Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Abstract

Introduction: Sleep disturbance is a frequently overlooked complication of intensive care unit (ICU) stay. Aim: To evaluate sleep quality among patients admitted to ICU and investigate environmental and non-environmental factors that affect sleep quality in ICU. Methods: Over a 22-month period, we consecutively recruited patients who spent ≥ 2 nights post-endotracheal extubation in ICU and who were orientated to time, place, and person on the day of discharge. Self-reported sleep quality, according to a modifi ed Freedman questionnaire, which provided data on self-reported ICU sleep quality in ICU and environmental factors affecting sleep quality in the ICU, were collected. We also investigated non-environmental factors, such as severity of illness, ICU interventions, and medications that can affect sleep quality. Results: Fifty males and 50 females were recruited with a mean (± SD) age of 65.1 ± 15.2 years. APACHE II score at admission to ICU was 18.1 ± 7.5 with duration of stay 6.7 ± 6.5days. Self-reported sleep quality score at home (1 = worst; 10 = best) was 7.0 ± 2.2; this decreased to 4.0 ± 1.7 during their stay in ICU (p < 0.001). In multivariate analysis with APACHE III as severity of illness (R 2 = 0. S C I E N T I F I C I N V E S T I G A T I O N SA frequently overlooked complication of intensive care unit (ICU) admission is a lack of adequate sleep. In critically ill patients the prevalence of sleep disturbance has been shown to be more than 50%.1 Disrupted sleep is associated with immune system dysfunction, impaired resistance to infection, alterations in nitrogen balance, impaired wound healing, and cardiorespiratory and neurological consequences.2 Several polysomnographic studies have demonstrated decreased total sleep time, sleep fragmentation, and altered sleep architecture in patients in ICU.3-10 When examining the etiologies of sleep disturbance, these studies have focused on environmental stimuli such as increased noise.11 However, increased ICU noise level as the sole cause of sleep deprivation has been questioned.12-14 Frequent interruptions for diagnostic tests and routine patient care may also cause frequent arousals from sleep. In addition to environmental causes of poor sleep, sleep disturbance may also be related to non-environmental factors, including the condition at presentation (e.g., chronic obstructive pulmonary disease, pulmonary edema, myocardial infarction, postoperative state), disease or illness severity, patient discomfort, 2,4,5,10,15,16 patient medications (home medications) prior to admission, particularly those prescribed for insomnia and anxiety or depression, ICU interventions such as ventilators (invasive and noninvasive), dialysis, intra-aortic balloon counter pulsation (IABP) and the drugs administered in ICU. We therebRIEF SUMMARY Current Knowledge/Study Rationale: Environmental factors are known to affect quality of sleep in ICU. Study Impact: In addition to previously established environmental factors, several non-environmental factors were identifi ed which were...

Examining the Evidence to Guide Practice: Challenging Practice Habits

“…42 The combination of ICU patient care routines (eg, frequent laboratory tests, invasive procedures, fully supportive care), the ICU environment (eg, equipment, alarms, light), and frequent visitation (providers and family) contributes in many ways to sleep disruption for ICU patients. [43][44][45][46][47] Regardless of the cause of sleep disruption, the consequences of lack of sleep include worsening symptoms, physical and cognitive dysfunction, mood instability, and fatigue. 42,43,45,46 This situation raises the question: Why are we, as critical care nurses, disrupting the sleep of patients who are at most risk for complications related to lack of sleep?…”

“…[43][44][45][46][47] Regardless of the cause of sleep disruption, the consequences of lack of sleep include worsening symptoms, physical and cognitive dysfunction, mood instability, and fatigue. 42,43,45,46 This situation raises the question: Why are we, as critical care nurses, disrupting the sleep of patients who are at most risk for complications related to lack of sleep? As much as possible, nurses need to restructure their work flow and environment to maximize sleep of critically ill patients.…”

Sleep in Intensive Care: Is there or not?

“…Kortikosteroidlerin, özellikle yüksek dozlarda, yavaş uyku ve REM sürelerini azalttığı bilinmektedir. Antibiyotiklerden bazılarının, özellikle beta-laktam ve kinolonların uyku bozuklukları ile ilişkili olduğu bildirilmiştir (43).…”

Effects of Mattress Material on Body Pressure Profiles in Different Sleeping Postures

“…3,4 Poor sleep quality can be attributed to a variety of environmental factors, which include temperature, light, noise, and mattress quality. 5,6 Addison et al 7 reported that 7% of sleep problems were due to uncomfortable mattresses, which affect the loading of the spine during sleep. 4 Several previous studies have suggested that mattress material can affect sleep quality.…”