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...
