Impact of clinical care on patient sleep in the intensive care

Impact of clinical care on patient sleep in the intensive care

Background: Sleep is a fundamental human need essential for recovery, yet it is critically disrupted for patients in the intensive care unit (ICU). Balancing the demand for frequent monitoring and interventions with the need for restorative sleep creates an environment in which sleep is often deprioritized, despite its known importance for recovery outcomes. The disruption of sleep in the ICU has diverse implications, contributing to prolonged recovery times, increased susceptibility to delirium, and diminished quality of life.
Aim: To investigate the nature and frequency of clinical interactions in the ICU and assess their impact on the quality of sleep experienced by patients.
Methods: We conducted a secondary analysis within a large, Level 3 tertiary ICU, encompassing data from a prior clinical trial. A within-subjects design was employed to gather concurrent patient-reported sleep experiences using the Richard-Campbell Sleep Questionnaire, alongside Actigraphy to capture biophysiological sleep data. Clinical interactions were recorded through Metavision (iMDsoft) electronic patient records, providing a comprehensive profile of interaction types and frequencies across shift times
Results: Patients consistently reported poor sleep quality across all questionnaire subscales (mean <50mm), and Actigraphy confirmed disrupted nocturnal sleep with median sleep time reduced to 5.6 hours (IQR 303.3-422min) and frequent overnight awakenings (mean 33.4, SD ±16.3). Interaction frequencies showed no significant variation across morning, afternoon, and night shifts (p>0.05), averaging 9 interactions per hour. Clinical assessments were the most frequent type (32.8%), with increased interaction frequency correlating with higher SOFA scores (rs(35)=0.33, p<0.05) and elevated CRP levels (rs(35)=-0.32, p<0.05).
Conclusion: ICU patients experience significant sleep disruption, raising questions about the feasibility of consolidated sleep amidst frequent care interactions. Findings highlight the need to re-evaluate care practices to prioritize the physiological requirement for sleep. Strategies are essential to promote sleep continuity, normalize sleep-wake patterns, and mitigate the adverse effects of sleep disruption, ultimately supporting better ICU patient outcomes.