Sleep deprivation in critical illness: its role in physical and psychological recovery

Abstract

Critically ill patients frequently experience poor sleep, characterized by frequent disruptions, loss of circadian rhythms, and a paucity of time spent in restorative sleep stages. Factors that are associated with sleep disruption in the intensive care unit (ICU) include patient-ventilator dysynchrony, medications, patient care interactions, and environmental noise and light. As the field of critical care increasingly focuses on patients' physical and psychological outcomes following critical illness, understanding the potential contribution of ICU-related sleep disruption on patient recovery is an important area of investigation. This review article summarizes the literature regarding sleep architecture and measurement in the critically ill, causes of ICU sleep fragmentation, and potential implications of ICU-related sleep disruption on patients' recovery from critical illness. With this background information, strategies to optimize sleep in the ICU are also discussed.

Figures

Figure 1

Normal adult hypnogram demonstrating usual sleep stage transitions. REM indicates rapid eye movement sleep.

Figure 2

Sleep fragmentation in 5 critically ill patients. Black areas represent sleep and white areas represent wakefulness. Reprinted with permission of the American Thoracic Society. Copyright © American Thoracic Society. Freedman NS, Gazendam J, Levan L, et al.

Figure 3

Etiology and potential outcomes of sleep disruption in the intensive care unit (ICU).