Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 27 , ISSUE 11 ( November, 2023 ) > List of Articles

Original Article

Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit

Pongpol Sirilaksanamanon, Thammasak Thawitsri, Somrat Charuluxananan, Naricha Chirakalwasan

Keywords : Bispectral index, Consciousness monitors, Intensive care units, Polysomnography, Postoperative care, Sleep stages, Sleep quality

Citation Information : Sirilaksanamanon P, Thawitsri T, Charuluxananan S, Chirakalwasan N. Diagnostic Value of the Bispectral Index to Assess Sleep Quality after Elective Surgery in Intensive Care Unit. Indian J Crit Care Med 2023; 27 (11):795-800.

DOI: 10.5005/jp-journals-10071-24555

License: CC BY-NC 4.0

Published Online: 30-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Purpose: Monitoring and improving sleep quality may help recovery from major illness. Polysomnography is a gold standard for measuring sleep quality, but routine use is not practical. The goal of this study is to investigate the diagnostic accuracy of an alternative monitor, the Bispectral Index (BIS), for evaluating the quality of sleep-in postoperative patients in the intensive care unit (ICU). Study design: An observational study. Materials and methods: Patients admitted to postoperative ICU after elective major noncardiac surgery were monitored with both BIS and PSG during the first night. The temporally synchronized data from both monitors were obtained for measurement of the association. Clinical outcomes were compared between patients with different postoperative sleep quality. Results: Thirty-three patients were enrolled in this study. For determining the average BIS index associated with good postoperative sleep quality, receiver operating characteristics (ROC) curve was generated. Area under the ROC curve (AUC) was 0.65. The cutoff with best discriminability was 75 with a sensitivity of 68% and a specificity of 56%. Compared with those with good and poor postoperative sleep quality, there were no differences in main postoperative outcomes including duration of mechanical ventilation and ICU stay. Although the quality of sleep after surgery of all subjects with postoperative delirium was poor, the incidence of delirium between the groups did not significantly differ (0% vs 10.3%; p = 0.184). Conclusion: The monitoring of BIS is a viable tool for evaluating sleep quality in mechanically ventilated patients in the postoperative ICU with acceptable precision. Trial registration:, TCTR20200310005.

  1. Kamdar BB, King LM, Collop NA, Sakamuri S, Colantuoni E, Neufeld KJ, et al. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Crit Care Med 2013;41(3):800–809. DOI: 10.1097/CCM.0b013e3182746442.
  2. Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000;117:809–818. DOI: 10.1378/chest.117.3.809.
  3. Altman MT, Knauert MP, Murphy TE, Ahasic AM, Chauhan Z, Pisani MA. Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: An observational cohort study. Ann Intensive Care 2018;8:63. DOI: 10.1186/s13613-018-0408-4.
  4. Sitasuwan T, Bussaratid S, Ruttanaumpawan P, Chotinaiwattarakul W. Reliability and validity of the Thai version of the Pittsburgh Sleep Quality Index. J Med Assoc Thai 2014;97 Suppl 3:S57–S67. PMID: 24772581.
  5. Berry B, Brooks R, Gamaldo C, Harding S, Lloyd R, Marcus C, et al. The ASSM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifcations, Version 2.6. Darien, Illinois: American Academy of Sleep Medicine; 2020.
  6. Pipanmekaporn T, Wongpakaran N, Mueankwan S, Dendumrongkul P, Chittawatanarat K, Khongpheng N, et al. Validity and reliability of the Thai version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Clinical Intervent Aging 2014;9:879. DOI: 10.2147/CIA.S62660.
  7. Charoensak S, Thunmanurukkit A, Sittironnarit G, Sartra T. Validity and reliability of the Thai version of the confusion assessment method. J Med Assoc Thai 2014;97:113–117. PMID: 24701738.
  8. Naik RD, Gupta K, Soneja M, Elavarasi A, Sreenivas V, Sinha S. Sleep quality and quantity in intensive care unit patients: A cross-sectional study. Indian J Crit Care Med 2018;22(6):408–414. DOI: 10.4103/ijccm.IJCCM_65_18.
  9. Weinhouse GL, Schwab RJ. Sleep in the critically ill patient. Sleep 2006;29(5):707–716. DOI: 10.1093/sleep/29.5.707.
  10. Czempik PF, Jarosińska A, Machlowska K, Pluta M. Impact of light intensity on sleep of patients in the intensive care unit: A prospective observational study. Indian J Crit Care Med 2020;24(1):33–37. DOI: 10.5005/jp-journals-10071-23323.
  11. Friese RS, Diaz-Arrastia R, McBride D, Frankel H, Gentilello LM. Quantity and quality of sleep in the surgical intensive care unit: Are our patients sleeping? J Trauma 2007;63(6):1210–1214. DOI: 10.1097/TA.0b013e31815b83d7.
  12. Parthasarathy S, Tobin MJ. Sleep in the intensive care unit. Intensive Care Med 2004;30(2):197–206. DOI: 10.1007/s00134-003-2030-6.
  13. Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: An observational study. Critical care (London, England) 2013;17(2): R46. DOI: 10.1186/cc12565.
  14. Sennholz G. Bispectral analysis technology and equipment. Minerva Anestesiol 2000;66(5):386–388. PMID: 10965721.
  15. Arbour R, Waterhouse J, Seckel MA, Bucher L. Correlation between the Sedation-Agitation Scale and the B in ventilated patients in the intensive care unit. Heart Lung 2009;38(4):336–345. DOI: 10.1016/j.hrtlng.2008.10.010.
  16. Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018;46(9):e825–e873. DOI: 10.1097/CCM.0000000000003299.
  17. Seo Y, Lee HJ, Ha EJ, Ha TS. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute Crit Care 2022;37(1):1–25. DOI: 10.4266/acc.2022.00094.
  18. Schwab KE, Ronish B, Needham DM, To AQ, Martin JL, Kamdar BB. Actigraphy to evaluate sleep in the intensive care unit. a systematic review. Ann Am Thorac Soc 2018;15(9):1075–1082. DOI: 10.1513/AnnalsATS.201801-004OC.
  19. Giménez S, Romero S, Alonso JF, Mañanas MÁ, Pujol A, Baxarias P, et al. Monitoring sleep depth: Analysis of bispectral index (BIS) based on polysomnographic recordings and sleep deprivation. J Clin Monitor Comput 2017;31(1):103–110. DOI: 10.1007/s10877-015-9805-5.
  20. Benissa MR, Khirani S, Hartley S, Adala A, Ramirez A, Fernandez-Bolanos M, et al. Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults. J Clin Monitor Comput: Springer Netherlands 2016;30(6):957–963. DOI: 10.1007/s10877-015-9800-x.
  21. Slater JA, Rossely A, Minogue T. Polysomnography: The measurement of sleep and sleep disorders. 2017 [cited 14-03-2023]. In: Sleep Medicine [Internet]. Melbourne: IP Communications [cited 14-03-2023].
  22. Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: Its role in physical and psychological recovery. J Intensive Care Med 2012;27(2):97–111. DOI: 10.1177/0885066610394322.
  23. Fadayomi AB, Ibala R, Bilotta F, Westover MB, Akeju O. A systematic review and meta-analysis examining the impact of sleep disturbance on postoperative delirium. Crit Care Med 2018;46(12):e1204–e1212. DOI: 10.1097/CCM.0000000000003400.
  24. Obanor OO, McBroom MM, Elia JM, Ahmed F, Sasaki JD, Murphy KM, et al. The impact of earplugs and eye masks on sleep quality in surgical ICU patients at risk for frequent awakenings. Crit Care Med 2021;49(9):e822–e832. DOI: 10.1097/CCM.0000000000005031.
  25. Tonna JE, Dalton A, Presson AP, Zhang C, Colantuoni E, Lander K, et al. The effect of a quality improvement intervention on sleep and delirium in critically ill patients in a surgical ICU. Chest 2021;160(3):899–908. DOI: 10.1016/j.chest.2021.03.030.
  26. Arttawejkul P, Reutrakul S, Muntham D, Chirakalwasan N. Effect of nighttime earplugs and eye masks on sleep quality in intensive care unit patients. Indian J Crit Care Med 2020;24(1):6–10. DOI: 10.5005/jp-journals-10071-23321.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.