Risk factors for sleep disruption in critically ill patients: A systematic review of the literature
CCCF ePoster library. Honarmand K. Oct 4, 2017; 198119; 97
Dr. Kimia Honarmand
Dr. Kimia Honarmand
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Risk factors for sleep disruption in critically ill patients: A systematic review of the literature

Honarmand, Kimia1,2,3; Le, Jamie2,3; Mohan, Sindu2,3; Rochwerg, Bram4; Bosma, Karen J1,2,3



1Critical Care Medicine, Western University, London, Canada

2Department of Medicine, Schulich Medicine & Dentistry, Western University, London, Canada

3​London Health Sciences Centre, London, Canada

4Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada


INTRODUCTION
Sleep disruption in ICU patients is common and may be associated with adverse outcomes including impaired healing response and delirium (1). There have been no systematic reviews of the literature to identify risk factors for sleep disruption in ICU.

OBJECTIVES
We conducted a systematic review to identify all premorbid and ICU-acquired risk factors associated with sleep disruption in ICU patients.

METHODS
A systematic search of PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, ISI Web of Science, and the International Pharmaceutical Abstracts was conducted by a professional medical librarian to identify relevant English language articles. Titles and abstracts were screened (JL, SM, KB) and full-text review (KH, JL, SM, KB) was undertaken to identify original studies that met the following inclusion criteria: adult ICU patients, reporting of sleep measures, and reporting of one or more possible risk factors for sleep disruption during the ICU stay. The results of studies that reported the proportion of patients affected by a risk factor were combined and will be presented in aggregate.

RESULTS
We screened 1329 titles and abstracts and identified 13 studies that reported premorbid risk factors (Figure 1) and 36 studies that reported ICU-acquired risk factors (Figure 2) for sleep disruption in ICU patients.

A compendium of all of the risk factors identified and their frequencies was developed. Among premorbid variables, poor sleep quality at home and use of sleep aids prior to admission were found to be risk factors for sleep disruption in ICU patients. Premorbid medical conditions showed no association with sleep disruption.

During the ICU stay, the most frequently reported symptom-related risk factors included pain and psychological stress. The environmental risk factors most frequently reported to disrupt sleep in ICU were nursing care, environmental noise, and lights. Among disease-related variables, disease severity was inconsistently found to be a risk factor.

Pharmacological risk factors reported included use of any sedative agent, benzodiazepines, propofol, morphine, midazolam, and steroids. Among these, steroid use was a risk factor for sleep disruption while the results were conflicting for other agents.

There were conflicting data with respect to mechanical ventilation (MV) as a risk factor for sleep disruption. MV-induced central sleep apnea and patient-ventilator asynchrony were risk factors associated with sleep disruption.

CONCLUSION
This review provides a systematic analysis of all premorbid and ICU-acquired factors associated with sleep disruption in ICU patients. Establishing an inventory of the premorbid risk factors associated with sleep disruption in ICU will allow clinicians to identify those patients who are at highest risk, allowing for a more timely interventions to prevent sleep disruption and its sequelae in ICU patients. Identifying ICU-acquired risk factors for sleep disruption is crucial in the establishment of evidence-based local protocols that aim to reduce the burden of sleep disruption in ICU patients, informs future research on this prevalent problem, and provides a framework for establishing guidelines for the prevention and treatment of sleep disruption in ICU patients.

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