Abstract
Introduction
Sleep is an indispensable physiological need often underestimated and disregarded especially in critically ill patients1. Sleep abnormalities occur frequently in the ICU. These abnormalities include sleep deprivation and disruption as well as abnormal sleep architecture2. Sleep deprivation has been associated with the release of inflammatory cytokines, worse cardiovascular outcomes, poorer immunological response, etc. Sleep disruption induces a catabolic state, impairs cellular and humoral immune response, and causes respiratory dysfunction due to muscle fatigue and central respiratory3. Factors affecting sleep in the ICU are numerous. In this study we aim to evaluate the sleep quality and sleep disturbing factors in patients in ICU.
Objectives
Primary Objective: To assess the quality of sleep in ICU patients. Secondary Objective: To evaluate the factors contributing to poor quality of sleep.
Materials and methods
A cross-sectional study using recall questionnaires was conducted on patients more than 18 years admitted to Bangalore Baptist Hospital Intensive Care Unit from November 2023 to December 2023. Study included patients who had an ICU stay of more than 72 hours, who were conscious and oriented to time place and person at the time of analysis and were screened for delirium using CAM ICU. The questionnaires used included the Richards- Campbell sleep questionnaire (RCSQ)4 to assess the sleep quality and modified freedman scale5 which collects data on environmental factors known to affect sleep quality. Patients with RCSQ score less than 50 was considered to have poor sleep3.
Results
Total of 50 patients were included in the study. Out of the 50 patients, 30 were male and 20 females. The mean age was 61.4 + 15.5 years. The main reason for stay in ICU was lower respiratory tract infection (25/50; 50%). 10 patients were mechanically ventilated prior to the assessment. The mean RCSQ score for our study population was 45.1 + 24.1. 60% patients had poor quality sleep (30/50). There was a significant reduction in self-reported quality of sleep from 9.4 + 0.78 at home to 4.62 + 2.51 in ICU (P<0.001). 17 out of 30 patients with poor quality sleep claimed nursing interventions, vital sign measurements, blood sample collection and administration of medicines as the major disruptive factor. Pain was the other main disruptive factor for the cause of poor-quality sleep (15/30). 4 out of 30 patients reported noise in ICU as the cause for poor sleep. 7 out of 10 mechanically ventilated patients had poor quality sleep. Additionally, we discovered that alterations in the sleeping locale of patients were a shared factor.
Discussions
There is high prevalence of poor-quality sleep among patients admitted to ICU. Our study shows that multiple factors are responsible for sleep disturbances in an ICU. Reduction of these factors is a chance to obtain better sleep quality in ICU. Attention must be brought to the medical staff working in the ICU to the significance of sleep and raise their awareness of the factors which may disturb sleep.
References
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