Non-pharmacological interventions for sleep promotion in the intensive care unit

Hu, Rongfang; Jiang, Xiaoying; Chen, Junmin; Zeng, Zhiyong; Chen, Xiao Y; Liu, Yueping; Xin, Hui-Ning; Evans, David; Wang, Shuo

doi:10.1002/14651858.cd008808.pub2

Cited by 134 publications

(137 citation statements)

References 92 publications

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“…It is unclear whether any improvements in practice or outcomes were maintained beyond the time in which the studies were conducted. Similar problems with methodology were revealed in a recent Cochrane review, which highlighted the need for well‐designed and conducted research to strengthen the evidence for the use of non‐pharmacological interventions for improving sleep in critically ill adults (Hu et al, ).…”

Section: Discussionmentioning

confidence: 78%

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

Menear

Elliott

Aitken

et al. 2017

Nursing in Critical Care

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To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep-promoting interventions has not been widely reported. An observational study was conducted in a 58-bed adult intensive care unit. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep-promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open-ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep-promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards-Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards-Campbell Sleep Questionnaire was used on repeated occasions, and sleep-promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards-Campbell Sleep Questionnaire for the subjective self-assessment of sleep quality in intensive care unit patients and the implementation of simple-promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.

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Section: Discussionmentioning

confidence: 78%

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

Menear

Elliott

Aitken

et al. 2017

Nursing in Critical Care

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“…Health behavior terms (alcohol terms adapted from Kaner et al, 2007; exercise from Foster et al, 2005; eating from Nield et al, 2007; smoking from Secker-Walker et al, 2002; and sleep from Hu et al, 2015) combined with OR:…”

Section: Methodsmentioning

confidence: 99%

Perseverative Cognition and Health Behaviors: A Systematic Review and Meta-Analysis

Clancy

Prestwich

Caperon

et al. 2016

Front. Hum. Neurosci.

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Recent developments in stress theory have emphasized the significance of perseverative cognition (worry and rumination) in furthering our understanding of stress-disease relationships. Substantial evidence has shown that perseverative cognition (PC) is associated with somatic outcomes and numerous physiological concomitants have been identified (i.e., cardiovascular, autonomic, and endocrine nervous system activity parameters). However, there has been no synthesis of the evidence regarding the association between PC and health behaviors. This is important given such behaviors may also directly and/or indirectly influence health and disease outcomes (triggered by PC). Therefore, the aim of the current review was to synthesize available studies that have explored the relationship between worry and rumination and health behaviors (health risk: behaviors which, if performed, would be detrimental to health; health promoting: behaviors which, if performed, would be beneficial for health). A systematic review and meta-analyses of the literature were conducted. Studies were included in the review if they reported the association between PC and health behavior. Studies identified in MEDLINE or PsycINFO (k = 7504) were screened, of which 19 studies met the eligibility criteria. Random-effects meta-analyses suggested increased PC was generally associated with increased health risk behaviors but not health promoting behaviors. Further analyses indicated that increases in rumination (r = 0.122), but not reflection (r = −0.080), or worry (r = 0.048) were associated with health risk behaviors. In conclusion, these results showed that increases in PC are associated with increases in health risk behaviors (substance use, alcohol consumption, unhealthy eating, and smoking) that are driven primarily through rumination. These findings provide partial support for our hypothesis that in Brosschot et al.'s (2006) original perseverative cognition hypothesis, there may be scope for additional routes to pathogenic disease via poorer health behaviors.

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“…The 2013 SCCM clinical practice guidelines for the management of pain, agitation, and delirium in the ICU recommend promoting sleep in adult ICU patients by using a multifaceted, bundled approach aimed at addressing modifiable disruptors of nighttime sleep in the inpatient setting (27,32), including environmental noise and light reduction via "quiet time" protocols (36-41); clustering of patient care activities (36); and consideration of earplugs, eye masks, or soothing music (36,(42)(43)(44)(45)(46).…”

Section: Original Researchmentioning

confidence: 99%

“…Complex and costly environmental interventions cannot be justified without high-level evidence to justify the cost (28,36). Additionally, complex environmental interventions cannot be instituted on an individual level (1,32,47).…”

Section: Original Researchmentioning

confidence: 99%

Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers

et al. 2016

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Rationale: Poor sleep affects a majority of critically ill patients and is believed to be associated with adverse intensive care unit (ICU) outcomes such as delirium. While recent guidelines recommend sleep promotion efforts to improve delirium and other ICU outcomes, little is known about critical care providers' beliefs regarding sleep in the ICU.Objectives: To evaluate providers' perceptions and practices regarding sleep in the ICU.Methods: From April to July 2014, the Sleep in the ICU Survey was disseminated to ICU providers via institutional e-mail lists and four international critical care society distribution lists. Measurements and Main Results:A total of 1,223 surveys were completed by providers from 24 countries. Respondents were primarily nurses (59%) or physicians (39%). Most respondents indicated that ICU patients experienced "poor" or "very poor" sleep (75%) and that poor sleep could affect the ICU recovery process (88%). Respondents also felt that poor sleep was associated with negative ICU outcomes such as the development of delirium (97%), longer length of stay (88%), poor participation in physical therapy (87%), and delayed liberation from mechanical ventilation (83%). The minority (32%) of providers had sleep-promoting protocols; these providers tended to believe their patients slept longer and experienced better sleep quality.Conclusions: Though most clinicians believe that sleep in the ICU is poor and adversely affects patient outcomes, a minority of the ICUs represented by our respondents have sleep promotion protocols. These findings highlight discordant provider perceptions and practices surrounding sleep in the ICU, as well as a possible lack of available evidence-based guidelines for promoting sleep in the ICU.

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Non-pharmacological interventions for sleep promotion in the intensive care unit

Cited by 134 publications

References 92 publications

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

Perseverative Cognition and Health Behaviors: A Systematic Review and Meta-Analysis

Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers

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