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VOLUME 22 , ISSUE 6 ( 2018 ) > List of Articles


Sleep quality and quantity in intensive care unit patients: A cross-sectional study

Sanjeev Sinha, Ramavath Devendra Naik, Kartik Gupta, Arunmozhimaran Elavarasi, V. Sreenivas

Keywords : Actigraphy, Intensive Care Unit, Richards-Campbell Sleep Questionnaire, sleep quality

Citation Information : Sinha S, Naik RD, Gupta K, Elavarasi A, Sreenivas V. 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

License: CC BY-ND 3.0

Published Online: 01-02-2015

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Lack of restorative sleep and altered sleep-wake cycle is a frequent problem among patients admitted to the Intensive Care Unit (ICU). This study was conducted to estimate the prevalence of poor sleep and patient's perspective of factors governing poor sleep in the ICU. Materials and Methods: A cross-sectional study was performed in medical ICU of a tertiary care hospital. A total of 32 patients admitted to the ICU for at least 24 h were recruited. A 72-h actigraphy was done followed by a subjective assessment of sleep quality by the Richards-Campbell Sleep Questionnaire (RCSQ). Patient's perspective of sleep quality and quantity and possible risk factors for poor sleep were recorded. Results: Poor sleep (defined as RCSQ <50, sensitivity 88% and specificity 87%) was found in 15 out of the 32 patients (47%). The prevalence of poor sleep was higher among patients on mechanical ventilation (n = 15) (66.7% vs. 33.3%, P < 0.05). Patients with poor sleep had higher age (median age [in years] 42.8 vs. 31.4, P = 0.008), acute physiology, and chronic health evaluation II score (mean 14 ± 5.15 vs. 9.3 ± 5.64, P = 0.02), SAPS 3 score (62.7 ± 8.9 vs. 45.6 ± 10.5, P ≤ 0.0001), and worse actigraphy parameters. Only 55.63% of total sleep time was in the night (2200–0600). All patients had discomfort from indwelling catheters and suctioning of endotracheal tubes. All patients suggested that there be a minimum interruption in the sleep for interventions or medications. Conclusion: There is a high prevalence of poor sleep among patients admitted to the ICU. There is a dire need to minimize untimely interventions and design nonpharmacological techniques to allow patients to sleep comfortably.

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  1. Collop NA, Salas RE, Delayo M, Gamaldo C. Normal sleep and circadian processes. Crit Care Clin 2008;24:449-60, v.
  2. Tembo AC, Parker V, Higgins I. The experience of sleep deprivation in intensive care patients: Findings from a larger hermeneutic phenomenological study. Intensive Crit Care Nurs 2013;29:310-6.
  3. Parthasarathy S, Tobin MJ. Sleep in the Intensive Care Unit. Intensive Care Med 2004;30:197-206.
  4. 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;63:1210-4.
  5. Helton MC, Gordon SH, Nunnery SL. The correlation between sleep deprivation and the Intensive Care Unit syndrome. Heart Lung 1980;9:464-8.
  6. Grandner MA, Sands-Lincoln MR, Pak VM, Garland SN. Sleep duration, cardiovascular disease, and proinflammatory biomarkers. Nat Sci Sleep 2013;5:93-107.
  7. Palmblad J, Cantell K, Strander H, Fröberg J, Karlsson CG, Levi L, et al. Stressor exposure and immunological response in man: Interferon-producing capacity and phagocytosis. J Psychosom Res 1976;20:193-9.
  8. White DP, Douglas NJ, Pickett CK, Zwillich CW, Weil JV. Sleep deprivation and the control of ventilation. Am Rev Respir Dis 1983;128:984-6.
  9. Salas RE, Gamaldo CE. Adverse effects of sleep deprivation in the ICU. Crit Care Clin 2008;24:461-76, v-vi.
  10. Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, et al. Contribution of the Intensive Care Unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003;167:708-15.
  11. Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: Its role in physical and psychological recovery. J Intensive Care Med 2012;27:97-111.
  12. BaHammam A. Sleep in acute care units. Sleep Breath 2006;10:6-15.
  13. Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: An observational study. Crit Care 2013;17:R46.
  14. Krachman SL, D'Alonzo GE, Criner GJ. Sleep in the Intensive Care Unit. Chest 1995;107:1713-20.
  15. Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF, et al. Sleep in the Intensive Care Unit. Am J Respir Crit Care Med 2015;191:731-8.
  16. Knauert MP, Yaggi HK, Redeker NS, Murphy TE, Araujo KL, Pisani MA, et al. Feasibility study of unattended polysomnography in medical Intensive Care Unit patients. Heart Lung 2014;43:445-52.
  17. Sadeh A, Hauri PJ, Kripke DF, Lavie P. The role of actigraphy in the evaluation of sleep disorders. Sleep 1995;18:288-302.
  18. Raj R, Ussavarungsi K, Nugent K. Accelerometer-based devices can be used to monitor sedation/agitation in the Intensive Care Unit. J Crit Care 2014;29:748-52.
  19. Mistraletti G, Taverna M, Sabbatini G, Carloni E, Bolgiaghi L, Pirrone M, et al. Actigraphic monitoring in critically ill patients: Preliminary results toward an “observation-guided sedation”. J Crit Care 2009;24:563-7.
  20. Grap MJ, Borchers CT, Munro CL, Elswick RK Jr., Sessler CN. Actigraphy in the critically ill: Correlation with activity, agitation, and sedation. Am J Crit Care 2005;14:52-60.
  21. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the Intensive Care Unit (CAM-ICU). JAMA 2001;286:2703-10.
  22. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:485-91.
  23. Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540-5.
  24. Levey AS, Coresh J. Chronic kidney disease. Lancet 2012;379:165-80.
  25. Schuiling WJ, Rinkel GJ, Walchenbach R, de Weerd AW. Disorders of sleep and wake in patients after subarachnoid hemorrhage. Stroke 2005;36:578-82.
  26. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  27. Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3 – From evaluation of the patient to evaluation of the Intensive Care Unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005;31:1345-55.
  28. Richards KC, O'Sullivan PS, Phillips RL. Measurement of sleep in critically ill patients. J Nurs Meas 2000;8:131-44.
  29. Kamdar BB, Shah PA, King LM, Kho ME, Zhou X, Colantuoni E, et al. Patient-nurse interrater reliability and agreement of the Richards-Campbell sleep questionnaire. Am J Crit Care 2012;21:261-9.
  30. Sinha S, Gupta K, Tripathy S, Dhooria S, Ranjan S, Pandey RM, et al. Nevirapine- versus efavirenz-based antiretroviral therapy regimens in antiretroviral-naive patients with HIV and tuberculosis infections in India: A multi-centre study. BMC Infect Dis 2017;17:761.
  31. Beecroft JM, Ward M, Younes M, Crombach S, Smith O, Hanly PJ, et al. Sleep monitoring in the Intensive Care Unit: Comparison of nurse assessment, actigraphy and polysomnography. Intensive Care Med 2008;34:2076-83.
  32. Tryon WW. Issues of validity in actigraphic sleep assessment. Sleep 2004;27:158-65.
  33. Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ, et al. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000;117:809-18.
  34. Nicolás A, Aizpitarte E, Iruarrizaga A, Vázquez M, Margall A, Asiain C, et al. Perception of night-time sleep by surgical patients in an Intensive Care Unit. Nurs Crit Care 2008;13:25-33.
  35. Myers BL, Badia P. Changes in circadian rhythms and sleep quality with aging: Mechanisms and interventions. Neurosci Biobehav Rev 1995;19:553-71.
  36. Frisk U, Nordström G. Patients' sleep in an Intensive Care Unit – Patients' and nurses' perception. Intensive Crit Care Nurs 2003;19:342-9.
  37. Bourne RS, Minelli C, Mills GH, Kandler R. Clinical review: Sleep measurement in critical care patients: Research and clinical implications. Crit Care 2007;11:226.
  38. Gabor JY, Cooper AB, Hanly PJ. Sleep disruption in the Intensive Care Unit. Curr Opin Crit Care 2001;7:21-7.
  39. Fanfulla F, Ceriana P, D'Artavilla Lupo N, Trentin R, Frigerio F, Nava S, et al. Sleep disturbances in patients admitted to a step-down unit after ICU discharge: The role of mechanical ventilation. Sleep 2011;34:355-62.
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