Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography

Beecroft, Jaime M.; Ward, Michael; Younes, Magdy; Crombach, Shelley A.; Smith, Orla M.; Hanly, Patrick J.

doi:10.1007/s00134-008-1180-y

Cited by 140 publications

(177 citation statements)

References 35 publications

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“…12 Wrist actigraphy is a potentially cheap and non-labor-intensive mode for monitoring sleep wake and agitation, 31 though it has not yet been fully validated in ICU. 32,33 Additionally, there may have been a recruitment and selection bias that limits the generalizability of the results to the ICU population as a whole. Only subjects discharged on Monday to Friday mornings from 08:00 to 12:00 were invited to participate, and the sample of 100 patients was mainly a convenience sample.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Bihari

McEvoy

Matheson

et al. 2012

Journal of Clinical Sleep Medicine

155

120

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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...

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Sleep Quality of Patients in Intensive Care Unit

Bihari

McEvoy

Matheson

et al. 2012

Journal of Clinical Sleep Medicine

155

120

View full text Add to dashboard Cite

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“…While studies have assessed the accuracy of actigraphy in ICU patients, as well as in controlled sleep conditions, no known study of the accuracy of actigraphy in general medicine patients has been conducted. 35,36 Another study limitation was the rate of Actiwatch removal or failure (24%); the most common reason was removal of the Actiwatch for a procedure, such as MRI, as clinical activities took precedence over our research. It is possible that the patients who consented to the sleep study differ from those that did not consent, raising the concern for selection bias.…”

Section: Discussionmentioning

confidence: 99%

Risk of Sleep Apnea in Hospitalized Older Patients

Shear

Balachandran

Mokhlesi

et al. 2014

Journal of Clinical Sleep Medicine

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Background/Objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. Design: Prospective cohort study. Setting: General medicine ward in academic medical center Participants: 424 hospitalized adult patients ≥ 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American). Main Measures: The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and effi ciency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI). Key Results: Two of every 5 inpatients ≥ 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ~ 5 h and mean sleep effi ciency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ~ 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These fi ndings remained signifi cant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ~ 5.5% less sleep effi ciency per night (-5.50 [-9.96 S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is a common sleep disorder that affects approximately 1 of every 4 adults in the United States.1,2 Unfortunately, up to 90% of people with OSA are undiagnosed.3 Without treatment, severe OSA is associated with increased risk of cardiovascular and cerebrovascular morbidity and mortality in both men and women.3-5 Early diagnosis and treatment of OSA have been recommended to improve patient health outcomes.Hospitalized patients are likely at high risk of OSA. One reason is that OSA is especially prevalent among patients with medical conditions that can result in hospitalization, such as congestive heart failure. [4][5][6][7] Hospitalized patients with OSA also have an increased risk of postoperative complications and exacerbations of chronic conditions. 8,9 Because hospitalization has been characterized as a period of acute sleep loss due to environmental factors, inpatients with undiagnosed OSA may experience even more sleep disruptions than their healthier counterparts.10 Despite these associations, in one study of inpatients, there was no documentation of sleep histories or any sleep-associated symptoms in their hospital charts.11 In addition, there is a high frequency of sleep disordered breathing in hospitalized patients referred for polysomnography, especially in patients with underlying cardiopulmonary disease. 12These fi ndings suggest that hospitalization may represent a missed opportunity to screen patients for sleep disorders. Risk of Sleep Apnea in Hospitalized Older Patients BRIEF SUMMARYCurrent Knowledge/Study Rationale: While the prevalence of OSA in the US is estimated at approximately 25%, it ...

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“…Although previous research involving the ICU patient population is limited and frequently involved small numbers, this technology may have a useful application in specific clinical situations and may not be suitabe for all ICU patients as indicated by Beecroft et al [63]. In their study involving mechnically ventilated patients (n=12) the accuracy of actigraphy compared with PSG was reported to be less than 65%.…”

Section: Behavioural Assessment Of Sleep Disturbancementioning

confidence: 99%