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

Louzon, Patricia; Andrews, Jessica L.; Torres, X.; Pyles, Eric; Ali, Mahmood; Du, Yi; Devlin, John W.

doi:10.1136/bmjresp-2020-000572

Cited by 16 publications

(14 citation statements)

References 25 publications

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“…This study is unique as it utilized a wearable device-an objective tool-to measure sleep and sleep quality, while prior studies utilized subjective methods of sleep diaries and perception of quality of sleep. 4,17,19,[30][31][32] Actigraphy was reported to be more accurate than sleep diary 4,20,21 ; similarly, reported subjective time of sleep by our residents was significantly lower than the time asleep recorded by the Fitbit. The ACGME restricted work hours for residents to improve sleep hygiene and well-being 33 ; nevertheless, this study has demonstrated that residents are sleep deprived with an average daily sleep of 5.9±1.6 hours and a deep sleep of 1.1±0.4 hours, values suboptimal to recommended total (7-9 hours) and deep sleep duration (1.5-2 hours).…”

Section: Sleep and Negative Emotionsmentioning

confidence: 44%

“…Actigraphy, coupled to a wrist-wearable pedometer, is a relatively inexpensive innovative instrument that can collect objective data on sleep quality for an extended period. 20,21 Accordingly, this study aimed to measure the relationship between medical residents' emotions and both total and deep sleep as measured by a wearable device. It also sought to describe the sleep quality among residents in terms of sleep stages and explore other nonsleep predictors of the negative emotions of the residents.…”

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confidence: 99%

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Impact of Sleep on Medical Residents’ Emotions: A Cross-Sectional Study Using a Wearable Device

Baba

Antoun

Mladenovic

et al. 2021

Fam Med

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Background and Objectives: Controlling negative emotions and getting sufficient sleep are key factors in reducing medical errors and optimizing quality of care. The objective of this study was to measure the relationship between the emotions of medical residents and sleep as measured by a wearable device. Methods: We conducted a cross-sectional study addressing all residents of all postgraduation years and specialties at an Accreditation for Graduate Medical Educations-I accredited institution over 6 months. Sleep quantity and quality were measured by Fitbit Charge 2 device, and daily emotions by the Positive and Negative Affect Schedule questionnaire. Results: We included a total of 45 participants with a total of 1,112 observations (response rate=19.3%). The mean duration of total daily sleep was 5.9±1.6 hours, with a deep sleep time of 1.1±0.4 hours. We found a negative association between negative emotions and total sleep (rrm=-0.14, P<.0001) and deep sleep (rrm=-0.11, P=.0005) using repetitive measures correlation. A linear regression model to predict the negative emotions of the residents revealed additional determinants beyond deep sleep. Conclusions: Our findings provide a further understanding of the importance of sleep quality on emotions by emphasizing deep sleep as a predictor of the second-day affect. Residency programs should strive to provide an ideal sleep environment to their residents and deliver workshops to deal with negative emotions.

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Section: Sleep and Negative Emotionsmentioning

confidence: 44%

mentioning

confidence: 99%

Impact of Sleep on Medical Residents’ Emotions: A Cross-Sectional Study Using a Wearable Device

Baba

Antoun

Mladenovic

et al. 2021

Fam Med

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“…ACTG monitoring is not infallible and its limitations need to be acknowledged in terms of its potential to distinguish between voluntary and involuntary movements. Whereby, patients’ wakeful inactivity may be identified as rest or sleep, and activity associated with care interventions such as repositioning may be inaccurately identified as a wakeful state [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

et al. 2021

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Background Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

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“…A full description of the sleep assessment methods has been previously published. 20 The primary outcome was to assess the difference in TST recorded by the activity tracker and patient-perceived sleep quality as evaluated by the RCSQ before and after sleep protocol implementation. The number of daily steps in the ICU (a surrogate of mobility) was also compared between groups.…”

Section: Patient Selection and Assessmentsmentioning

confidence: 99%

Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality

et al. 2020

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Background: Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation. Objective: To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception. Methods: Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non–mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures. Results: Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; P = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; P = 0.0003) compared with before implementation. Conclusion and Relevance: A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.

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

Cited by 16 publications

References 25 publications

Impact of Sleep on Medical Residents’ Emotions: A Cross-Sectional Study Using a Wearable Device

Impact of Sleep on Medical Residents’ Emotions: A Cross-Sectional Study Using a Wearable Device

The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality

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