A Systematic Review of Sleep Measurement in Critically Ill Patients

Abstract

Background: Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice.

Investigating the construct and concurrent validity of the Richards-Campbell Sleep Questionnaire with intensive care unit patients and home sleepers

“…However, PSG is burdensome, and its use in ICU patients has acknowledged challenges regarding technical issues and scoring reliability, among others. 45 Thus, it was not an option in this study. Nonetheless, this should be considered for future research.…”

Updated Perspectives on the Management of Sleep Disorders in the Intensive Care Unit

“…Actigraphy is considered an acceptable method due to its ease and low cost of use, 31 but it commonly overestimates sleep time, sleep efficiency, and number of awakenings compared to a PSG. 20,32 A major limit is the detection of sleep/wake movements, since these are already reduced in ICU patients independently of sedation.…”

“…The diagnostic process is dependent on the severity of the patient's disease, his consciousness, and the necessary therapeutic and diagnostic interventions. 20,21 To date, polysomnography (PSG) is considered the gold standard in objective sleep assessment. 22 are a 3-leads recording of EEG activity, combined with EOG, EMG, electrocardiogram (ECG), airflow sensors at nares and mouth, respiratory effort (chest and abdominal belt), pulse oximetry and positional measurement.…”

“…An up-to-date overview of measurement methods can be found in the systematic review presented by Richards. 20 Next to the technical procedures, systematic observation methods were developed to evaluate sleep, like the assessment from nurses and physician staff based on specific patient behavioral activities. These methods are semiobjective, but offer an uncomplicated way to assess sleep in the ICU.…”

“…Subjective validation options include, but are not limited to, the Richards-Campbell Sleep Questionnaire (RCSQ), the Verran Snyder Harper Sleep Scale (VSH), the coronary care unit (CCU) questionnaire, the Insomnia Severity Index (ISI), and the numerical rating scale (NRS)-Sleep. 20,24,25…”