Improving the quality and quantity of sleep for the intensive care patient
- Publication Type:
- Thesis
- Issue Date:
- 2011
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Patients in intensive care units (ICUs) frequently experience sleep disruption. Few
recent sleep studies using polysomnography (PSG) conducted in ICU are available.
Interventional studies to improve sleep in ICU are rare and PSG is infrequently used to
evaluate interventions designed to improve sleep in ICU.
The primary aim of the study was to explore ICU patients’ quality and quantity of
sleep, using 24-hour PSG recording, patient self-report and nurse nocturnal observation.
Secondary aims included an assessment of 24-hour sound and illuminance levels; selfreported
sleep quality on the Ward and at home two months after discharge from
hospital; patients’ psychological well-being at home two months after discharge from
hospital; and the effect of the introduction of a ‘rest and sleep’ guideline.
An exploratory approach was taken in this quasi-experimental study. Thirty
patients completed 24-hour PSG sleep recording before the introduction of the Guideline
and 23 patients after. The Guideline was developed using a consultative approach in
which research evidence and suggestions from ICU health care personnel were
incorporated. Audits were conducted in the postintervention phase to assess guideline
adoption.
The sample comprised 70% men and the mean age was 58 years. Diagnoses were
mainly nonoperative (66%). Fifty-four percent received mechanical ventilation during PSG
recording. Median duration of mechanical ventilation was six days and median length of
ICU stay was 12 days.
Median total sleep time was five hours. The majority of sleep was stage 1 and 2.
There was significant sleep fragmentation (median duration of sleep without waking: 3:15
min:sec). Forty-four per cent of sleep was during the day. There were concerns about the
interrater reliability of the PSG data analysis using the Rechtshaffen and Kales criteria
(Kappa values: 0.56 and 0.51). Patients’ self-reported sleep in ICU using the Richards
Campbell Sleep Questionnaire was poor (mean: 51 mm). Nurses’ estimations of nocturnal
sleep were higher than the PSG derived value. Sound levels exceeded international
standards for hospitals. Night-time illuminance levels were appropriately low. The
introduction of the Guideline did not appear to result in an improvement in sleep however
Guideline uptake was limited.
This investigation revealed the need for alternative methods of analysing ICU
patients’ PSG data. The study protocol demonstrates the feasibility of conducting further
extensive investigations into potential relationships between patients’ sleep disruption
and outcomes. The method in which the Guideline was developed may be of interest to
other clinicians wishing to develop guidelines when research evidence is limited.
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