Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units

Koen S Simons, Eva Verweij, Paul M C Lemmens, Sam Jelfs, Munhum Park, Peter E Spronk, Johannes P C Sonneveld, Hilde-Marieken Feijen, Marijke S van der Steen, Armin G Kohlrausch, Mark van den Boogaard, Cornelis P C de Jager, Koen S Simons, Eva Verweij, Paul M C Lemmens, Sam Jelfs, Munhum Park, Peter E Spronk, Johannes P C Sonneveld, Hilde-Marieken Feijen, Marijke S van der Steen, Armin G Kohlrausch, Mark van den Boogaard, Cornelis P C de Jager

Abstract

Background: High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about the effect of noise on sleep quality in ICU patients. The study aim is to determine the effect of noise on subjective sleep quality.

Methods: This was a multicenter observational study in six Dutch ICUs. Noise recording equipment was installed in 2-4 rooms per ICU. Adult patients were eligible for the study 48 h after ICU admission and were followed up to maximum of five nights in the ICU. Exclusion criteria were presence of delirium and/or inability to be assessed for sleep quality. Sleep was evaluated using the Richards Campbell Sleep Questionnaire (range 0-100 mm). Noise recordings were used for analysis of various auditory parameters, including the number and duration of restorative periods. Hierarchical mixed model regression analysis was used to determine associations between noise and sleep.

Results: In total, 64 patients (68% male), mean age 63.9 (± 11.7) years and mean Acute Physiology And Chronic Health Evaluation (APACHE) II score 21.1 (± 7.1) were included. Average sleep quality score was 56 ± 24 mm. The mean of the 24-h average sound pressure levels (LAeq, 24h) was 54.0 dBA (± 2.4). Mixed-effects regression analyses showed that background noise (β = - 0.51, p < 0.05) had a negative impact on sleep quality, whereas number of restorative periods (β = 0.53, p < 0.01) and female sex (β = 1.25, p < 0.01) were weakly but significantly correlated with sleep.

Conclusions: Noise levels are negatively associated and restorative periods and female gender are positively associated with subjective sleep quality in ICU patients.

Trial registration: www.ClinicalTrials.gov, NCT01826799 . Registered on 9 April 2013.

Keywords: Critical illness; Intensive care unit; Noise; RCSQ; Sleep quality.

Conflict of interest statement

Authors’ information

Munhum Park and Armin G. Kolhrausch were affiliated with Philips Research during the study design and data acquisition.

Ethics approval and consent to participate

The need for formal ethical approval was waived by the regional medical ethics committee (registration number MJ504, Medisch-Ethische Toetsing Onderzoek Patienten en Proefpersonen (METOPP), Tilburg, The Netherlands).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests related to this study.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The 24-h average sound pressure levels (LAeq,24h) for three recording periods: all (24 h, midnight to midnight); day (from 7 a.m. to 11 p.m.); night (from 11 p.m. to 7 a.m.)
Fig. 2
Fig. 2
Standardized regression coefficients for the best fitting model for sleep quality evaluated by the patients. Error bars indicate 95% confidence intervals. Standardized coefficients are expressed in units of standard deviations to enable easy assessment of which of the regression predictors imparts the largest changes in the regression outcome variable

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