Factors that impact on sleep in intensive care patients

Summary

This literature review shows that sleep is important for healing and survival of critical illness (Richardson et al., 2007, Straham and Brown, 2004). Sleep deprivation impinges on recovery, ability to resist infection, brings about neurological problems such as delirium, respiratory problems because it weakens upper air way muscles thus prolonging the duration of ventilation, ICU stay and complicating periods just after extubation (Friese, 2008, Parthasarathy and Tobin, 2004). Noise, pain and discomfort (Jacobi et al., 2002, Honkus, 2003) modes of ventilation and drugs have been cited as causes of sleep deprivation in critically ill patients (Friese, 2008, Parthasarathy and Tobin, 2004). The inability of nurses to accurately assess patients’ sleep has also been cited as a concern while polysonography has been cited as the most effective way of assessing patients’ sleep despite the difficulties associated with it.

While some of these causes of sleep disruption can not be easily alleviated, every effort must be made to promote REM and SWS sleep. More research is needed to find solutions to sleep disruption in ICU. More research is needed to ascertain the impact of mechanical ventilation on sleep disruption and more focused ways of sleep assessment are needed. Nurses need to minimise disruptions by clustering their care at night in order to allow patients to have the much needed REM sleep. Furthermore, more specific way of sleep assessment in the critically ill.

Introduction

Over time, studies have shown that sleep is important in the critically ill for healing and survival (Richardson et al., 2007, Honkus, 2003, Pandharipande and Ely, 2006) and yet there is consistent evidence reporting that patients in ICU still do not have enough sleep (Feeley and Gardner, 2006). This paper presents the literature available on factors that impact on sleep in ICU, the consequences of sleep disruption and the possible recommendations for practice, nursing education and future research to enhance sleep in the critically ill.

This review explored research reports and other relevant literature that examined sleep disruption in ICU patients over the last decade. The aim of the review was to identify factors consistently reported as contributing to sleep disturbance, strategies employed to assess and promote sleep, changes in sedation practice and their implications on sleep related outcomes for patients.

The literature search was conducted in order to answer the following questions:

What factors impact on patients’ ability to sleep in ICU? How do these factors operate to interfere with sleep? What are the consequences of sleep disturbance for patients’ recovery?

A literature search from Medline, CINAHL, Proquest and psychinfo databases was conducted. The search was conducted using the following inclusion criteria: all full text articles written in English, using the search terms, sleep in ICU, sleep deprivation, critical illness, intensive care units and nursing. Three hundred hits were achieved overall. The search was narrowed through combining terms and limiting to those published since 2000, identifying twenty two articles, of which eight were literature reviews, five were qualitative studies and nine were quantitative studies. Fourteen articles were American, five were European and three were Australasian. A summary of studies reviewed is presented in Table 1.