Clinical Care Interaction and Patient Sleep in the Intensive Care Unit: A Secondary Data Analysis

Sleep is a fundamental biophysiological requirement, essential for both physiological and psychological health. Patients admitted to intensive care are vulnerable to sleep disturbances due to continuous monitoring and the intensity of care provided. Despite this, the relationship between clinical care interactions and sleep quality remains underexplored.

To examine the association between clinical interactions, patient acuity and inflammatory biomarkers on sleep, and to characterise ICU patient sleep using objective and subjective measures.

A secondary data analysis of a clinical trial conducted within a 36-bed tertiary intensive care unit. The primary study employed a within-subjects design, integrating patient self-reported sleep experiences (Richard-Campbell's Sleep Questionnaire) and Actigraphy (biophysiological sleep monitoring) to characterise the sleep quality of ICU patients. Data on clinical interactions were extracted from electronic patient records (Metavision: iMDsoft).

Patients (n = 37) reported poor sleep quality, with mean RCSQ scores below 50 mm across all subscales. Actigraphy reported a median nocturnal sleep duration of 5.6 h (IQR 303.3-422 min), with a mean of 33.4 awakenings per hour (SD ± 16.3). Patients experienced a median of nine interactions per hour, with clinical assessments (32.8%) being the most frequent. Higher SOFA scores correlated with increased clinical interaction (r_s(35) = 0.33, p = 0.05), whilst lower APACHEII scores were associated with greater sleep disturbance (r_s(33) = -0.39, p = 0.02).

Intensive care patients experience impaired sleep characterised by fragmentation and poor perceived quality. Whilst frequent nocturnal interactions were documented, these did not appear to be the primary contributor to patients' perceived poor sleep quality. Patients with reduced acuity were highly susceptible to impaired quality of sleep, indicating the need to implement tailored strategies to support sleep in the ICU setting.

Routine clinical care practices need to be re-evaluated to better align with the physiological requirements for sleep. Lower acuity patients cared for in ICU are disproportionately experiencing sleep disturbance and poor-quality sleep. Therefore, future ICU models of care must integrate sleep-supportive strategies as a component of standard care.

The primary study was formally registered as a clinical trial with the Australian New Zealand Clinical Trial Registry (ACTRN12615000945527).