Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU

Perioperative sleep disturbances in older adults: a scoping review of epidemiology and treatment

PURPOSE

Perioperative sleep disturbances are prevalent in older adults undergoing surgery, contributing to poor postoperative recovery, increased complications, and prolonged hospitalization. Despite their clinical significance, standardized assessment and management approaches remain insufficient.

METHODS

A scoping review conducted in accordance with PRISMA-ScR guidelines was performed using PubMed, Embase, and Web of Science. Studies focusing on perioperative sleep disturbances in older adults (aged ≥ 65 years) were included, covering prevalence, risk factors, and outcomes. No language restrictions were applied, and studies in English, Chinese, and Japanese were included. Both subjective (e.g., Pittsburgh Sleep Quality Index) and objective (e.g., actigraphy, polysomnography) assessment tools were reviewed, with data synthesized narratively to summarize evidence on prevalence, risk factors, and management strategies.

RESULTS

Preoperative sleep disturbances prevalence ranges from 0 to 91%, while postoperative sleep disturbances affect 6.7% to 93% of patients. Most included studies enrolled participants aged 65-75 years, limiting generalizability to older adults ≥ 80 years. sleep disturbances are associated with increased postoperative pain sensitivity, heightened risk of delirium, cognitive decline, and prolonged recovery. Additionally, sleep disturbances correlate with worsened emotional states, including anxiety and depression, which further impair functional recovery. Key risk factors include pain, anesthesia, hospital environmental factors, and preexisting psychological distress. Management strategies involve multimodal analgesia, psychological interventions, environmental modifications, and pharmacologic treatments (e.g., dexmedetomidine, melatonin).

CONCLUSION

Perioperative sleep disturbances significantly impact postoperative recovery by affecting pain levels, cognitive function, emotional stability, and overall rehabilitation progress. Standardized assessment and targeted interventions are needed to mitigate these effects. Future research should refine diagnostic criteria and explore individualized treatment approaches to optimize perioperative sleep management.

Risk prediction models for post-intensive care syndrome of ICU discharged patients: A systematic review

Objectives

This systematic review aimed to assess the properties and feasibility of existing risk prediction models for post-intensive care syndrome outcomes in adult survivors of critical illness.

Methods

As of November 1, 2023, Cochrane Library, PubMed, Embase, CINAHL, Web of Science, PsycInfo, China National Knowledge Infrastructure (CNKI), SinoMed, Wanfang database, and China Science and Technology Journal Database (VIP) were searched. Following the literature screening process, we extracted data encompassing participant sources, post-intensive care syndrome (PICS) outcomes, sample sizes, missing data, predictive factors, model development methodologies, and metrics for model performance and evaluation. We conducted a review and classification of the PICS domains and predictive factors identified in each study. The Prediction Model Risk of Bias Assessment Tool was employed to assess the quality and applicability of the studies.

Results

This systematic review included a total of 16 studies, comprising two cognitive impairment studies, four psychological impairment studies, eight physiological impairment studies, and two studies on all three domains. The discriminative ability of prediction models measured by area under the receiver operating characteristic curve was 0.68-0.90. The predictive performance of most models was excellent, but most models were biased and overfitted. All predictive factors tend to encompass age, pre-ICU functional impairment, in-ICU experiences, and early-onset new symptoms.

Conclusions

This review identified 16 prediction models and the predictive factors for PICS. Nonetheless, due to the numerous methodological and reporting shortcomings identified in the studies under review, clinicians should exercise caution when interpreting the predictions made by these models. To avert the development of PICS, it is imperative for clinicians to closely monitor prognostic factors, including the in-ICU experience and early-onset new symptoms.

Light, sleep and circadian rhythm in critical illness

PURPOSE OF REVIEW

Sleep and circadian disruption (SCD) are associated with worse outcomes in the ICU population. We discuss sleep, circadian physiology, the role of light in circadian entrainment and its possible role in treating SCD, with special attention to the use of light therapies and ICU design.

RECENT FINDINGS

The American Thoracic Society recently published an official research statement highlighting key areas required to define and treat ICU SCD. Recent literature has been predominantly observational, describing how both critical illness and the ICU environment might impair normal sleep and impact circadian rhythm. Emerging consensus guidance outlines the need for standardized light metrics in clinical trials investigating effects of light therapies. A recent proof-of-concept randomized controlled trial (RCT) showed improvement in delirium incidence and circadian alignment from ICU room redesign that included a dynamic lighting system (DLS).

SUMMARY

Further investigation is needed to define the optimal physical properties of light therapy in the ICU environment as well as timing and duration of light treatments. Work in this area will inform future circadian-promoting design, as well as multicomponent nonpharmacological protocols, to mitigate ICU SCD with the objective of improving patient outcomes.

Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis

BACKGROUND

Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological intervention is most effective in enhancing sleep quality remains unanswered. This study was conducted to comprehensively evaluate and compare the efficacy of various non-pharmacological interventions aimed at improving sleep quality among critically ill individuals.

METHODS

We conducted a search of PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) without language restrictions to identify articles published until July 15, 2023. Randomized controlled trials (RCTs) that investigated various nursing interventions designed to improve sleep quality in critically ill patients were included in this network meta-analysis. All analyses were performed using R software (version 3.4.3) with the "gemtc" package.

RESULTS

A total of 2036 patients from 31 RCTs were included in the network meta-analysis, involving 11 different nursing interventions (routine care, relaxation combined with imagery (RI), nursel, music + earplugs + eye masks, music, eye masks, earplugs + eye masks, earplugs, aromatherapy, Warm footbath combined with acupoint exercise (WFA), Virtual reality meditation (VR)). Eye masks and earplugs + eye masks were associated with improved sleep quality compared to routine care intervention (P < .05).

CONCLUSIONS

In summary, eye masks and earplugs + eye masks stand out as the most effective interventions for enhancing sleep quality in critically ill patients. Therefore, critical care nurses should consider incorporating the use of eye masks alone or combining music with eye masks into the sleep care regimen for critically ill patients.