Influencing factors for Sleep Disturbance in the Intensive Care Unit Patients: A Systematic Review

Purpose : Sleep disturbances in patients in the intensive care unit (ICU) are related to health problems after discharge. Therefore, active prevention and management are required. Hence, identification of the factors that affect sleep in patients who are critically ill is necessary.Methods : The PubMed, Cochrane Library, CINAHL, EMBASE, and Web of Science databases were searched. Selection criteria were observational and experimental studies that assessed sleep as an outcome, included adult patients admitted to the ICU, and published between November 2015 and April 2022.Results : A total of 21,136 articles were identified through search engines and manual searches, and 42 articles were selected. From these, 22 influencing factors and 11 interventions were identified. Individual factors included disease severity, age, pain, delirium, comorbidities, alcohol consumption, sex, sleep disturbance before hospitalization, chronic obstructive pulmonary disease (COPD), cardiovascular disease, and high diastolic blood pressure (DBP), low hemoglobin (Hb), and low respiratory rate (RR). Environmental factors included light level, noise level, and temperature. Furthermore, treatment-related factors included use of sedatives, melatonin administration, sleep management guidelines, ventilator application, nursing treatment, and length of ICU stay. Regarding sleep interventions, massage, eye mask and earplugs, quiet time and multicomponent protocols, aromatherapy, acupressure, sounds of the sea, adaptive intervention, circulation lighting, and single occupation in a room were identified.Conclusion : Based on these results, we propose the development and application of various interventions to improve sleep quality in patients who are critically ill.

[1]  E. B. Andrés,et al.  Factors affecting sleep quality in Intensive Care Units. , 2021 .

[2]  Y. Fujimura,et al.  The mediating effects of perceived cognitive disturbances on reported sleep disturbance, presenteeism, and functional disability in Japanese adult workers , 2021, Journal of Affective Disorders Reports.

[3]  G. Nilius,et al.  Updated Perspectives on the Management of Sleep Disorders in the Intensive Care Unit , 2021, Nature and science of sleep.

[4]  Jing Zheng,et al.  Impact of a sleep promotion protocol on off-pump coronary artery bypass graft patients. , 2021, Nursing in critical care.

[5]  E. Mayo-Wilson,et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews , 2021, BMJ.

[6]  M. Pluta,et al.  Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study , 2020, Scientific Reports.

[7]  E. Bisbal Andrés,et al.  Factors affecting sleep quality in Intensive Care Units. , 2020, Medicina intensiva.

[8]  S. Mousavinasab,et al.  The effect of foot reflexology massage on burn-specific pain anxiety and sleep quality and quantity of patients hospitalized in the burn intensive care unit (ICU). , 2020, Burns : journal of the International Society for Burn Injuries.

[9]  Mohammad Mahmoud bani Younis,et al.  Factors influencing sleep quality among Jordanian intensive care patients. , 2020, British journal of nursing.

[10]  D. Needham,et al.  Use of actigraphy to characterize inactivity and activity in patients in a medical ICU. , 2020, Heart & lung : the journal of critical care.

[11]  Chia-Hao Chang,et al.  Back massage intervention for improving health and sleep quality among intensive care unit patients. , 2019, Nursing in critical care.

[12]  Natalie S Blencowe,et al.  RoB 2: a revised tool for assessing risk of bias in randomised trials , 2019, BMJ.

[13]  Myaa Lightfoot,et al.  Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring , 2019, Hospital pharmacy.

[14]  Hamza Alduraidi,et al.  Effectiveness of using eye mask and earplugs on sleep length and quality among intensive care patients: A quasi-experimental study. , 2019, International journal of nursing practice.

[15]  H. Makhlouf,et al.  Study of sleep quality among patients admitted to the respiratory intensive care unit , 2019 .

[16]  A. Lana,et al.  Impact of a Nurse Intervention to Improve Sleep Quality in Intensive Care Units: Results From a Randomized Controlled Trial , 2018, Dimensions of critical care nursing : DCCN.

[17]  D. Needham,et al.  Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU , 2018, Critical care medicine.

[18]  P. Jennum,et al.  Sleep in critically ill, mechanically ventilated patients with severe sepsis or COPD , 2018, Acta anaesthesiologica Scandinavica.

[19]  T. Murphy,et al.  Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: an observational cohort study , 2018, Annals of Intensive Care.

[20]  M. Pisani,et al.  Sleep Disturbance after Hospitalization and Critical Illness: A Systematic Review , 2017, Annals of the American Thoracic Society.

[21]  K. Persson Waye,et al.  Evaluation of a sound environment intervention in an ICU: A feasibility study. , 2017, Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.

[22]  Mayur B. Patel,et al.  The ABCDEF Bundle in Critical Care. , 2017, Critical care clinics.

[23]  Christian Guilleminault,et al.  Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels , 2017, Annals of Intensive Care.

[24]  M. Hernán,et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions , 2016, British Medical Journal.

[25]  Randall S Friese,et al.  Sleep in the intensive care unit. , 2015, American journal of respiratory and critical care medicine.

[26]  Carmen Adams,et al.  Implementing Clinical Practice Guidelines for Screening and Detection of Delirium in a 21-Hospital System in Northern California: Real Challenges in Performance Improvement , 2015, Clinical nurse specialist CNS.

[27]  P. Caruso,et al.  ICU Architectural Design Affects the Delirium Prevalence: A Comparison Between Single-Bed and Multibed Rooms* , 2014, Critical care medicine.

[28]  H. Greenberg,et al.  Sleep and the ICU , 2013 .

[29]  I. Higgins,et al.  The experience of sleep deprivation in intensive care patients: findings from a larger hermeneutic phenomenological study. , 2013, Intensive & critical care nursing.

[30]  V. Kapur,et al.  Post-discharge insomnia symptoms are associated with quality of life impairment among survivors of acute lung injury. , 2012, Sleep medicine.

[31]  V. Ranieri,et al.  Sleep disturbances in the critically ill patients: role of delirium and sedative agents. , 2011, Minerva anestesiologica.

[32]  Zhihui Zeng,et al.  Influence of humanized care on self-efficacy, sleep and quality of life of patients in cardiovascular surgery intensive care unit. , 2021, American journal of translational research.

[33]  E. Litton,et al.  Quality sleep using earplugs in the intensive care unit: the QUIET pilot randomised controlled trial. , 2017, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.