Study of sleep – Related breathing disorders in patients admitted to respiratory intensive care unit

Impact of Noninvasive Ventilation on Quality of Sleep among Patients Admitted to the Critical Care Unit

Background and aims

Patients in critical care units (CCUs) on noninvasive ventilation (NIV) may experience sleep disturbances due to various reasons. Identifying the variables that affect a patient's sleep quality is essential for the medical treatment process, as it ensures the maintenance of a regular sleep cycle. The study aimed to assess the impact of NIV on the quality of sleep among patients admitted to the CCU.

Patients and methods

This observational questionnaire study was conducted between July 2023 to February 2024, which included 84 subjects who received NIV for more than 24 hours. The sleep quality was assessed using The St. Mary's Hospital (SMH) Sleep Questionnaire. The impact of NIV on sleep quality and sleep-disruptive factors was analyzed.

Results

A total of 84 subjects (71.4% weaned and 28.5% intubated) were included, and a significant association was found between the impact of NIV and sleep quality (p < 0.05). Leakage from the NIV mask impacted the quality of sleep (χ² = 15.6) and falling back to sleep (χ² = 18.4). Discomfort with the NIV mask interruption from sleep (χ² = 15.8), quality of sleep (χ² = 23.6), and falling back to sleep (χ² = 22.3). Excessive air from the ventilator impacted the quality of sleep (χ² = 13.5) and falling back to sleep (χ² = 13.5). Nasal and oral dryness influenced the quality of sleep (χ² = 9.79) and alertness (χ² = 14.6). The major factors that interfered with sleep were thirst (84.5%), pain (60.7%), and light (58.3%).

Conclusion

Our study highlights that the impact of NIV on sleep quality among patients in critical care is significant, with factors such as mask leakage, discomfort, excessive air delivery, and dryness affecting sleep negatively. Addressing these issues can potentially improve sleep quality and reduce the need for intubation.

How to cite this article

Kunjappan A, Reddy MM, Prabhu SS, Bhatt MT, R Vani Lakshmi. Impact of Noninvasive Ventilation on Quality of Sleep among Patients Admitted to the Critical Care Unit. Indian J Crit Care Med 2025;29(5):424-430.

Effect of earplugs and eye masks on the sleep quality of intensive care unit patients: A systematic review and meta-analysis

AIMS

To evaluate the effect of earplugs and eye masks on the sleep quality of patients in intensive care unit (ICU).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Randomized controlled trial studies conducted before May 5, 2020 were searched for in Embase, MEDLINE, Cochrane Library, CINAHL and Index to Taiwan Periodical Literature System databases.

REVIEW METHODS

Analyses in this study were according to the PRISMA statement. The heterogeneity of the data was investigated through sub-group analysis while a meta-analysis was performed using the Review Manager 5.3 software.

RESULTS

A total of 797 patients from 13 studies were included in this study. Without considering alone or combined use of earplugs and eye masks, the meta-analysis supported that there was a significant effect on self-reported sleep quality. The overall standardized mean difference of the effect size was 1.44 (95% confidence interval [CI]: [0.80, 2.09]). Sub-group analysis indicated that the use of earplugs alone had no significant effect on sleep quality (effect size: 0.07, 95% [CI]: [-0.50, 0.64]). The use of eye masks alone had a significant effect on sleep quality (effect size: 1.56, 95% [CI]: [1.08, 2.05]). The use of both earplugs and eye masks proved to have the largest effect size on sleep quality (effect size: 2.08, 95% [CI]: [0.95, 3.21]).

CONCLUSION

The combined use of earplugs and eye masks or the standalone use of eye masks is a non-invasive, economical and effective way to promote sleep quality in adult ICU patients.

IMPACT

Clinical nurses could use this meta-analysis as it recommends that nurses provide adult ICU patients with either one or both earplugs and eye masks to improve the patients' sleep quality.

STUDY REGISTRATION

The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews (www.crd.York.ac.uk/Prospero with the registration number # CRD42021221185).