Showler L, Ali Abdelhamid Y, Goldin J, Deane AM. Sleep during and following critical illness: A narrative review. World J Crit Care Med 2023; 12(3): 92-115 [PMID: 37397589 DOI: 10.5492/wjccm.v12.i3.92]
Corresponding Author of This Article
Laurie Showler, MBChB, Doctor, Intensive Care Medicine, The Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Victoria, Australia. laurie.showler@mh.org.au
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 9, 2023; 12(3): 92-115 Published online Jun 9, 2023. doi: 10.5492/wjccm.v12.i3.92
Sleep during and following critical illness: A narrative review
Laurie Showler, Yasmine Ali Abdelhamid, Jeremy Goldin, Adam M Deane
Laurie Showler, Yasmine Ali Abdelhamid, Adam M Deane, Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
Jeremy Goldin, Sleep and Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
Author contributions: All authors contribute equally to the design and structure of this review; Showler L was the primary reviewer of the included literature and wrote the manuscript; Deane AM was the second reviewer of the included articles and edited the manuscript; Ali Abdelhamid Y and Goldin J wrote and edited the manuscript.
Conflict-of-interest statement: There are no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Laurie Showler, MBChB, Doctor, Intensive Care Medicine, The Royal Melbourne Hospital, 300 Grattan Street, Parkville 3050, Victoria, Australia. laurie.showler@mh.org.au
Received: December 28, 2022 Peer-review started: December 28, 2022 First decision: January 31, 2023 Revised: February 13, 2023 Accepted: March 22, 2023 Article in press: March 22, 2023 Published online: June 9, 2023 Processing time: 162 Days and 7.9 Hours
Abstract
Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.
Core Tip: Disturbed sleep is common among the critically ill and contributes to adverse physiological and psychological outcomes. Multiple contributory factors have been identified, including environmental, care-related and patient elements. Assessing sleep in the ICU is challenging, and objective and subjective methods are required to evaluate the disruption to sleep architecture and the patient’s experience of this. Both pharmacological and non-pharmacological interventions to improve sleep quality and quantity have been studied with mixed results, however, a multimodal approach to sleep optimisation is likely necessary to improve outcomes.
