Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction

Broughton, Roger; Baron, Robert B.

doi:10.1016/0013-4694(78)90187-6

Cited by 142 publications

(71 citation statements)

References 20 publications

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“…2 Several polysomnographic studies have demonstrated decreased total sleep time, sleep fragmentation, and altered sleep architecture in patients in ICU. [3][4][5][6][7][8][9][10] When examining the etiologies of sleep disturbance, these studies have focused on environmental stimuli such as increased noise.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

“…[12][13][14] Frequent interruptions for diagnostic tests and routine patient care may also cause frequent arousals from sleep. 1,2 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 there-ed in every patient bed and in the central nursing station, which overlooks the patient bays.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

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Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Bihari

McEvoy

Matheson

et al. 2012

Journal of Clinical Sleep Medicine

153

120

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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...

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Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Bihari

McEvoy

Matheson

et al. 2012

Journal of Clinical Sleep Medicine

153

120

View full text Add to dashboard Cite

show abstract

“…It has been shown that a great percentage of cardiac events, including myocardial infarction and sudden deaths, occur throughout the nocturnal period. 1,2,32 It has also been reported that myocardial ischemia occurring during sleep is not limited to REM, but may occur to a greater extent during SW sleep; 33 however, the underlying mechanisms have not been elucidated. A body of evidence indicates a link between increases in sympathetic activity and the increased risk for lifethreatening arrhythmias, whereas increases in parasympathetic activity would reduce the risk for ventricular arrhythmias 34,35 and cardiovascular events.…”

Section: Perspectivesmentioning

confidence: 99%

Baroreflex Buffering of Sympathetic Activation During Sleep

et al. 2004

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Abstract--We examined the effects of sleep microstructure, ie, the cyclic alternating pattern (CAP), on heart rate (HR)-and blood pressure (BP)-regulating mechanisms and on baroreflex control of HR in healthy humans and tested the hypothesis that sympathetic activation occurring in CAP epochs during non-rapid eye movement (non-REM) sleep periods is buffered by the arterial baroreflex. Ten healthy males underwent polysomnography and simultaneous recording of BP, ECG, and respiration. Baroreflex sensitivity (BRS) was calculated by the sequences method. Autoregressive power spectral analysis was used to investigate R-R interval (RRI) and BP variabilities. During overall non-REM sleep, BP decreased and RRI increased in comparison to wakefulness, with concomitant decreases in low-frequency RRI and BP oscillations and increases in high-frequency RRI oscillations. These changes were reversed during REM to wakefulness levels, with the exception of RRI. During CAP, BP increased significantly in comparison to non-CAP and did not differ from REM and wakefulness. The low-frequency component of BP variability was significantly higher during CAP than non-CAP. RRI and its low-frequency spectral component did not differ between CAP and non-CAP. BRS significantly increased during CAP in comparison to non-CAP. BRS was not different during CAP and REM and was greater during both in comparison with the awake state. Even during sleep stages, like non-REM sleep, characterized by an overall vagal predominance, phases of sustained sympathetic activation do occur that resemble that occurring during REM. Throughout the overnight sleep period, the arterial baroreflex acts to buffer surges of sympathetic activation by means of rapid changes in cardiac vagal circuits.

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“…SWS increases during the subsequent nights, and remains high until at least nine nights after the infarction (Broughton & Baron 1978). Before surgery, sleep patterns were within normal limits.…”

Section: Polysomnography In Cad Before and After Surgerymentioning

confidence: 89%

“…Polysomnographically recorded sleep has been performed previously in studies of nocturnal angina pectoris ( (Broughton & Baron 1978). SWS increases during the subsequent nights, and remains high until at least nine nights after the infarction (Broughton & Baron 1978).…”

Section: Polysomnography In Cad Before and After Surgerymentioning

confidence: 99%

Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting

Edéll-Gustafsson

1999

Nordic Journal of Psychiatry

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In this thesis sleep, psychological symptoms and quality of life (Qol) in patients undergoing coronary artery bypass grafting (CABG) at the University Hospital in Linköping were evaluated. Interviews and 24-hour polysomnography were performed prior to surgery, immediately after surgery and again at one month, with a six-monthfollow-up mailed questionnaire. Habitual sleep was evaluated using the Uppsala Sleep Inventory questionnaire and a diary the recorded mornings. The Spielberger State of Anxiety Scale and the Zung´s Self-rating Depression Scale were used to measure anxiety and depression, respectively. Physical functional capacity was assessed according to the New York Heart Association´s (NYHA) classes and Qol, with the Nottingham Health Profile instrument (NHP).A retrospective evaluation of nurse's documentation about sleep was also performed. In addition, the quality and quantity of sleep were assessed before surgery and in the immediate postoperative period in a pilot study, with a one-month follow-up interview. The results indicated disturbed sleep, and changes in behaviour and mental state after surgery due to fragmented sleep, pain and anxiety.Forty-four patients were examined prior to surgery. The results showed that almost two-fifths experienced too little sleep habitually and 50 % had a combination of at least two sleep problems. Poorer health, higher level of anxiety and increased difficulties maintaining sleep (DMS) were consistent with significantly longer sleep latency, increased fragmented sleep, and reduced stages 3 and 4 and REM sleep measured by polysomnography. The level of Qol on the NHP was significantly associated with objectively measured sleep.In the immediate period following CABG there is a changed distribution of sleep, with a reduction of nocturnal sleep duration and an increase in daytime sleep, which had almost returned to preoperative values one month after surgery. Qol was significantly improved six months after surgery compared to before surgery.It was noted that patients with a more anxiety prone reactivity during six months following CABG had significantly more sleep disturbances, reduced energy and functional physical capacity, and lower quality of life, compared to those without such reactivity. Significantly more sleep disturbances, reduced energy and lower quality of life were more prominent among those with sadness/depression or cognitive/behavioural fatigue as reactions to sleep loss. A higher degree of cognitive/behavioural fatigue and dysphoria reactions were associated with a higher NYHA class.In conclusion, patients with coronary artery disease have poor quantity and quality of sleep. Increased psychological symptoms in patients with CAD prior to surgery were associated with greater symptoms six months after surgery. Physical functional capacity and quality of life were significantly improved six months after surgery

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Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction

Cited by 142 publications

References 20 publications

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Baroreflex Buffering of Sympathetic Activation During Sleep

Sleep, psychological symptoms and quality of life in patients undergoing coronary artery bypass grafting

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