Sleep assessment in critically ill adults: A systematic review and meta-analysis

Ellaha Kakar; Matthijs Priester; Pascale Wessels; Arjen J C Slooter; M Louter; Mathieu van der Jagt

doi:10.1016/j.jcrc.2022.154102

Sleep assessment in critically ill adults: A systematic review and meta-analysis

Ellaha Kakar, Matthijs Priester, Pascale Wessels, Arjen J C Slooter, M Louter, Mathieu van der Jagt

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Abstract

Purpose: To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients. Materials and methods: We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible. Results: 132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ). Conclusions: Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.

Original language	English
Article number	154102
Journal	Journal of Critical Care
Volume	71
DOIs	https://doi.org/10.1016/j.jcrc.2022.154102
Publication status	Published - Oct 2022

Bibliographical note

Funding Information:
The authors would like to thank W. Bramer, biomedical information specialist at the Medical Library of the Erasmus University Medical Center, for developing and updating the search strategies for this review. Author contribution: Each author certifies that he has made a direct and substantial contribution to the work reported in the manuscript. All authors approved the final version of the manuscript.

Publisher Copyright:
© 2022 The Authors

Copyright:
Copyright 2023 Elsevier B.V., All rights reserved.

Keywords

Adult
Critical Illness
Humans
Intensive Care Units
Prospective Studies
Retrospective Studies
Sleep

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Cite this

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title = "Sleep assessment in critically ill adults: A systematic review and meta-analysis",

abstract = "Purpose: To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients. Materials and methods: We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible. Results: 132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ). Conclusions: Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.",

keywords = "Adult, Critical Illness, Humans, Intensive Care Units, Prospective Studies, Retrospective Studies, Sleep",

author = "Ellaha Kakar and Matthijs Priester and Pascale Wessels and Slooter, {Arjen J C} and M Louter and {van der Jagt}, Mathieu",

note = "Funding Information: The authors would like to thank W. Bramer, biomedical information specialist at the Medical Library of the Erasmus University Medical Center, for developing and updating the search strategies for this review. Author contribution: Each author certifies that he has made a direct and substantial contribution to the work reported in the manuscript. All authors approved the final version of the manuscript. Publisher Copyright: {\textcopyright} 2022 The Authors Copyright: Copyright 2023 Elsevier B.V., All rights reserved.",

year = "2022",

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doi = "10.1016/j.jcrc.2022.154102",

language = "English",

volume = "71",

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AU - Priester, Matthijs

AU - Wessels, Pascale

AU - Slooter, Arjen J C

AU - Louter, M

AU - van der Jagt, Mathieu

N1 - Funding Information: The authors would like to thank W. Bramer, biomedical information specialist at the Medical Library of the Erasmus University Medical Center, for developing and updating the search strategies for this review. Author contribution: Each author certifies that he has made a direct and substantial contribution to the work reported in the manuscript. All authors approved the final version of the manuscript. Publisher Copyright: © 2022 The Authors Copyright: Copyright 2023 Elsevier B.V., All rights reserved.

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N2 - Purpose: To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients. Materials and methods: We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible. Results: 132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ). Conclusions: Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.

AB - Purpose: To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients. Materials and methods: We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible. Results: 132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ). Conclusions: Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.

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Sleep assessment in critically ill adults: A systematic review and meta-analysis

Abstract

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Keywords

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