Table 1.
Studies Assessing Sleep-promoting Interventions in Critically ill Patients
| Study | Quality scores* | Study design | Participants | Intervention | Control | Outcome measure | Comment |
|---|---|---|---|---|---|---|---|
| Alexopoulou 201326 | I | RCT, cross-over | Intubated, COPD, n=13 |
PAV | PSV | PSG-derived Sleep efficiency Sleep fragmentation index |
PAV failed to improve sleep in mechanically ventilated patients |
| Andrejak 201337 | I | RCT, cross-over | Intubated; n=35 (n=9 discarded) |
PCV | PSV | PSG-derived Sleep efficiency Sleep fragmentation index |
Sleep quantity and quality were significantly improved with PCV compared to low-PSV |
| Bosma 200727 | I | RCT, cross-over | Intubated; n=16 (n=3 discarded) |
PAV | PSV | PSG-derived Sleep efficiency Sleep fragmentation index |
PAV resulted in fewer patient-ventilator asynchronies and better sleep quality. |
| Bourne 200828 | I | RCT | Tracheostomized patients undergoing weaning (n=24) | Melatonin (10 mg) |
Placebo | Bispectral index (time spent <80; sleep efficiency); area under curve (sleep quality) | Melatonin use was associated with increased nocturnal sleep efficiency over 4 nights |
| Cabello 200816 | I | RCT, cross over, 3 arms | Intubated and tracheostomized patients (n=15) | Clinically adjusted PSV (Cabello 2008a) or automatically adjusted PSV (Cabello 2008b) |
ACV | PSG-derived Sleep efficiency Sleep fragmentation index |
The ventilatory mode did not influence sleep pattern, arousals and awakenings. |
| Cordoba-Izquierdo 201330 | I | RCT | Non-invasive ventilation; n=25 (n=1 discarded) |
Dedicated ICU ventilator | Conventional noninvasive ventilator | PSG-derived (Sleep efficiency and Sleep fragmentation index) | There were no observed differences in sleep quality corresponding to the type of ventilator used despite slight differences in patient–ventilator asynchrony. |
| Kondilli 201231 | I | RCT, cross-over | Invasive ventilation; n=13 (n=1 discarded) |
Propofol | No propofol | PSG-derived (Sleep efficiency and Sleep fragmentation index) | In critically ill patients ventilated on assisted modes, propofol administration to achieve the recommended level of sedation suppresses the REM sleep stage and further worsens the poor sleep quality of these patients. |
| Oto 201119 | I | RCT | Invasive ventilation; n=22 | Continuous infusion | Daily interruption of sedation | PSG-derived (Sleep efficiency and Sleep fragmentation index) | In the continuous infusion group, sleep efficiency was greater and sleep fragmentation was lower when compared to group with daily sedation interruption. |
| Parthasarathy 200232 | I | RCT, cross-over | Intubated patients, n=11 |
ACV | PSV | PSG-derived (Sleep efficiency and Sleep fragmentation index) | PSV was associated with sleep fragmentation when compared to ACV |
| Richards 199833 | I | RCT, cross-over, 3 arms | Critically ill men admitted to ICU (n=71); 2 subjects were excluded | Two of 3 arms back massage (n=24) | Usual care (n=17)(Richa rds 1998) or music & relaxation (n=28)(Richa rds 2008b) | PSG-derived (Sleep efficiency and Sleep fragmentation index) | Back massage was useful in promoting sleep in critically ill older men |
| Roche-Campo 201334 | I | RCT, cross-over | Tracheostomized patients undergoing weaning from mechanical ventilation (n=16) | PSV | Spontaneous ventilation (control) | PSG-derived (Sleep efficiency and Sleep fragmentation index) | Sleep quality was similar with or without the ventilator. Sleep quantity was higher during mechanical ventilation. |
| Su 201235 | I | RCT | 28 patients in a medical ICU | Music therapy | Usual care | PSG-derived sleep efficiency (sleep fragmentation was not measured) | Greater amount of slow wave sleep in the music group |
| Toublanc 200736 | I | RCT, cross-over | Intubated patients (n=22)(2 patients were discarded) | ACV | PSV | PSG-derived (Sleep efficiency and Sleep fragmentation index) | ACV was significantly associated with a better sleep quality than those recorded during PSV |
PAV = proportional assist ventilation; PSV = pressure support ventilation; COPD = chronic obstructive pulmonary disease; RCT = randomized controlled trial; PSG = polysomnography; ICU = Intensive care unit. USPTF Hierarchy of research design with range of I, II-1, II-2, II-3, and III (with I being best and defined as, “Evidence obtained from at least one properly randomized controlled trial”).