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Intensive Care Medicine
Published in: Intensive Care Medicine 11/2008

01-11-2008 | Original

Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography

Authors: Jaime M. Beecroft, Michael Ward, Magdy Younes, Shelley Crombach, Orla Smith, Patrick J. Hanly

Published in: Intensive Care Medicine | Issue 11/2008

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Abstract

Objective

Sleep loss and sleep disruption are common in critically ill patients and may adversely affect clinical outcomes. Although polysomnography remains the most accurate and reliable way to measure sleep, it is costly and impractical for regular use in the intensive care unit. This study evaluates the accuracy of two other methods currently used for measuring sleep, actigraphy (monitoring of gross motor activity) and behavioural assessment by the bedside nurse, by comparing them to overnight polysomnography in critically ill patients.

Design

Observational study with simultaneous polysomnography, actigraphy and behavioural assessment of sleep.

Setting

Medical-surgical intensive care unit.

Patients and participants

Twelve stable, critically ill, mechanically ventilated patients [68 (13) years, Glasgow coma scale 11 (0)].

Interventions

None.

Measurements and results

Sleep was severely disrupted, reflected by decreased total sleep time and sleep efficiency, high frequency of arousals and awakenings and abnormal sleep architecture. Actigraphy overestimated total sleep time and sleep efficiency. The overall agreement between actigraphy and polysomnography was <65%. Nurse assessment underestimated the number of awakenings from sleep. Estimated total sleep time, sleep efficiency and number of awakenings by nurse assessment did not correlate with polysomnographic findings.

Conclusions

Actigraphy and behavioural assessment by the bedside nurse are inaccurate and unreliable methods to monitor sleep in critically ill patients.
Appendix
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Literature
1.
Hanly P (2006) Sleep in the ventilated patient. In: Tobin M (ed) Principles and practice of mechanical ventilation, 2nd edn. McGraw-Hill, New York, pp 1173–1184
2.
Cooper AB, Gabor JY, Hanly PJ (2001) Sleep in the critically ill patient. Semin Respir Crit Care Med 22:153–164PubMedCrossRef
3.
Gabor JY, Cooper AB, Hanly PJ (2001) Sleep disruption in the intensive care unit. Curr Opin Crit Care 7:21–27PubMedCrossRef
4.
Weinhouse GL, Schwab RJ (2006) Sleep in the critically ill patient. Sleep 29:707–716PubMed
5.
Aurell J, Elmqvist D (1985) Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care. Br Med J (Clin Res Ed) 290:1029–1032CrossRef
6.
Broughton R, Baron R (1978) Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction. Electroencephalogr Clin Neurophysiol 45:348–360PubMedCrossRef
7.
Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ (2000) Sleep in critically ill patients requiring mechanical ventilation. Chest 117:809–818PubMedCrossRef
8.
Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ (2001) Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 163:451–457PubMed
9.
Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, Hanly PJ (2003) Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 167:708–715PubMedCrossRef
10.
Hilton BA (1976) Quantity and quality of patients’ sleep and sleep-disturbing factors in a respiratory intensive care unit. J Adv Nurs 1:453–468PubMedCrossRef
11.
12.
13.
Richards KC, Bairnsfather L (1988) A description of night sleep patterns in the critical care unit. Heart Lung 17:35–42PubMed
14.
Knill RL, Moote CA, Skinner MI, Rose EA (1990) Anesthesia with abdominal surgery leads to intense REM sleep during the first postoperative week. Anesthesiology 73:52–61PubMedCrossRef
15.
Rosenberg J, Wildschiodtz G, Pedersen MH, von Jessen F, Kehlet H (1994) Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. Br J Anaesth 72:145–150PubMedCrossRef
16.
Bosma K, Ferreyra G, Ambrogio C, Pasero D, Mirabella L, Braghiroli A, Appendini L, Mascia L, Ranieri VM (2007) Patient–ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med 35:1048–1054PubMedCrossRef
17.
Parthasarathy S, Tobin MJ (2002) Effect of ventilator mode on sleep quality in critically ill patients. Am J Respir Crit Care Med 166:1423–1429PubMedCrossRef
18.
Hardin KA, Seyal M, Stewart T, Bonekat HW (2006) Sleep in critically ill chemically paralyzed patients requiring mechanical ventilation. Chest 129:1468–1477PubMedCrossRef
19.
Fontaine DK (1989) Measurement of nocturnal sleep patterns in trauma patients. Heart Lung 18:402–410PubMed
20.
Horne JA (1998) Why we sleep: the functions of sleep in humans and other mammals. Oxford University Press, Oxford
21.
Hansell HN (1984) The behavioral effects of noise on man: the patient with “intensive care unit psychosis”. Heart Lung 13:59–65PubMed
22.
Ely EW, Gautam S, Margolin R, Francis J, May L, Speroff T, Truman B, Dittus R, Bernard R, Inouye SK (2001) The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 27:1892–1900PubMedCrossRef
23.
Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G (1998) The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548PubMedCrossRef
24.
Chen HI, Tang YR (1989) Sleep loss impairs inspiratory muscle endurance. Am Rev Respir Dis 140:907–909PubMed
25.
Cooper KR, Phillips BA (1982) Effect of short-term sleep loss on breathing. J Appl Physiol 53:855–858PubMed
26.
White DP, Douglas NJ, Pickett CK, Zwillich CW, Weil JV (1983) Sleep deprivation and the control of ventilation. Am Rev Respir Dis 128:984–986PubMed
27.
Schiffman PL, Trontell MC, Mazar MF, Edelman NH (1983) Sleep deprivation decreases ventilatory response to CO2 but not load compensation. Chest 84:695–698PubMedCrossRef
28.
Benca RM, Quintas J (1997) Sleep and host defenses: a review. Sleep 20:1027–1037PubMed
29.
30.
Toublanc B, Rose D, Glérant JC, Francois G, Mayeux I, Rodenstein D, Jounieaux V (2007) Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in intubated ICU patients. Intensive Care Med 33:1148–1154PubMedCrossRef
31.
Alexopoulou C, Kondili E, Vakouti E, Klimathianaki M, Prinianakis G, Georgopoulos D (2007) Sleep during proportional-assist ventilation with load-adjustable gain factors in critically ill patients. Intensive Care Med 33:1139–1147PubMedCrossRef
32.
Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects (NIH publication no. 204). Brain Information Service/Brain Research Institute, UCLA, Los Angeles
33.
Sadeh A, Hauri PJ, Kripke DF, Lavie P (1995) The role of actigraphy in the evaluation of sleep disorders. Sleep 18:288–302PubMed
34.
Shilo L, Dagan Y, Smorjik Y, Weinberg U, Dolev S, Komptel B, Balaum H, Shenkman L (1999) Patients in the intensive care unit suffer from severe lack of sleep associated with loss of normal melatonin secretion pattern. Am J Med Sci 317:278–281PubMedCrossRef
35.
Shilo L, Dagan Y, Smorjik Y, Weinberg U, Dolev S, Komptel B, Shenkman L (2000) Effect of melatonin on sleep quality of COPD intensive care patients: a pilot study. Chronobiol Int 17:71–76PubMedCrossRef
36.
Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, Brown T, Chesson A Jr, Coleman J, Lee-Chiong T, Pancer J, Swick TJ (2007) Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep 30:519–529PubMed
37.
Bourne RS, Minelli C, Mills GH, Kandler R (2007) Clinical review: sleep measurement in critical care patients: research and clinical implications. Crit Care 11:226PubMedCrossRef
38.
39.
Edwards GB, Schuring LM (1993) Pilot study: validating staff nurses’ observations of sleep and wake states among critically ill patients, using polysomnography. Am J Crit Care 2:125–131PubMed
40.
Olson DM, Borel CO, Laskowitz DT, Moore DT, McConnell ES (2001) Quiet time: a nursing intervention to promote sleep in neurocritical care units. Am J Crit Care 10:74–78PubMed
41.
Richardson A, Crow W, Coghill E, Turnock C (2007) A comparison of sleep assessment tools by nurses and patients in critical care. J Clin Nurs 16:1660–1668PubMedCrossRef
42.
Beecroft J, Ward M, Younes M, Crombach S, Smith O, Lukic D, Lawrence J, Hanly P (2005) Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography. Proc Am Thorac Soc 2:A793
43.
Riker RR, Picard JT, Fraser GL (1999) Prospective evaluation of the sedation–agitation scale for adult critically ill patients. Crit Care Med 27:1325–1329PubMedCrossRef
44.
Jacobson S, Jerrier H (2000) EEG in delirium. Semin Clin Neuropyschiatry 5:86–92
45.
Miller RRIII, Ely EW (2006) Delirium and cognitive dysfunction in the intensive care unit. Semin Respir Crit Care Med 27:210–220PubMedCrossRef
Metadata
Title
Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography
Authors
Jaime M. Beecroft
Michael Ward
Magdy Younes
Shelley Crombach
Orla Smith
Patrick J. Hanly
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1180-y

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