Sleep disruption in the intensive care unit
Abstract
Subjective and objective measures of sleep quality indicate that the sleep of patients in the intensive care unit (ICU) is extraordinarily disturbed. Several studies spanning the past two decades have demonstrated that critically ill patients exhibit reduced sleep efficiency, reduced restorative sleep, and frequent arousals and awakenings. A number of potential sleep disrupters exist in the ICU environment, with noise being the predominant focus of investigation. Excessive noise levels in the ICU correlate with poor sleep quality in healthy subjects and patients. Medications, light, and frequent care-related activities can also interfere with a patient's ability to obtain good-quality sleep. Sleep disruption can have significant adverse consequences for critically ill patients, such as immune system compromise and respiratory abnormalities. Although several questions remain unanswered, including the impact of sleep disruption on the clinical outcome of patients in the ICU, there is a growing interest in developing new strategies to improve sleep quality.
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The relationship between longer sleep duration and mortality has been reported in previous reviews and meta-analyses.
“The relationship between longer sleep duration and mortality, while unexpected, has been reported in previous reviews and meta-analyses”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [205]
Cites
Brzezinski, A. (1997) · New England Journal of Medicine · doi:10.1056/nejm199701163360306 · Cited by 1,549 · see citing works
Sleep in Critically Ill Patients Requiring Mechanical Ventilation
Cooper, A., Thornley, K. S., Young, G. B., et al. (2000) · CHEST Journal · doi:10.1378/chest.117.3.809 · Cited by 459 · see citing works
Self-citationPatient Perception of Sleep Quality and Etiology of Sleep Disruption in the Intensive Care Unit
Freedman, N. S., Kotzer, N., & Schwab, R. J. (1999) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.159.4.9806141 · Cited by 428 · see citing works
Aurell, J., & Elmqvist, D. (1985) · BMJ · doi:10.1136/bmj.290.6474.1029 · Cited by 364 · see citing works
Anesthesia with Abdominal Surgery Leads to Intense REM Sleep during the First Post-operative Week
Knill, R. L., Moote, C. A., Skinner, M. I., & Rose, E. (1990) · Anesthesiology · doi:10.1097/00000542-199007000-00009 · Cited by 319 · see citing works
Arterial blood pressure responses to graded transient arousal from sleep in normal humans
Davies, R. J. O., Belt, P. J., Roberts, S. J., Ali, N. J., & Stradling, J. R. (1993) · Journal of Applied Physiology · doi:10.1152/jappl.1993.74.3.1123 · Cited by 314 · see citing works
Assessment of patientsʼ experience of discomforts during respirator therapy
Bergbom-Engberg, I., & Haljamäe, H. (1989) · Critical Care Medicine · doi:10.1097/00003246-198910000-00021 · Cited by 308 · see citing works
Adverse Environmental Conditions in the Respiratory and Medical ICU Settings
Meyer, T. J., Eveloff, S. E., Bauer, M. S., Schwartz, W. A., Hill, N. S., & Millman, R. P. (1994) · CHEST Journal · doi:10.1378/chest.105.4.1211 · Cited by 259 · see citing works
An exploratory study of patients' perceptions, memories and experiences of an intensive care unit
Russell, S. (1999) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1999.00953.x · Cited by 233 · see citing works
Environmental Noise as a Cause of Sleep Disruption in an Intermediate Respiratory Care Unit
Aaron, J. N., Carlisle, C. C., Carskadon, M. A., Meyer, T. J., Hill, N. S., & Millman, R. P. (1996) · SLEEP · doi:10.1093/sleep/19.9.707 · Cited by 232 · see citing works
Sériès, F., Roy, N., & Marc, I. (1994) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.150.2.8049833 · Cited by 230 · see citing works
McGuire, B. E., Basten, C. J., Ryan, C. J., & Gallagher, J. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.7.906 · Cited by 194 · see citing works
Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern
Rosenberg, J., Wildschiødtz, G., PEDERSEN, M. H., von Jessen, F., & Kehlet, H. (1994) · British Journal of Anaesthesia · doi:10.1093/bja/72.2.145 · Cited by 192 · see citing works
Hilton, B. A. (1976) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.1976.tb00932.x · Cited by 174 · see citing works
What the patients say: A study of reactions to an intensive care unit
Jones, J. A., Hoggart, B., Withey, J., Donaghue, K. C., & Ellis, B. W. (1979) · Intensive Care Medicine · doi:10.1007/bf01686054 · Cited by 171 · see citing works
Walder, B., Francioli, D., Meyer, J.-J., Lançon, M., & Romand, J.-A. (2000) · Critical Care Medicine · doi:10.1097/00003246-200007000-00010 · Cited by 170 · see citing works
Patients' perceptions of intensive care
Simini, B. (1999) · The Lancet · doi:10.1016/s0140-6736(99)02728-2 · Cited by 168 · see citing works
EFFECT OF MELATONIN ON SLEEP QUALITY OF COPD INTENSIVE CARE PATIENTS: A PILOT STUDY
Shilo, L., Dagan, Y., Smorjik, Y., Weinberg, U., Dolev, S., Komptel, B., & Shenkman, L. (2000) · Chronobiology International · doi:10.1081/cbi-100101033 · Cited by 167 · see citing works
Sleep and Host Defenses: A Review
Benca, R. M., & Quintáns, J. (1997) · SLEEP · doi:10.1093/sleep/20.11.1027 · Cited by 157 · see citing works
Sleep patterns in the intensive care unit and on the ward after acute myocardial infarction
Broughton, R., & Baron, R. B. (1978) · Electroencephalography and Clinical Neurophysiology · doi:10.1016/0013-4694(78)90187-6 · Cited by 156 · see citing works
Sleep Loss Impairs Inspiratory Muscle Endurance
Chen, H., & Tang, Y.-R. (1989) · American Review of Respiratory Disease · doi:10.1164/ajrccm/140.4.907 · Cited by 155 · see citing works
An Electroencephalographic Classification for Coma
Young, G. B., McLachlan, R. S., Kreeft, J. H., & Demelo, J. (1997) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100032996 · Cited by 154 · see citing works
Metabolism during normal, fragmented, and recovery sleep
Bonnet, M. H., Berry, R. B., & Arand, D. L. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.71.3.1112 · Cited by 151 · see citing works
The effect of sleep fragmentation on sleep and performance in younger and older subjects
Bonnet, M. H. (1989) · Neurobiology of Aging · doi:10.1016/s0197-4580(89)80006-5 · Cited by 129 · see citing works
The effect of earplugs on sleep measures during exposure to simulated intensive care unit noise
Wallace, C. J., Robins, J., Alvord, L. S., et al. (1999) · American Journal of Critical Care · doi:10.4037/ajcc1999.8.4.210 · Cited by 128 · see citing works
Effect of short-term sleep loss on breathing
Cooper, K. R., & Phillips, B. A. (1982) · Journal of Applied Physiology · doi:10.1152/jappl.1982.53.4.855 · Cited by 126 · see citing works
A description of night sleep patterns in the critical care unit.
Richards, K. C., & Bairnsfather, L. E. (1988) · PubMed · Cited by 121 · see citing works
Treggiari-Venzi, M. M., Borgeat, A., Fuchs‐Buder, T., Gachoud, J. ‐., & Suter, P. M. (1996) · Intensive Care Medicine · doi:10.1007/bf01709334 · Cited by 120 · see citing works
Sleep disturbances after open heart surgery
Orr, W. C., & Stahl, M. L. (1977) · The American Journal of Cardiology · doi:10.1016/s0002-9149(77)80191-4 · Cited by 119 · see citing works
Perceived noise in surgical wards and an intensive care area: an objective analysis.
Bentley, S., Murphy, F., & Dudley, H. A. F. (1977) · BMJ · doi:10.1136/bmj.2.6101.1503 · Cited by 117 · see citing works
Effects of critical care unit noise on the subjective quality of sleep
Topf, M., Bookman, M., & Arand, D. L. (1996) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1996.22315.x · Cited by 113 · see citing works
Balogh, D., Kittinger, E., Benzer, A., & Hackl, J. M. (1993) · Intensive Care Medicine · doi:10.1007/bf01694709 · Cited by 112 · see citing works
Critical care unit noise and rapid eye movement (REM) sleep.
Topf, M., & Davis, J. E. (1993) · PubMed · Cited by 100 · see citing works
The Effect of Sleep Loss on Breathing in Chronic Obstructive Pulmonary Disease
Phillips, B. A., Cooper, K. R., & Burke, T. V. (1987) · CHEST Journal · doi:10.1378/chest.91.1.29 · Cited by 99 · see citing works
Effect of sound on the hypothalamic-pituitary-adrenal axis
Henkin, R. I., & Knigge, K. M. (1963) · American Journal of Physiology-Legacy Content · doi:10.1152/ajplegacy.1963.204.4.710 · Cited by 96 · see citing works
Infrequent periodic sleep disruption: Effects on sleep, performance and mood
Bonnet, M. H. (1989) · Physiology & Behavior · doi:10.1016/0031-9384(89)90236-9 · Cited by 88 · see citing works
Sleep in herniorrhaphy patients
Kavey, N. B., & Altshuler, K. Z. (1979) · The American Journal of Surgery · doi:10.1016/0002-9610(79)90348-9 · Cited by 82 · see citing works
Effects of personal control over hospital noise on sleep
Topf, M. (1992) · Research in Nursing & Health · doi:10.1002/nur.4770150105 · Cited by 79 · see citing works
Sleep Deprivation Decreases Ventilatory Response to CO2 But Not Load Compensation
Schiffman, P. L., Trontell, M. C., Mf, M., & Edelman, N. H. (1983) · CHEST Journal · doi:10.1378/chest.84.6.695 · Cited by 76 · see citing works
Shilo, L., Dagan, Y., Smorjik, Y., et al. (1999) · The American Journal of the Medical Sciences · doi:10.1097/00000441-199905000-00002 · Cited by 68 · see citing works
Landis, C. A., Savage, M. V., Lentz, M. J., & Brengelmann, G. L. (1998) · SLEEP · doi:10.1093/sleep/21.1.101 · Cited by 66 · see citing works
Effects of Sleep Deprivation and Reversal of Diurnal Activity on Protein Metabolism of Young Men
Scrimshaw, N. S., Habicht, J., PELLET, P., PICHÉ, M. L., & Cholakos, B. (1966) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/19.5.313 · Cited by 55 · see citing works
The production of hypertension in male albino rats subjected to experimental stress
Rosecrans, J. A., Watzman, N., & Buckley, J. P. (1966) · Biochemical Pharmacology · doi:10.1016/0006-2952(66)90078-5 · Cited by 45 · see citing works
Effect of the benzodiazepine antagonist Ro 15‐1788 on flunitrazepam‐ induced sleep changes.
Gaillard, J., & Blois, R. (1983) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.1983.tb02086.x · Cited by 38 · see citing works
Reducing the effects of noise in hospital
Haddock, J. (1994) · Nursing Standard · doi:10.7748/ns.8.43.25.s43 · Cited by 25 · see citing works
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The Sleep-Immune Crosstalk in Health and Disease
Besedovsky, L., Lange, T., & Haack, M. (2019) · Physiological Reviews · doi:10.1152/physrev.00010.2018 · Cited by 1,479 · see citing works
Sick and tired: does sleep have a vital role in the immune system?
Bryant, P. A., Trinder, J., & Curtis, N. (2004) · Nature Reviews Immunology · doi:10.1038/nri1369 · Cited by 551 · see citing works
Neural-immune interactions in the regulation of sleep
Opp, M. R. (2003) · Frontiers in Bioscience · doi:10.2741/1061 · Cited by 92 · see citing works
Koban, M., Le, W. W., & Hoffman, G. E. (2006) · Endocrinology · doi:10.1210/en.2005-0695 · Cited by 85 · see citing works
Grossman, M. N., Anderson, S. L., Worku, A., Marsack, W., Desai, N., Tuvilleja, A., Ramos, J., Francisco, M. A., Lafond, C., Balachandran, J. S., et al. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6468 · Cited by 73 · see citing works
- Authors
- Gabor, J. Y., Cooper, A. B., & Hanly, P. J.
- Affiliations
- University of Toronto (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Hanly, Patrick J.
- ORCID
- Hanly, Patrick J.
- Venue
- Current Opinion in Critical Care
- Published
- 2001-02
- Volume
- 7
- Issue
- 1
- Pages
- 21-27
- ISSN
- 1070-5295 (ISSN-L)
- OpenAlex
- W2080044055
- Cited by
- 130
- References
- 45
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 2 · 2016: 4 · 2015: 10 · 2014: 7 · 2013: 8 · 2012: 9
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Keywords
- sleep disruption, intensive care unit, critically ill patients, sleep quality, ICU noise, sleep efficiency, light exposure, medication, respiratory abnormalities, sleep quality interventions
- MeSH terms
- Canada, Humans, Intensive Care Units, Quality of Health Care, Quality of Life, Sleep, Sleep Wake Disorders, Critical Illness, Polysomnography
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