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Mermer E, Arslan S. The effect of audiobooks on sleep quality and vital signs in intensive care patients. Intensive Crit Care Nurs 2024; 80:103552. [PMID: 37797438 DOI: 10.1016/j.iccn.2023.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/26/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Improving sleep quality in the intensive care unit is significant for the recovery process. This study investigated the effect of listening to audiobooks on sleep quality and vital signs in intensive care patients. METHODS This quasi-experimental study utilized the pre-posttest design, involving control and intervention groups. The study was conducted in the internal medicine intensive care unit of a hospital in Turkey between January-June 2022. Standard nursing care was given to both groups on the first night, and the Sleep Evaluation Form and Richard Campbell Sleep Scale were used to measure sleep quality in the morning. On the second day, the intervention group listened to a recorded story, and the control group had standard care. Sleep quality and vital signs were measured again. RESULTS Data from 56 participants were analyzed. Noise (96.4%), light (69.6%), unfamiliar environment (64.8%), concerns about illness (33.9%), and care and treatments (58.9%) are the main causes of sleep disruption. The effect of these factors decreased in the intervention group after the Audiobook Listening Practice, which significantly improved the sleep quality of the ICU patients (p < 0.001). Among the vital signs, a significant difference was found in pulse and blood pressure (p < 0.001), while no changes were observed in temperature and respiratory rate in time group interaction (p > 0.05). CONCLUSIONS The Audiobook Listening Practice improved sleep quality and life parameters in the ICU. Nurses can use the practice to improve sleep quality in intensive care units. IMPLICATIONS FOR CLINICAL PRACTICE Evidence-based studies are needed to improve the sleep quality of patients in intensive care units, to ensure clinical improvement, and to reduce the length of stay at hospital. The practice is effective in manipulating environmental stressors. This low-cost method significantly improves patient care activities. It is recommended to integrate such complementary activities into intensive care units, to train nurses about the practice, and to support the practice with new studies.
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Affiliation(s)
- Elmas Mermer
- Konya City Hospital, Intensive Care Unit, Konya Turkey.
| | - Selda Arslan
- Department of Internal Medicine Nursing, Nursing Faculty, Necmettin Erbakan University, Konya, Turkey.
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Zhang Y, Zhang Y, Teng M, Wang B, Cheng M, Zhong S, Zhang X, Ding X, Liu C, Ma J. Study on the Sleep Quality Classification and Influencing Factors of Adult ICU Awake Patients Based on Latent Profile Analysis: A Cross-Sectional Survey. Nat Sci Sleep 2023; 15:861-871. [PMID: 37928370 PMCID: PMC10625327 DOI: 10.2147/nss.s430635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
Objective To explore the potential category characteristics of sleep quality in conscious adult patients in the intensive care unit (ICU) and to analyze the differences in characteristics of different categories of conscious adult patients in the ICU. Methods From 5/4/2023 to 30/6/2023, we selected ICU patients of a Class iii Grade A hospital in Wuhan as subjects by simple random sampling. The general information questionnaire, Acute Physiology and Chronic Health Evaluation II, Numerical Rating Scale (NRS)/Critical Care Pain Observation Tool (CPOT) and Richards-Campbell Sleep Questionnaire (RCSQ) were used for investigation. To analyze the latent profile of sleep quality characteristics of adult ICU awake patients and to identify the influencing factors of the latent profile through univariate analysis and logistic regression analysis. Results A total of 298 awake ICU patients were investigated. There were three potential profiles of sleep quality characteristics, namely "low sleep quality" type (16.31%), "medium sleep quality" type (52.11%), and "high sleep quality" type (31.57%). Logistic regression analysis showed that age (36-60), disease type admitted to ICU, oxygen administration method, CPOT or NRS score, postoperative or not, use of analgesic drugs or not, and use of sleep-promoting drugs or not were the factors affecting the sleep quality of adult ICU awake patients (P < 0.05). Conclusion The sleep quality of adult ICU awake patients has obvious classification characteristics. Health professionals can carry out individualized interventions according to the influencing factors of different potential profiles to improve the sleep quality of adult ICU awake patients.
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Affiliation(s)
- Yanting Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Yuan Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Manting Teng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Bingxue Wang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Miying Cheng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Si Zhong
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Xiao Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Xinbo Ding
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Chang Liu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Clinical Research Center of Hubei Critical Care Medicine, Wuhan, 430071, People’s Republic of China
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Eschbach E, Wang J. Sleep and critical illness: a review. Front Med (Lausanne) 2023; 10:1199685. [PMID: 37828946 PMCID: PMC10566646 DOI: 10.3389/fmed.2023.1199685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Critical illness and stays in the Intensive Care Unit (ICU) have significant impact on sleep. Poor sleep is common in this setting, can persist beyond acute critical illness, and is associated with increased morbidity and mortality. In the past 5 years, intensive care clinical practice guidelines have directed more focus on sleep and circadian disruption, spurring new initiatives to study and improve sleep complications in the critically ill. The global SARS-COV-2 (COVID-19) pandemic and dramatic spikes in patients requiring ICU level care also brought augmented levels of sleep disruption, the understanding of which continues to evolve. This review aims to summarize existing literature on sleep and critical illness and briefly discuss future directions in the field.
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Affiliation(s)
- Erin Eschbach
- Division of Pulmonary, Critical Care, and Sleep, Mount Sinai Hospital, New York, NY, United States
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Ahn YH, Lee HY, Lee SM, Lee J. Factors influencing sleep quality in the intensive care unit: a descriptive pilot study in Korea. Acute Crit Care 2023; 38:278-285. [PMID: 37562953 PMCID: PMC10497899 DOI: 10.4266/acc.2023.00514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND As sleep disturbances are common in the intensive care unit (ICU), this study assessed the sleep quality in the ICU and identified barriers to sleep. METHODS Patients admitted to the ICUs of a tertiary hospital between June 2022 and December 2022 who were not mechanically ventilated at enrollment were included. The quality of sleep (QoS) at home was assessed on a visual analog scale as part of an eight-item survey, while the QoS in the ICU was evaluated using the Korean version of the Richards-Campbell Sleep Questionnaire (K-RCSQ). Good QoS was defined by a score of ≥50. RESULTS Of the 30 patients in the study, 19 reported a QoS score <50. The Spearman correlation coefficient showed no meaningful relationship between the QoS at home and the overall K-RCSQ QoS score in the ICU (r=0.16, P=0.40). The most common barriers to sleep were physical discomfort (43%), being awoken for procedures (43%), and feeling unwell (37%); environmental factors including noise (30%) and light (13%) were also identified sources of sleep disruption. Physical discomfort (median [interquartile range]: 32 [28.0-38.0] vs. 69 [42.0-80.0], P=0.004), being awoken for procedures (36 [20.0-48.0] vs. 54 [36.0-80.0], P=0.04), and feeling unwell (31 [18.0-42.0] vs. 54 [40.0-76.0], P=0.01) were associated with lower K-RCSQ scores. CONCLUSIONS In the ICU, physical discomfort, patient care interactions, and feeling unwell were identified as barriers to sleep.
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Affiliation(s)
- Yoon Hae Ahn
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong Yeul Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang-Min Lee
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Fang CS, Chang SL, Fang CJ, Chou FH. Effect of massage therapy on sleep quality in critically ill patients: A systematic review and meta-analysis. J Clin Nurs 2023. [PMID: 36823692 DOI: 10.1111/jocn.16660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/26/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
AIM The aim of the study was to compare the effects of massage interventions on sleep quality among patients in the adult critical care unit. BACKGROUND Massage interventions have positive effects when applied to manage sleep quality in critical care units. However, research identifying the effect of massage intervention is limited. DESIGN This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS Five databases were searched from their inception to 15 April 2022 (the last search was conducted on 15 November 2022, but it yielded no additional eligible studies). The literature search was conducted using Embase, MEDLINE, the Cochrane Library, CINAHL, PsycINFO and additional sources such as Google Scholar. The Cochrane risk of bias tool for randomised trials (RoB 2.0) was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the certainty of evidence and recommendations. RESULTS In total, ten randomised controlled trials comprising 569 participants were used in the systematic review, and eight trials were included in the meta-analysis. Subgroup analysis revealed significant effects of foot reflexology massage on subjective sleep quality. Massage therapy for a two-night duration in cardiac care unit patients exhibited a significant effect on subjective sleep quality. The overall GRADE certainty of evidence was low. CONCLUSION Massage intervention, particularly foot reflexology massage, with a two-night duration showed improvement in subjective sleep quality among critically ill patients. Although evidence quality was low, the results suggest that massage interventions provide a non-invasive, low-cost and effective way to promote sleep quality in critically ill adult patients. RELEVANCE TO CLINICAL PRACTICE Massage interventions can enable nurses to recommend and implement strategies promoting and improving sleep quality among critically ill patients. 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 # CRD42022332371). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution if such details are not necessary or do not apply to your work and state why.
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Affiliation(s)
- Chiu-Shu Fang
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Lun Chang
- Department of Otorhinolaryngology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pet Care and Grooming, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Ching-Ju Fang
- Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Library, National Cheng Kung University, Tainan, Taiwan
| | - Fan-Hao Chou
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Koçak AT, Arslan S. Sleep of Intensive Care Patients: A Qualitative Study Based on Experiences of Nurses. Dimens Crit Care Nurs 2022; 41:305-12. [PMID: 36179308 DOI: 10.1097/DCC.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intensive care patients experience a high rate of poor sleep quality. As the sleep quality is improved with nursing practices, patients' recovery and the length of stay in the intensive care unit (ICU) may be positively influenced, and patients may benefit from treatment and care at the highest level. Therefore, it is important to explore the experiences and evaluation of nurses working in ICUs. OBJECTIVES This study was carried out to explore the experiences and evaluations of ICU nurses about patients' sleep. METHODS The study is a qualitative study conducted in a descriptive phenomenological design. The data were collected using the individual in-depth interview method with the semistructured interview form. Thematic analysis was performed to analyze the data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS The analysis revealed 4 main themes, which are (1) importance of sleep, (2) evaluation of sleep, (3) reasons for poor sleep, and (4) sleep promotion interventions. CONCLUSIONS This study revealed that nurses are aware of the importance of sleep; however, they do not evaluate sleep and try to improve sleep quality only based on their own knowledge and experience rather than on evidence-based approaches. However, their interventions are not sufficient and they are restricted because of physical conditions and intensive care procedures.
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Kakar E, Priester M, Wessels P, Slooter AJC, Louter M, van der Jagt M. Sleep assessment in critically ill adults: A systematic review and meta-analysis. J Crit Care 2022; 71:154102. [PMID: 35849874 DOI: 10.1016/j.jcrc.2022.154102] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients. MATERIALS AND METHODS We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible. RESULTS 132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ). CONCLUSIONS Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | | | | | - Arjen J C Slooter
- Department of Intensive Care Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - M Louter
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - M van der Jagt
- Department of Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Martinez FE, Poulter A, Seneviratne C, Chrimes A, Havill K, Balogh ZJ, Paech GM. ICU Patients’ Perception of Sleep and Modifiable versus Non-Modifiable Factors That Affect It: A Prospective Observational Study. J Clin Med 2022; 11:3725. [PMID: 35807010 PMCID: PMC9267898 DOI: 10.3390/jcm11133725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Good sleep quantity and quality are essential for patient recovery while in the intensive care unit (ICU). Patients commonly report poor sleep while in the ICU, and therefore, identifying the modifiable factors that patients perceive as impacting their sleep is important to improve sleep and recovery. This study also assessed night-time light and sound levels in an ICU in an effort to find modifiable factors. Methods: A total of 137 patients (51F) aged 58.1 ± 16.8 years completed a survey including questions about their sleep before and during their ICU stay, factors contributing to poor sleep in the ICU, and perceived factors that may have improved their sleep in the ICU. Night-time light and sound levels were measured in patient rooms and nurses’ stations. Results: Patients reported poorer sleep quantity and quality while in the ICU compared to home. Among the most common reasons for poor sleep, easily modifiable factors included noise (50.4%) and lights (45.3%), potentially modifiable factors included pain (46.7%), and non-modifiable factors included IV lines (42.3%). Patients felt their sleep would have been improved with interventions such as dimming lights (58.4%) and closing doors/blinds at night (42.3%), as well as potentially implementable interventions such as a sleeping pill (51.8%). Overnight sound levels in bedrooms were above the recommended levels (40 dB) and light levels averaged over 100 lux. Conclusions: Sleep quality and quantity were both worse in ICU than at home. Modifiable factors such as sound and light are common factors that patients perceive impact their sleep in the ICU. Readily implementable sleep management strategies aimed at minimizing the impacts of sound and light levels in the ICU are ways to improve patients’ sleep in the ICU.
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Polat E, Çavdar İ, Şengör K. The Effect of Earplugs and Eye Masks Usage in the Intensive Care Unit on Sleep Quality: Systematic Review. Dubai Med J 2022. [DOI: 10.1159/000522066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Patients in the intensive care unit (ICU) have severe and complex disease characteristics and their sleep problems should not be ignored. Poor-quality sleep is associated with impaired immune function and associated susceptibility to disease and infection, decreased energy levels, delirium, delays in recovery. This study is conducted to examine the results of studies examining sleep quality using earplugs and eye masks in the ICU. <b><i>Methods:</i></b> PubMed, Science Direct, Google Scholar, and Medline databases were scanned using “Earplugs, Eye masks, Sleep quality, Intensive care units” as keywords. For the search strategy, a query in a patient-intervention-compare-result (PICO) format was used. P: Patients in intensive care; I: Earplugs and eye mask; C: Noise, Light, and Sleep Quality; O: Using earplugs and eye masks improves sleep quality. <b><i>Results:</i></b> We included the 17 most eligible studies meeting defined inclusion/exclusion criteria involving 1,372 participants. Randomized controlled trial was used mostly as study design. The interventions within the scope of the studies were earplugs, eye masks, relaxing music, and quiet time protocol. Richard Campbell Sleep Questionnaire and Verran and Snydern Halpern Sleep Scale were the most used scale. Most of the studies reviewed found that the use of non-pharmacological interventions showed a significant improvement in sleep quality. Earplugs and eye masks were found to have potential positive effects on sleep quality and delirium incidence in ICU patients. <b><i>Conclusion:</i></b> The use of earplugs and eye masks is a noninvasive, economical, and effective way to improve sleep quality in adult ICU patients.
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Beltrami FG, John ÂB, de Macedo BR, Corrêa Júnior V, Nguyen XL, Pichereau C, Maury E, Fleury B, Gus M, Fagondes SC. A multi-intervention protocol to improve sleep quality in a coronary care unit. Eur J Cardiovasc Nurs 2021; 21:464-472. [PMID: 34935040 DOI: 10.1093/eurjcn/zvab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/17/2020] [Accepted: 01/18/2021] [Indexed: 11/14/2022]
Abstract
AIMS Poor sleep is a frequent occurrence in the critical illness. Evaluate sleep quality and test the effect of a multi-intervention sleep care protocol in improving sleep quality in a coronary care unit (CCU). METHODS AND RESULTS Quasi-experimental study, carried out in two phases. During the first phase, the control group (n = 58 patients) received usual care. Baseline sleep data were collected through the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the Intensive Care Unit Questionnaire (SICUQ). During the second phase (n = 55 patients), a sleep care protocol was implemented. Interventions included actions to promote analgesia, reduce noise, brightness, and other general measures. Sleep data were collected again to assess the impact of these interventions. The intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); P = 0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); P = 0.011]; return to sleep [90 (69.7-100) vs. 71.2 (40.7-96.5); P = 0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); P = 0.026]; and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); P = 0.002] than the baseline group. The main barriers to sleep were pain [1 (1.0-5.5)], light [1 (1.0-5.0)], and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intravenous pump alarm [1.5 (1.0-5.00)]. and mechanical ventilator alarm [1 (1.0-5.0)]. All were significantly lower in the intervention group than in the baseline group. CONCLUSION A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and reducing some barriers to sleep in CCU patients.
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Affiliation(s)
- Flávia Gabe Beltrami
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Ângela Beatriz John
- Laboratório do Sono, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2050, 90035-003 Porto Alegre, RS, Brazil
| | - Bruno Rocha de Macedo
- Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Vicente Corrêa Júnior
- Ambulatório de Hipertensão do Hospital de Clínicas de Porto Alegre, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
| | - Xuân-Lan Nguyen
- Unité de Somnologie et Fonction Respiratoire, Département de Physiologie Respiratoire et Sommeil, Hôpital Saint-Antoine, Paris, France
| | - Claire Pichereau
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Paris, France
| | - Bernard Fleury
- Collège de Médecine des Hôpitaux de Paris, Département de Physiologie Respiratoire et Sommeil, Hôpital Saint-Antoine, Paris, France
| | - Miguel Gus
- Unidade de Cuidados Cardiovasculares, Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simone Chaves Fagondes
- Laboratório do Sono, Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, Room 2050, 90035-003 Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Ramiro Barcelos, 2350,90035-003, RS, Brazil
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Lin YC, Lin TJ, Liu CH, Chen YT, Lai HL. Effects of an earplug placement intervention on sleep quality in patients in a medical intensive care unit: A randomized controlled trial. Int J Nurs Pract 2021; 28:e13016. [PMID: 34541752 DOI: 10.1111/ijn.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/26/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to evaluate the effects of an intervention involving earplug placement during nocturnal sleep in non-ventilated intensive care unit patients. METHODS A randomized controlled trial was conducted in 107 adult patients between January 2017 and December 2018. Participants in the intervention group (n = 55) slept with earplugs between 10 pm and 7 am on the second night of their intensive care unit stay. In the control group, participants slept with no earplugs. Outcome parameters included sleep, urinary 6-sulfatoxymelatonin levels, relaxation responses measured using the Richards-Campbell Sleep Questionnaire, liquid chromatography-mass spectrometry results and vital signs. Urine was collected between 10 pm and 7 am. RESULTS Overall, 28.03% of participants showed virtually no 6-sulfatoxymelatonin excretion in the collected urine. Outcome parameters were not significantly different between the groups, indicating that wearing earplugs alone did not affect sleep quality, urinary 6-sulfatoxymelatonin and vital signs. CONCLUSIONS The effects of using earplugs alone on sleep quality, urinary 6-sulfatoxymelatonin and relaxation responses in patients admitted to the intensive care unit were inconclusive. Additional research is required before earplugs alone can be widely used to improve sleep quality.
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Affiliation(s)
- Yun-Chian Lin
- Department of Nursing Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Tsung-Jen Lin
- Program in Pharmacology and Toxicology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chin-Hung Liu
- Program in Pharmacology and Toxicology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yi-Ting Chen
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hui-Ling Lai
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2021; 45:470-476. [PMID: 34456175 DOI: 10.1016/j.medine.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/24/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, Spain
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
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Honarmand K, Rafay H, Le J, Mohan S, Rochwerg B, Devlin JW, Skrobik Y, Weinhouse GL, Drouot X, Watson PL, McKinley S, Bosma KJ. A Systematic Review of Risk Factors for Sleep Disruption in Critically Ill Adults. Crit Care Med 2020; 48:1066-74. [PMID: 32433122 DOI: 10.1097/CCM.0000000000004405] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Numerous risk factors for sleep disruption in critically ill adults have been described. We performed a systematic review of all risk factors associated with sleep disruption in the ICU setting. DATA SOURCES PubMed, EMBASE, CINAHL, Web of Science, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews. STUDY SELECTION English-language studies of any design published between 1990 and April 2018 that evaluated sleep in greater than or equal to 10 critically ill adults (> 18 yr old) and investigated greater than or equal to 1 potential risk factor for sleep disruption during ICU stay. We assessed study quality using Newcastle-Ottawa Scale or Cochrane Risk of Bias tool. DATA EXTRACTION We abstracted all data independently and in duplicate. Potential ICU sleep disruption risk factors were categorized into three categories based on how data were reported: 1) patient-reported reasons for sleep disruption, 2) patient-reported ratings of potential factors affecting sleep quality, and 3) studies reporting a statistical or temporal association between potential risk factors and disrupted sleep. DATA SYNTHESIS Of 5,148 citations, we included 62 studies. Pain, discomfort, anxiety/fear, noise, light, and ICU care-related activities are the most common and widely studied patient-reported factors causing sleep disruption. Patients rated noise and light as the most sleep-disruptive factors. Higher number of comorbidities, poor home sleep quality, home sleep aid use, and delirium were factors associated with sleep disruption identified in available studies. CONCLUSIONS This systematic review summarizes all premorbid, illness-related, and ICU-related factors associated with sleep disruption in the ICU. These findings will inform sleep promotion efforts in the ICU and guide further research in this field.
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Singleterry LR, Caulfield SL. Holistic Approaches to Support Sleep in the Intensive Care Unit Patient. Crit Care Nurs Clin North Am 2021; 33:131-144. [PMID: 34023081 DOI: 10.1016/j.cnc.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sleep disruption in intensive care unit patients has internal, interpersonal, behavioral, and environmental factors to consider when developing sleep promotion protocols. Holistic approaches are integrative practices that go beyond modifying environmental factors. This article presents 3 holistic approaches that are cost-effective, easy to use, and independent nursing actions that are integrative in nature. Aromatherapy, guided imagery, and mindfulness show promising effects in the literature to improve comfort, anxiety and stress, which are thought to improve sleep.
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Affiliation(s)
- Lisa R Singleterry
- Bronson School of Nursing, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI 49008, USA.
| | - Susan L Caulfield
- School of Interdisciplinary Health Programs, Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo, MI 49008, USA
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15
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Kornienko A. Intensive Care Unit Environment and Sleep. Crit Care Nurs Clin North Am 2021; 33:121-9. [PMID: 34023080 DOI: 10.1016/j.cnc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients undergoing treatment in intensive care unit are in an extremely vulnerable state and require a complex multidisciplinary approach. Adequate sleep is required to maintain physiologic functions of the human body. Good sleep quality plays a vital role in the process of recovery. Sleep disruption in intensive care settings is a well-known fact. The consequences of sleep deprivation can cause numerous complications including delayed mechanical ventilation wean, neurocognitive dysfunction, decreased immune function and increased mortality rates. This review describes how the intensive care unit environment impacts sleep architecture.
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Abstract
ABSTRACT BACKGROUND: Intensive care unit (ICU) patients with severe health problems experience a high rate of sleep deprivation that harms their psychological and physiological health. Environmental factors are considered to be the greatest cause of sleep deprivation in the ICU, and noise and light are leading among these factors. This study aimed to investigate the effect of eye masks and earplugs on the sleep quality and vital signs of conscious ICU patients. METHODS: This study used a quasi-experimental, in similar groups, pretest-posttest design with a control group. The Richards-Campbell Sleep Questionnaire (RCSQ) was used to collect data, and vital signs were recorded every 2 hours. On day 1, standard care was provided to the experimental group (n = 32), and they were provided with eye masks and earplugs on day 2. The control group (n = 32) was provided with standard care on both days. Chi-square, t, and McNemar and McNemar-Bowker tests were used to analyze the data. Multiple regression analysis was used for predictive analysis. RESULTS: The RCSQ mean (SD) pretest and posttest scores were 50.21 (16.02) and 68.50 (17.57), respectively, for the experimental group and 55.34 (16.62) and 49.03 (15.53), respectively, for the control group. In the experimental group, the posttest RCSQ score was significantly higher than the pretest RCSQ score (P < .01). No differences in vital signs were observed in the control group. All the vital signs were found to be similar in the experimental group, except for the mean daily pulse rate. CONCLUSION: The use of earplugs and eye masks may help reduce sleep deprivation. Eye masks and earplugs can be used by nurses to improve the sleep quality of patients in ICUs.
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Chaudhary A, Kumari V, Neetu N. Sleep Promotion among Critically Ill Patients: Earplugs/Eye Mask versus Ocean Sound-A Randomized Controlled Trial Study. Crit Care Res Pract 2020; 2020:8898172. [PMID: 33425385 DOI: 10.1155/2020/8898172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/03/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Poor sleep quality is common in the intensive care unit (ICU), where several factors including environmental factors contribute to sleep deprivation. Objective This study aims to assess and compare the effectiveness of earplugs and eye mask versus ocean sound on sleep quality among ICU patients. Design A true experimental crossover design was used. Setting. Medical ICU of the Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana, India. Participants. Sixty-eight patients admitted in the medical ICU were randomly allocated by lottery methods into group 1 and group 2. Methods Nocturnal nine-hour (10 : 00 pm to 7 : 00 am) for a four-night period were measured. Earplugs and eye mask versus ocean sound were crossed over between two groups. Subjective sleep quality of four nights was assessed using a structured sleep quality scale. Scores for each question range from 0 to 3, with a higher score indicating poor sleep quality. Results Repeated measures ANOVA showed that there was a significant change in the sleep quality score (p=0.001), which showed that sleep quality score was improved after the administration of earplugs and eye mask and ocean sound. Fisher's LSD post hoc comparison showed a significant difference (p=0.001). Conclusion Earplugs and eye mask were better than ocean sound in improving sleep quality. Earplugs, eye mask, and ocean sound are safe and cost effective, which could be used as an adjuvant to pharmacological interventions to improve sleep quality among ICU patients. However, further research in this area needs to be conducted. This trial is registered with NCT03215212.
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Lewandowska K, Mędrzycka-Dąbrowska W, Pilch D, Wach K, Fortunato A, Krupa S, Ozga D. Sleep Deprivation from the Perspective of a Patient Hospitalized in the Intensive Care Unit-Qualitative Study. Healthcare (Basel) 2020; 8:E351. [PMID: 32967235 DOI: 10.3390/healthcare8030351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
(1) Introduction: Sleep architecture of Intensive Care Unit (ICU) patients is altered, with over 60% of them reporting sleep disorders or even sleep deprivation during their stay. The aim of the study was to describe the experiences related to sleep and nighttime rest of patients hospitalized in the ICU. (2) Method: the study used a qualitative project based on phenomenology as a research method. A semi-structured interview was used as the method to achieve the goal. The patients’ answers were recorded and transcribed. The data were coded and cross-processed. (3) Results: twenty-three patients were surveyed, fifteen men and eight women. The average age was 49.7 years. The average time of hospitalization was 34.3 days. During the ICU stay, patients required mechanical ventilation through the tracheostomy tube. Five themes were identified from the interview as factors disturbing sleep: fear, noise, light, medical staff, and at home best. (4) Conclusions: chronic anxiety appears to contribute to sleep disturbances in the ICUs, psychological support, and individualized approach to the hospitalized patient seem necessary. By raising the awareness of the essence of sleep among medical staff, environmental factors can be reduced as disturbing sleep. Based on the participants’ comments, it is possible that repeated actions could also increase the patients’ sense of security.
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2020; 45:S0210-5691(20)30114-5. [PMID: 32482371 DOI: 10.1016/j.medin.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, España
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
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20
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Reuter-Rice K, McMurray MG, Christoferson E, Yeager H, Wiggins B. Sleep in the Intensive Care Unit: Biological, Environmental, and Pharmacologic Implications for Nurses. Crit Care Nurs Clin North Am 2020; 32:191-201. [PMID: 32402315 DOI: 10.1016/j.cnc.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is a clear relationship between lack of sleep, poor health outcomes, and delayed recovery from illness in the intensive care unit. Several factors can contribute to poor quality sleep in the intensive care unit, including (1) environmental disruptions such as light and sound, (2) physiologic disruptions such as discomfort, nausea, and pain, (3) psychological disruptions such as anxiety and a lack of privacy, and (4) health care provider-related disruptions, such as medication administration and nursing care. Nursing implications include increased attention to the role of sleep to promote intensive care unit patient's health outcomes and using multicomponent sleep-promoting protocols.
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21
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Abstract
Sleep disturbance is common in patients in the intensive care unit (ICU). Numerous factors can contribute to this. High noise and light levels, nursing interventions and medication administration are major factors. This study investigated the demographic and environmental factors that might adversely affect ICU patients' quality of sleep. Data were collected from 103 patients using a demographic data sheet, the Freedman Quality of Sleep Scale and the Richards-Campbell Sleep Scale. Patients' demographic characteristics were found to have no significant effects on their perceived quality of sleep. Environmental factors, including noise, light, nursing interventions, diagnostic testing, the administration of medication, talking and phones ringing, were significantly related to the patients' perceived quality of sleep.
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Affiliation(s)
- Mohammad Bani Younis
- Assistant Professor, Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
| | - Feryal Hayajneh
- Professor, Faculty of Nursing, University of Jordan, Amman, Jordan
| | - Yousef Rubbai
- Lecturer, Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
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22
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Pisani MA, D'Ambrosio C. Sleep and Delirium in Adults Who Are Critically Ill: A Contemporary Review. Chest 2019; 157:977-984. [PMID: 31874132 DOI: 10.1016/j.chest.2019.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/28/2019] [Accepted: 12/09/2019] [Indexed: 01/09/2023] Open
Abstract
Sleep is important to health and well-being, and studies in healthy adults have demonstrated that sleep deprivation impacts respiratory, immune, and cognitive function. Historically, because of the nature of critical illness, sleep has not been considered a priority for patient care in the ICU. More recently, research has demonstrated that sleep is markedly abnormal in patients who are critically ill. In addition, there is often disruption of circadian rhythms. Delirium is a syndrome of acute alteration in mental status that occurs in the setting of contributing factors such as serious illness, medication, and drug or alcohol intoxication or withdrawal. Delirium is a frequent occurrence in critical illness, and research has demonstrated several adverse outcomes associated with delirium including persistent cognitive impairment and increased mortality. Sleep deprivation and delirium share many common symptoms. The similarity in symptoms between sleep disruption and delirium have prompted experts to draw links between the two and question both the relationship and its direction. In addition, the inclusion of sleep disturbance to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition in its constellation of symptoms used in diagnosing delirium has increased awareness of the link between sleep and delirium. This paper will review the literature on sleep in critical illness and the potential mechanisms and pathways that may connect sleep and delirium.
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23
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Bani Younis M, Hayajneh F, Alshraideh JA. Effect of noise and light levels on sleep of intensive care unit patients. Nurs Crit Care 2021; 26:73-8. [DOI: 10.1111/nicc.12490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 01/10/2023]
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24
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Abstract
Objective To reveal the correlation between APACHE III score and sleep quality in patients in the intensive care unit (ICU). Methods This prospective, observational study included patients aged ≥18 years, who had been admitted to an integrated ICU for ≥48 h. Age, sex, Pittsburgh Sleep Quality Index (PSQI) prior to ICU, Numeric Rating Scales (NRS), noise, illumination, number of nursing interventions, Richards Campbell Sleep Questionnaire (RCSQ), and APACHE III score during sleep were evaluated. Results A total of 124 ICU patients were included, all with APACHE III scores < 60. APACHE III scores were not significantly associated with RCSQ scores. There were significant inverse associations between sleep quality in the ICU and PSQI score prior to ICU (odds ratio [OR] 0.587, 95% confidence interval [CI] 0.365, 0.945) and noise (OR 0.628, 95% CI 0.522, 0.756). Conclusion In ICU patients with APACHE III scores below 60 points, APACHE III score was not associated with sleep quality. PSQI score prior to ICU and noise were significantly inversely associated with sleep quality in this ICU patient population.
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Affiliation(s)
- Chang-Yong Wang
- 1 Division of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Shang
- 1 Division of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li-Zhi Feng
- 2 Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chen-Liang Zhou
- 2 Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing-Shan Zhou
- 2 Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Hu
- 1 Division of Respiratory Disease, Renmin Hospital of Wuhan University, Wuhan, China
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Lefman SH, Prittie JE. Psychogenic stress in hospitalized veterinary patients: Causation, implications, and therapies. J Vet Emerg Crit Care (San Antonio) 2019; 29:107-120. [PMID: 30861632 DOI: 10.1111/vec.12821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review the sources, adverse effects, diagnosis, treatment, and prevention of psychogenic stress in hospitalized human and veterinary patients. DATA SOURCES Data were collected by searching PubMed for veterinary and human literature from the past 10 years. HUMAN DATA SYNTHESIS Psychogenic stress has been linked to immune suppression; gastrointestinal, cardiovascular, and cutaneous diseases; delayed wound healing; alterations in pain perception; and neurologic impairment. Sources of psychogenic stress include environmental alterations such as excessive noise and light, social and physical factors, sleep disruption, drugs, and underlying disease. Nonpharmacologic options for stress reduction include environmental and treatment modifications, music therapy, and early mobilization. Pharmacologic options include sedation with benzodiazepines and dexmedetomidine. Trazodone and melatonin have been examined for use in sleep promotion but are not currently recommended as standard treatments in ICU. VETERINARY DATA SYNTHESIS Activation of the stress response in veterinary patients is largely the same as in people, as are the affected body systems. Possible sources of stress can include social, physical, and environmental factors. No gold standard currently exists for the identification and quantification of stress. A combination of physical examination findings and the results of serum biochemistry, CBC, and biomarker testing can be used to support the diagnosis. Stress scales can be implemented to identify stressed patients and assess severity. Nonpharmacologic treatment options include low-stress handling, pheromones, environmental modifications, and sleep promotion. Pharmacologic options include trazodone, benzodiazepines, dexmedetomidine, and melatonin. CONCLUSION The prevalence and clinical significance of psychogenic stress in hospitalized veterinary patients is unknown. Future studies are needed to specifically examine the causative factors of psychogenic stress and the effects of various therapies on stress reduction. The recognition and reduction of psychogenic stress in veterinary patients can lead to improvements in patient care and welfare.
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Affiliation(s)
- Sara H Lefman
- Emergency and Critical Care, The Animal Medical Center, New York, NY
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Abstract
Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.
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27
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Carrera-Hernández L, Aizpitarte-Pejenaute E, Zugazagoitia-Ciarrusta N, Goñi-Viguria R. Patients' perceptions of sleep in a Critical Care Unit. Enferm Intensiva (Engl Ed) 2018; 29:53-63. [PMID: 29605589 DOI: 10.1016/j.enfi.2018.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/18/2017] [Accepted: 01/13/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients' sleep can be disturbed during their stay in an Intensive Care Unit. Many factors can explain this disturbance, both within the ICU environment and caused by patients' illnesses. There is evidence that patients' sleep can be improved within ICUs. The aim of this study is to describe patientś perceptions of a night's sleep and develop a care plan that promotes a night's sleep. METHODOLOGY A prospective descriptive study was performed in the ICU of a training hospital. The sleep of 125 patients was explored. Sociodemographic and clinical variables were collected from patients' medical records. The 5-item Richards-Campbell Sleep Questionnaire was utilised to assess patients' perception of a night's sleep. In addition, an ad-hoc 9-item questionnaire was developed which included factors that can affect sleep according to the literature. Patients had to grade the level of interference of those factors with their night's sleep. RESULTS The sleep of patients in our Intensive Care Unit was moderately deep, with light arousals and ease in falling sleep again. The average value on the Richards-Campbell Sleep Questionnaire was 52.92mm. The factors that significantly interfered with sleep were: pain (P=0.009), worries/anxiety (P=.01), staff voices (P=0.033), alarm/medical devices sounds (P=0.047) and peripheral intravenous lines (P=.036). CONCLUSIONS Our patients' perception of a night's sleep in the ICU was fair. Optimising pain management, answering questions or worries, minimizing background noise and voices have the potential to improve sleep quality.
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Affiliation(s)
- L Carrera-Hernández
- Universidad de Navarra, enfermera de la Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España.
| | - E Aizpitarte-Pejenaute
- Universidad de Navarra, enfermera de la Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - N Zugazagoitia-Ciarrusta
- Universidad de Navarra, enfermera de la Unidad de Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, España
| | - R Goñi-Viguria
- Enfermera de Práctica Avanzada del Área de Críticos, Clínica Universidad de Navarra, Pamplona, España
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Hansen IP, Langhorn L, Dreyer P. Effects of music during daytime rest in the intensive care unit. Nurs Crit Care 2017; 23:207-213. [PMID: 29159864 DOI: 10.1111/nicc.12324] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/17/2017] [Accepted: 10/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sleep is essential to the recovery of patients in the intensive care unit. Patients in the intensive care unit frequently experience poor sleep, characterized by sleep deprivation, sleep fragmentation and abnormal sleep architecture. Factors affecting sleep are multifactorial. AIM To investigate the effects of music on self-reported quality of sleep during daytime rest among patients in the intensive care unit. STUDY DESIGN A randomized controlled trial. METHODS The study was conducted between February and April 2016 in two Danish multidisciplinary intensive care units. The study sample consisted of 37 patients (19 in the control group and 18 in the intervention group) who complied with the criteria of inclusion for the study. Patients were randomly assigned to either an intervention group or a control group. The intervention group listened to music for 30 min during daytime rest while the control group rested without music. The Richards-Campbell Sleep Questionnaire was used to measure the subjective quality of sleep. RESULTS Significant differences in the mean scores of the subjective quality of sleep were found between the intervention group and the control group (p < 0·02). Significant differences were also found between groups in three items of sleep scores: sleep depth (p < 0·02), awakenings (p < 0·00) and the overall perceived quality of sleep (p < 0·01). The perceived noise level score was higher in the intervention group compared with the control group, although not statistically significant (p < 0·67). CONCLUSION Listening to music during daytime rest improves subjective sleep in patients in the intensive care unit. Furthermore, there are indications that listening to music reduces the subjective experience of noise in some patients. RELEVANCE TO CLINICAL PRACTICE The result of this study implies that music can be an effective practice for nurses to improve sleep among patients in the intensive care unit.
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Affiliation(s)
| | - Leanne Langhorn
- Department of Neurosurgery/Department of Anaesthesiology and Intensive Care, North Section, Aarhus University Hospital, Dk-8000 Aarhus C, Denmark
| | - Pia Dreyer
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus University Hospital; Department of Anaesthesia and Intensive Care Medicine, Dk-8000 Aarhus C, Denmark
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Menear A, Elliott R, M Aitken L, Lal S, McKinley S. Repeated sleep-quality assessment and use of sleep-promoting interventions in ICU. Nurs Crit Care 2017; 22:348-354. [PMID: 29044819 DOI: 10.1111/nicc.12315] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/11/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Abstract
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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Affiliation(s)
- Ashika Menear
- Faculty of Science, University of Technology Sydney, Broadway, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Broadway, Australia.,Intensive Care Unit, Royal North Shore Hospital, St Leonards, Australia
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, Northampton Square, London, UK.,Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia.,Menzies Health Institute Queensland & School of Nursing and Midwifery, Griffith University, Nathan, Australia
| | - Sara Lal
- Faculty of Science, University of Technology Sydney, Broadway, Australia
| | - Sharon McKinley
- Intensive Care Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia, (in place of University of London)
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Litton E, Elliott R, Thompson K, Watts N, Seppelt I, Webb SAR; ANZICS Clinical Trials Group and The George Institute for Global Health. Using Clinically Accessible Tools to Measure Sound Levels and Sleep Disruption in the ICU: A Prospective Multicenter Observational Study. Crit Care Med 2017; 45:966-71. [PMID: 28362644 DOI: 10.1097/CCM.0000000000002405] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To use clinically accessible tools to determine unit-level and individual patient factors associated with sound levels and sleep disruption in a range of representative ICUs. DESIGN A cross-sectional, observational study. SETTING Australian and New Zealand ICUs. PATIENTS All patients 16 years or over occupying an ICU bed on one of two Point Prevalence study days in 2015. INTERVENTIONS Ambient sound was measured for 1 minute using an application downloaded to a personal mobile device. Bedside nurses also recorded the total time and number of awakening for each patient overnight. MEASUREMENTS AND MAIN RESULTS The study included 539 participants with sound level recorded using an application downloaded to a personal mobile device from 39 ICUs. Maximum and mean sound levels were 78 dB (SD, 9) and 62 dB (SD, 8), respectively. Maximum sound levels were higher in ICUs with a sleep policy or protocol compared with those without maximum sound levels 81 dB (95% CI, 79-83) versus 77 dB (95% CI, 77-78), mean difference 4 dB (95% CI, 0-2), p < 0.001. There was no significant difference in sound levels regardless of single room occupancy, mechanical ventilation status, or illness severity. Clinical nursing staff in all 39 ICUs were able to record sleep assessment in 15-minute intervals. The median time awake and number of prolonged disruptions were 3 hours (interquartile range, 1-4) and three (interquartile range, 2-5), respectively. CONCLUSIONS Across a large number of ICUs, patients were exposed to high sound levels and substantial sleep disruption irrespective of factors including previous implementation of a sleep policy. Sound and sleep measurement using simple and accessible tools can facilitate future studies and could feasibly be implemented into clinical practice.
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