Pilot study: an intensive care unit sleep promotion protocol

Abstract

PurposeDisturbances, such as in-room activity and sound, are significant sources of sleep disruption among critically ill patients. These factors are potentially modifiable. We tested the impact of an intensive care unit (ICU) sleep promotion protocol on overnight in-room disturbance.MethodsOur protocol restricted non-urgent bedside care from 00:00 to 03:59. Patients were assigned to usual care (n=30) or the sleep protocol (n=26). The primary outcomes were measures of in-room activity, sound and light. These three types of disturbance were compared between arms during a baseline time block (20:00–23:59) and a rest time block (00:00–03:59). We assessed the sleep protocol effect with generalised linear models.ResultsUsual care and sleep protocol patients had equivalent levels of in-room activity, sound and light during the baseline time block (20:00–23:59). In contrast, during the rest time block (00:00–03:59), the sleep protocol arm had 32% fewer room entries (rate ratio (RR) 0.68, p=0.001) and 9.1 fewer minutes of in-room activity (p=0.0002). Also, the length of time between room entrances increased from 26.4 to 45.8 min (p=0.0004). The sleep protocol arm also had lower sound during the rest time block. Mean A-weighted sound was 2.5 decibels lower (p=0.02), and there were 36% fewer peaks (RR 0.64, p=0.02). Light levels were highly variable and not changed by the sleep protocol.ConclusionsSleep promotion protocols can improve in-room activity and sound. This provides a better sleep opportunity and may, therefore, improve ICU sleep.Trial registration number1112009428

Characterisation of ICU sleep by a commercially available activity tracker and its agreement with patient-perceived sleep quality

“…1 Disrupted sleep in this setting may increase delirium risk and prolong mechanical ventilation. 1 2 The use of sleep improvement protocols in the ICU, while being shown to reduce noise and patient interruption 3 and lower delirium, 4 have generally not been shown to improve sleep quality. 1 An important barrier to demonstrating ICU sleep protocols improve sleep quality is the current lack of a low-cost, quantitative method to evaluate sleep in the ICU that is both reliable and feasible to use in daily practice.…”

Metabolomics pilot study identifies circadian desynchronization and distinct intra-patient variability patterns in critical illness

“…In this study, we observed LAeq levels far above this threshold in ICU patient rooms. Other groups have observed similar trends (15,37,38). It has been known for over 20 years that high noise levels are present in the ICU and that they adversely affect sleep (15,39,40).…”

Circadian Biology and Its Importance to Intensive Care Unit Care and Outcomes

“…One study found patient rooms were being entered at an average of once every 28 minutes during the middle of the night period. 33 Other studies found that patients experienced 43 care interactions per overnight period and that many of these care interactions were nonurgent. 44,45 Disruption of the normal daytime feeding/night time fasting rhythm has numerous adverse metabolic and circadian consequences.…”

“…31 Nocturnal light has been shown to be too high and too variable, especially in the case of more sick patients who spent more time at light levels greater than 20 lux. 32,33 Highlight variability provides a poor circadian signal; in one study, there were several bright pulses of light up to 300 lux during procedures or bedside patient checks. 34 Similarly, a study of light and sound measurements in a medical ICU showed that both were nearly completely disconnected from solar time.…”