The importance of the intensive care unit environment in sleep—A study with healthy participants

Abstract

Summary Sleep disruption is common among intensive care unit patients, with potentially detrimental consequences. Environmental factors are thought to play a central role in ICU sleep disruption, and so it is unclear why environmental interventions have shown limited improvements in objectively assessed sleep. In critically ill patients, it is difficult to isolate the influence of environmental factors from the varying contributions of non‐environmental factors. We thus investigated the effects of the ICU environment on self‐reported and objective sleep quality in 10 healthy nurses and doctors with no history of sleep pathology or current or past ICU employment participated. Their sleep at home, in an unfamiliar environment (‘Control’), and in an active ICU (‘ICU’) was evaluated using polysomnography and the Richard‐Campbell Sleep Questionnaire. Environmental sound, light and temperature exposure were measured continuously. We found that the control and ICU environment were noisier and warmer, but not darker than the home environment. Sleep on the ICU was perceived as qualitatively worse than in the home and control environment, despite relatively modest effects on polysomnography parameters compared with home sleep: mean total sleep times were reduced by 48 min, mean rapid eye movement sleep latency increased by 45 min, and the arousal index increased by 9. Arousability to an awake state by sound was similar. Our results suggest that the ICU environment plays a significant but partial role in objectively assessed ICU sleep impairment in patients, which may explain the limited improvement of objectively assessed sleep after environmental interventions.

Sleep in Isolated, Confined, and Extreme (ICE): A Review on the Different Factors Affecting Human Sleep in ICE

“…Data from other settings that share some features with the polar environments and the space missions also contribute to blur the general picture. For instance, studies in underwater settings and Intensive Care Units substantially failed to highlight significant alterations of sleep or of the sleep/wake cycle (e.g., Trousselard et al, 2015;Reinke et al, 2019), whereas studies in caves showed an increased SWS (Mogilever et al, 2018), contrarily to what has been reported in polar settings. Instead, the decrease in SWS has been extensively observed during the exposure to a systemic stressor such as noise (Basner and Samel, 2005;Griefahn et al, 2006), or hypoxia (Rojc et al, 2014;Morrison et al, 2017), even if not conclusive.…”

“…Keeping that in mind, patients in ICU showed decreased SWS and REM sleep and increased awakenings (Boyko et al, 2012). The only study investigating the effects on healthy participants (nurses and doctors) found similar results when participants were sleeping in the ICU compared to when they were sleeping at home or in an unknown environment (Reinke et al, 2019). Noise has been considered one of the most influential detrimental factors for sleep in ICU.…”

Sleep cycle in children with severe acute bronchopneumonia during mechanical ventilation at different depths of sedation

“…patient-ventilator synchrony, and prevent unplanned extubation [8][9][10] . Respiratory failure, invasive mechanical ventilation, and use of sedatives and analgesics may decrease sleep quality in children 11 .…”