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Sleep in the intensive care unit
Eugenia Y Lee1, M Elizabeth Wilcox1,2
1Interdepartmental Division of Critical Care Medicine, University of Toronto.
Current Opinion in Pulmonary Medicine
|September 14, 2022
Summary
Critically ill patients experience sleep and circadian disruption in intensive care units (ICUs), impacting physiology and outcomes. While interventions show promise, further research is needed to validate their effectiveness and guide pharmacotherapy.
Area of Science:
- Critical care medicine
- Sleep science
- Circadian biology
Background:
- Sleep and circadian rhythms are vital for critically ill patients.
- Disruptions in intensive care units (ICUs) affect physiology and clinical outcomes.
- Understanding these disruptions is crucial for improving patient care.
Purpose of the Study:
- To review the latest evidence on sleep and circadian disruption in ICUs.
- To examine the impact on patient physiology and clinical outcomes.
- To explore recent advances in sleep and circadian rhythm promoting interventions.
Main Methods:
- Literature review of recent evidence.
- Analysis of molecular, physiological, and clinical findings.
- Evaluation of sleep-promoting interventions and therapeutics.
Main Results:
- Clock gene dysrhythmia and altered immunity are linked, especially in sepsis.
- Sleep architecture changes correlate with delirium incidence.
- Multifaceted care bundles may reduce delirium, but melatonin RCT showed no significant benefit.
Conclusions:
- Clinical relevance of ICU sleep disruption requires further investigation.
- Standardized sleep promotion protocols need validation in large trials.
- Individualized interventions and further evaluation of pharmacotherapies like melatonin and dexmedetomidine are necessary.
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