Blood gas sampling in the intensive care unit: A prospective before-and-after interventional study on the effect of an educational program on blood gas testing frequency

BACKGROUND

Blood gas analysis is the most commonly ordered test in the intensive care unit. Each investigation, however, comes with risks and costs to the patient and healthcare system. Evidence suggests that many tests are performed with no appropriate clinical indication.

OBJECTIVES

The primary aim of our prospective interventional study was to investigate the proportion of blood gases undertaken with a valid clinical indication before and after an educational intervention. A secondary aim was to examine sleep interruption secondary to blood gas sampling.

METHODS

A prospective, before-and-after interventional study was conducted across two metropolitan intensive care units in Melbourne, Australia. Adults aged ≥18 years who were admitted to intensive care were eligible for inclusion. Two observation periods were conducted across a 2-week period in May and September 2022 (Periods 1 and 2), where clinicians were encouraged to record the purpose of blood gas sampling and other relevant data via an electronic questionnaire. These data were reviewed with corresponding electronic medical records. In between these periods, an interventional educational program to inform the clinical rationale for blood gas testing was delivered during July and August 2022, including introduction of a clinical guideline.

RESULTS

There were 68 patients with 688 tests included in Period 1 compared to 69 patients with 756 tests in Period 2. There was no significant difference between the median number of blood gas analyses performed per patient before and after the educational intervention (6.0 tests per patient vs 5.0 tests per patient, p = 0.609). However, there was a significant increase in the percentage of tests with a valid clinical indication (49.0% vs 59.7%, p = 0.0025). The most common indications selected were routine measurement, monitoring a clinical value, change in ventilator settings/oxygen therapy, and clinical deterioration. In addition, there were a large number of patients who were awakened upon drawing of a blood sample for analysis (26.1% for Period 1 and 37.6% for Period 2, p = 0.06).

CONCLUSION

The implementation of an educational program resulted in a significant increase in the proportion of blood gases performed with an appropriate clinical indication. There was, however, no reduction in the overall number of blood gases performed.

Gender perspective in the implementation of hygiene in cardiology intensive care

INTRODUCTION

Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective.

METHODS

Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed.

RESULTS

Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters).

CONCLUSION

Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

The effects of ergonomic sleep mask use on sleep quality and comfort in intensive care patients

This study was conducted to determine the effects of the use of ergonomic sleep mask on sleep quality and comfort in intensive care patients. This randomised controlled experimental study was completed with 128 surgical intensive care patients (control = 64, experimental = 64). During the second night of their stay in the unit, ergonomic sleep masks were given to the patients in the experimental group, and earplugs and eye masks were given to the patients in the control group. A Patient information form, Visual analogue scale for discomfort, and the Richard-Campbell sleep questionnaire were used to collect data. While 51.6% of the patients were female, the mean age of the patients was 63.87 ± 14.94 years. The highest rates of patients had undergone cardiovascular surgery (28.9%) and general anaesthesia (57.8%). It was determined that the sleep quality of the patients in the experimental group was statistically and clinically significantly higher after the intervention (50.86 ± 21.46 vs 37.64 ± 14.97, t = -5.355, Cohen's d = 0.450, p < 0.001). Likewise, the patients who used ergonomic sleep masks had a statistically significantly lower mean VAS for Discomfort score, and their comfort level was higher (p < 0.001), but the difference was not clinically significant (Cohen's d = 0.208). The results of this study showed that the use of ergonomic sleep masks in surgical intensive care patients had a more positive effect on both the sleep quality and comfort levels of patients compared with earplugs and eye masks. The use of an ergonomic sleep mask is recommended in the early period to facilitate sleep and rest in surgical intensive care patients.

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.

Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients

Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors. It is associated with many adverse clinical outcomes including cognitive impairment, functional decline, prolonged hospitalization, and increased nursing service. The prevalence of delirium was high in department of cardiology, geriatric, and intensive care unit of hospital. With the increase in the aged population, further increases in delirium seem likely. However, it remains poorly recognized in the clinical practice. This article comprehensively discusses the latest research perspectives on the epidemiological data, risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium, including specific measures to manage delirium in clinical real-world situations. This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.

Nurses' experiences of managing cognitive problems in intensive care unit patients: A qualitative study

OBJECTIVES

Nurses hold a key position in identifying symptoms and initiating preventive strategies for cognitive impairment in delirious and non-delirious intensive care unit patients. However, it remains unclear whether nurses consider cognitive impairment as a distinct concern from delirium. By understanding nurses' perspectives, we may identify barriers and facilitators in caring for patients with cognitive challenges in the intensive care unit. The objective of this study was to explore nurses' experiences of cognitive problems in patients admitted to an intensive care unit.

RESEARCH METHODOLOGY

A phenomenological-hermeneutic study of interviews with ten nurses from intensive care units. Data were collected in March-April 2022 and analysed using a Ricœur-inspired method of interpretation.

FINDINGS

Three themes related to nurses' experiences of cognitive problems emerged through analysis; 1) Cognitive problems and delirium are seen as two sides of the same coin, 2) Searching for the person behind the patient, and 3) Maintaining a sense of normality in a confusing environment.

CONCLUSIONS

The interconnected concept of cognitive impairment and delirium syndrome meant that nurses assessed and managed cognitive problems in intensive care unit patients by focusing on preventing delirium. Apart from delirium screening, nurses relied on relatives' knowledge to assess patients' cognition. Most significantly, our study revealed a previously unexplored approach by nurses to manage patients' cognition, which involved "shielding" patients from the noisy and disruptive intensive care unit environment.

IMPLICATIONS FOR CLINICAL PRACTICE

Effective communication methods, coupled with family involvement may aid nurses in identifying patients' cognitive problems. In the acute phase of critical illness, distinguishing between delirium and cognitive problems may not be clinically relevant, as delirium protocols may protect patients' cognition. Further investigating the concept of shielding may reveal previously unexplored nursing approaches to manage cognitive problems.

Emotional response of critically-ill cardiac patients during hygiene procedures in intensive care: a prospective and descriptive study

OBJECTIVE

to analyze the emotional response of critically-ill conscious patients during daily hygiene procedures in a Cardiology Intensive Care Unit and to compare it based on the existence of previous experiences or not.

METHOD

a prospective and descriptive study. A 30-item ad hoc survey based on the first-day hygiene procedures was applied to 148 patients. Questions are asked about the feelings during the hygiene procedures and about positive and negative aspects of the experience. The patients are compared based on whether they had been already subjected to hygiene procedures or not.

RESULTS

67.6% were men and their mean age was 67±15 years old; 45.9% proved to be satisfied, 27% felt embarrassment and 86.3% were grateful to the professionals for talking to them during the hygiene procedures. 33.1% of the patients had never been subjected to hygiene procedures in bed, were significantly younger and single, and presented a lower cleanliness sensation. 32% stated that they would like for a family member to collaborate in the hygiene procedures.

CONCLUSION

the patients do not feel that their intimacy is invaded when they are subjected to hygiene procedures and appreciate communication with the health personnel while this care is provided. Those who had never been subjected to hygiene procedures in bed are younger, feel more embarrassed and are more disturbed by interruptions, in addition to being more aware of them.

Sleep in neurointensive care patients, and patients after brain tumor surgery

BACKGROUND

Severely brain injured patients treated in the neuro intensive care unit (NICU) are usually sedated. Sedation may affect not only the ability to sleep, but also the EEG rhythms used to identify sleep.

AIM

The aims were: To study if sleep patterns could be identified in the severely brain injured and sedated patients in the NICUTo study if sleep patterns could be identified in patients the night after brain tumor surgery in the neurointermediate care unit (NIMCU)To search for risk factors for not being able to sleep after brain tumor surgery.

STUDY DESIGN

Two populations were included; one with patients affected by severe brain injury and one with patients who had undergone planned brain tumor surgery. This was a quantitative observational study using EEG. Eligible neurointensive care patients for this study had to be suffering from a neurosurgical condition (for example subarachnoid haemorrhage, acute subdural hematoma, intracerebral haemorrhage and meningitis), have affected consciousness and age over 18 years. Thirty-seven patients were included from NICU. Ninety-eight patients, with a suspected glioma (WHO grade II-IV) planned for surgery were also included.

RESULTS

Neuro intensive care patients, sedated and treated in ventilator, showed no EEG sleep patterns at all. After brain tumor surgery, sleep occurred in 74% of the patients, despite frequent wake-up tests. The patients with sleep patterns were on average 8 years younger, p = 0.03.

CONCLUSIONS

Patients with severe brain injury are at risk of having no sleep when treated at the NICU, whereas after brain tumor surgery, sleep occurs in three-fourths of the patients. Further studies and new methods are warranted to identify sleep and investigate how the loss of sleep affects these patients and how sleep disturbances can be managed.

Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta-analysis

AIM

The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit.

BACKGROUND

Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited.

DESIGN

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS

Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations.

RESULTS

In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta-analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two-night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low.

CONCLUSION

Massage intervention, particularly foot reflexology massage, with a two-night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non-invasive, low-cost and effective way to promote sleep quality in critically ill adult patients.

RELEVANCE TO CLINICAL PRACTICE

Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients.

STUDY REGISTRATION

The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42022332371).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution if such details are not necessary or do not apply to your work and state why.

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.

Sleep after Traumatic Brain Injury

Sleep disturbances are common after traumatic brain injury of all levels of severity, interfere with acute and long-term recovery, and can persist for years after injury. There is increasing evidence of the importance of sleep in improving brain function and recovery. Noticing and addressing sleep disturbances are important aspects of nursing care, especially for the prevention or early recognition of delirium. Nonpharmacologic interventions can improve sleep. Teaching about the importance of sleep after traumatic brain injury, promoting sleep hygiene, and multidisciplinary approaches to addressing sleep problems and improving sleep are important for recovery from traumatic brain injury.

The Impact of Obstructive Sleep Apnea on the Sleep of Critically Ill Patients

Obstructive sleep apnea is becoming increasingly prevalent in society and thus critical care practitioners need to be prepared to care for these patients in the intensive care unit. Preparation begins with equipping the critical care nurse with the knowledge necessary to provide interventions which can enhance patient outcomes and mitigate complications.

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.

Sleep deprivation aggravates brain injury after experimental subarachnoid hemorrhage via TLR4-MyD88 pathway

Subarachnoid hemorrhage (SAH) is a life-threatening cerebrovascular disease, and most of the SAH patients experience sleep deprivation during their hospital stay. It is well-known that sleep deprivation is one of the key components of developing several neurological disorders, but its effect on brain damage after SAH has not been determined. Therefore, this study was designed to evaluate the effect of sleep deprivation using an experimental SAH model in rats. Induction of sleep deprivation for 24 h aggravated the SAH-induced brain damage, as evidenced by brain edema, neuronal apoptosis and activation of caspase-3. Sleep deprivation also worsened the neurological impairment and cognitive deficits after SAH. The results of immunostaining and western blot showed that sleep deprivation increased the activation of microglial cells. In addition, sleep deprivation differently regulated the expression of anti-inflammatory and pro-inflammatory cytokines. The results of immunofluorescence staining and western blot showed that sleep deprivation markedly increased the activation of Toll-like receptor 4 (TLR4) and myeloid differentiation primary response protein 88 (MyD88). Mechanically, treatment with the TLR4 inhibitor TAK-242 or the MyD88 inhibitor ST2825 significantly attenuated the brain damage and neuroinflammation induced by sleep deprivation after SAH. In conclusion, our results indicate that sleep deprivation aggravates brain damage and neurological dysfunction following experimental SAH in rats. These effects were mediated by the activation of the TLR4-MyD88 cascades and regulation of neuroinflammation.