Feasibility study of unattended polysomnography in medical intensive care unit patients

Knauert, Melissa P.; Yaggi, H. Klar; Redeker, Nancy S.; Murphy, Terrence E.; Araujo, Katy; Pisani, Margaret A.

doi:10.1016/j.hrtlng.2014.06.049

Cited by 73 publications

(80 citation statements)

References 46 publications

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“…To our knowledge, this study represents the first large-scale evaluation of ICU healthcare The results of this SLEEPii Survey demonstrate that practitioners are aware of decreased sleep quality and quantity in the ICU and, in line with current literature, categorize sleep in this setting as "poor" or "very poor" (3,6). Respondents at institutions with established protocols did believe that their patients experienced higher-quality and slightly longer sleep than those without protocols.…”

Section: Discussionsupporting

confidence: 67%

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Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers

et al. 2016

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Rationale: Poor sleep affects a majority of critically ill patients and is believed to be associated with adverse intensive care unit (ICU) outcomes such as delirium. While recent guidelines recommend sleep promotion efforts to improve delirium and other ICU outcomes, little is known about critical care providers' beliefs regarding sleep in the ICU.Objectives: To evaluate providers' perceptions and practices regarding sleep in the ICU.Methods: From April to July 2014, the Sleep in the ICU Survey was disseminated to ICU providers via institutional e-mail lists and four international critical care society distribution lists. Measurements and Main Results:A total of 1,223 surveys were completed by providers from 24 countries. Respondents were primarily nurses (59%) or physicians (39%). Most respondents indicated that ICU patients experienced "poor" or "very poor" sleep (75%) and that poor sleep could affect the ICU recovery process (88%). Respondents also felt that poor sleep was associated with negative ICU outcomes such as the development of delirium (97%), longer length of stay (88%), poor participation in physical therapy (87%), and delayed liberation from mechanical ventilation (83%). The minority (32%) of providers had sleep-promoting protocols; these providers tended to believe their patients slept longer and experienced better sleep quality.Conclusions: Though most clinicians believe that sleep in the ICU is poor and adversely affects patient outcomes, a minority of the ICUs represented by our respondents have sleep promotion protocols. These findings highlight discordant provider perceptions and practices surrounding sleep in the ICU, as well as a possible lack of available evidence-based guidelines for promoting sleep in the ICU.

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Section: Discussionsupporting

confidence: 67%

“…Studies using polysomnography have demonstrated that critically ill patients experience decreased total sleep time, increased sleep during daytime hours (circadian misalignment), frequent arousals from sleep, and abnormal sleep architecture with reduced or absent slow wave sleep and REM stages (2)(3)(4)(5)(6).…”

mentioning

confidence: 99%

Perceptions and Practices Regarding Sleep in the Intensive Care Unit. A Survey of 1,223 Critical Care Providers

et al. 2016

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“…Factors affecting sleep in the ICU are numerous and are detailed below. Compared with healthy adults, studies characterizing sleep disturbances in ICU patients using polysomnography (PSG) have demonstrated prolonged sleep latency, sleep fragmentation, decreased sleep efficiency, numerous arousals, a preponderance of stage 2 sleep, decreased or absent stage 3 ("deep") sleep, and decreased or absent REM sleep (8)(9)(10)(11). Although mean total sleep time does not differ markedly from healthy adults, approximately 50% of ICU sleep occurs during the daytime hours, with a marked shift toward light stages of sleep.…”

Section: Sleep Abnormalities In Icu Patientsmentioning

confidence: 99%

“…Studies that have used PSG and standard Rechtschaffen and Kales (R&K) scoring reveal that sleep in ICU patients is abnormal, with less slow-wave and REM sleep, increased arousals, and altered circadian timing (10,11,13,14). Some studies have also noted EEG patterns that do not reliability fit into any stage, rendering R&K less useful.…”

Section: Sleep Abnormalities In Icu Patientsmentioning

confidence: 99%

Sleep in the Intensive Care Unit

Pisani

Friese

Gehlbach

et al. 2015

Am J Respir Crit Care Med

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Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.

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“…Atypical biophysiological sleep activity has been widely reported amongst ICU patients, which confounds the ability to distinguish between NREM sleep stages [23,28,[50][51]. PSG based studies reveal a lack of discernible sleep spindles and K complexes, along with challenges associated with electrical interference, and the impact of pharmacological agents in detecting submental muscle atonia [23,28,[50][51][52].…”

Section: Objective Sssessment Of Sleep Disturbancementioning

confidence: 99%