Chest
Postgraduate Education CornerContemporary Reviews in Sleep MedicineSleep in the ICU: Potential Mechanisms and Clinical Implications
Section snippets
Normal Sleep Architecture and Regulation
Sleep is characterized by a variety of physiologic, behavioral, and EEG changes and is necessary for restoration of cognitive, mood, and physiologic functions.12, 14 Normal sleep architecture, measured by polysomnography (PSG) is divided into the following two distinct states: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep.14, 15, 16 NREM is composed of three distinct stages based on EEG criteria. Stage 1 and 2 are considered to reflect light sleep followed by deep
Implications of Sleep Deprivation
Studies of sleep-deprived animals and healthy humans reveal many derangements in physiologic parameters that could negatively affect the underlying pathophysiology, treatment, and recovery from acute critical illness in ICU patients.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 Even short-term, partial sleep deprivation (6 nights of 4 to 5 h of sleep per night) results in untoward effects. Studies demonstrate decreased glucose tolerance and increased insulin resistance, which could impact
Sleep Patterns in ICU Patients
More than 60% of patients surviving ICU admission report poor sleep or being sleep deprived.32, 33 Other studies have shown that patients recall frequent interruptions and memories of pain, anxiety, and fear that impaired their ability to sleep.33, 34 In a study of 464 patients, 51% recalled experiencing dreams and nightmares over the course of their ICU admission; 14% of these patients, 6 months after ICU discharge, believed these dreams continued to negatively impact their quality of life.35
Factors Contributing to Sleep Disruption
Many factors can disturb sleep in ICU patients. These include the environment with disruptions due to noise, lighting, and patient care activities; disruption due to medical illness itself; and sleep disturbance due to medical treatments, such as respiratory care, drug therapies, and mechanical ventilation.7, 9, 10, 11
Summary
Sleep in the ICU is perceived by patients to be poor, often associated with fear, anxiety, and nightmares that impair later quality of life. Quantitative and qualitative sleep deprivation occurs and can have negative consequences on physiologic function, particularly immune mechanisms, as well as psychological well-being. Noise, particularly staff talking and patient-care activities, are clearly contributing factors and represent 40% of the source of sleep disruption. Medications such as
Acknowledgment
I would like to offer a special thanks to Dr. Mark Sanders for his advice and support in the preparation of this manuscript.
References (90)
- et al.
Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction
Electroencephalogr Clin Neurophysiol
(1978) - et al.
Polysomnography in acutely ill intensive care unit patients
Chest
(1992) - et al.
Sleep in the intensive care unit
Chest
(1995) - et al.
Adverse environmental conditions in the respiratory and medical ICU settings
Chest
(1994) Neurobiology of REM and NREM sleep
Sleep Med
(2007)- et al.
Links between the innate immune system and sleep
J Allergy Clin Immunol
(2005) - et al.
Effects of sleep deprivation and reversal of diurnal activity on protein metabolism of young men
Am J Clin Nutr
(1966) - et al.
Sleep deprivation decreases ventilatory response to CO2 but not load compensation
Chest
(1983) - et al.
The effect of sleep loss on breathing in chronic obstructive pulmonary disease
Chest
(1987) Patients' perceptions of intensive care
Lancet
(1999)
Sleep in critically ill patients requiring mechanical ventilation
Chest
Sleep in critically ill chemically paralyzed patients requiring mechanical ventilation
Chest
Sleep organization pattern as a prognostic marker at the subacute stage of post-traumatic coma
Clin Neurophysiol
Identification and modification of environmental noise in an ICU setting
Chest
Noise and sleep disturbance factors before and after implementation of a behavioural modification programme
Intensive Crit Care Nurs
The influence of white noise on sleep in subjects exposed to ICU noise
Sleep Med
Patients in the intensive care unit suffer from severe lack of sleep associated with loss of normal melatonin secretion pattern
Am J Med Sci
Respiratory patterns during sleep in obesity-hypoventilation patients treated with nocturnal pressure support: a preliminary report
Chest
Delirium: the underlying pathophysiological mechanisms and the need for clinical research
J Psychosom Res
The use of continuous IV sedation is associated with prolongation of mechanical ventilation
Chest
Possible involvement of the endocannabinoid system in the actions of three clinically used drugs
Trends Pharmacol Sci
A double-blind placebo-controlled randomized pilot study of nocturnal melatonin in tracheostomised patients
Crit Care Resusc
Sleep deprivation and pain perception
Sleep Med Rev
Keeping cool: a hypothesis about the mechanisms and functions of slow-wave sleep
Trends Neurosci
Neurologic complications of systemic critical illness
Neurol Crit Care
Quantity and quality of patients' sleep and sleep disturbing factors in a respiratory intensive care unit
J Adv Nurs
A description of night sleep patterns in the critical care unit
Heart Lung
Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving post operative care
BMJ
Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit
Am J Respir Crit Care Med
Quantity and quality of sleep in the surgical intensive care unit: are our patients sleeping?
J Trauma
Effect of ventilator mode on sleep quality in critically ill patients
Am J Respir Crit Care Med
Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects
Am J Respir Crit Care Med
Sleep in the intensive care unit
Intensive Care Med
The correlation between sleep deprivation and the intensive care unit syndrome
Heart Lung
Normal human sleep: an overview
The AASM manual for the scoring of sleep and associated events
Melatonin: possible implications for the postoperative and critically ill patient
Intensive Care Med
Sleep in the critically ill patient
Sleep
Impact of sleep debt on metabolic and endocrine function
Lancet
Effect of sleep deprivation on response to immunization
JAMA
Effects of 48 hours sleep deprivation on human immune profile
Sleep Res Online
Sleep deprivation and control of ventilation
Am Rev Respir Dis
The effect of sleep deprivation on the activity of the genioglossus muscle
Am Rev Respir Dis
Sleep loss impairs inspiratory muscle endurance
Am Rev Respir Dis
Sleep deprivation per se does not decrease the hypercapnic ventilatory response in humans
Am J Respir Crit Care Med
Cited by (88)
Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis
2023, Intensive and Critical Care NursingSleep in children with cancer and other chronic diseases
2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second EditionA key role of gut microbiota-vagus nerve/spleen axis in sleep deprivation-mediated aggravation of systemic inflammation after LPS administration
2021, Life SciencesCitation Excerpt :Changes in circadian rhythm after sepsis can aggravate the disease and increase mortality [3]. Evidence has shown that prolonged sleep deprivation (SD) can evoke a persistent production of pro-inflammatory cytokines such as interleukin (IL)-6, IL-1 and tumor necrosis factor-α (TNF-α), and produce a chronic low-grade inflammation, which can potentially expand the pathological sequelae of sepsis [7–10]. However, the underlying roles and mechanisms of SD in systemic inflammation after lipopolysaccharide administration remain unclear.
Promoting nighttime sleep in the intensive care unit: Alternative strategies in nursing
2019, Intensive and Critical Care NursingImplications of disturbances in circadian rhythms for cardiovascular health: A new frontier in free radical biology
2018, Free Radical Biology and Medicine
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).