• critical care
• dexmedetomidine
• melatonin
• multicomponent sleep bundle
• pharmacist
• sleep

• Humans
• Pharmacists/organization & administration
• Intensive Care Units/organization & administration
• Critical Illness/therapy
• Sleep Wake Disorders/therapy
• Sleep Wake Disorders/drug therapy
• Professional Role
• Pharmacy Service, Hospital/organization & administration
• Risk Factors
• Critical Care/methods
• Sleep/drug effects
• Sleep/physiology

• ICU
• critical care
• critically ill
• dexmedetomidine
• intensive care
• melatonin
• orexin receptor antagonist
• polysomnography
• propofol
• ramelteon
• sleep
• sleep efficiency
• sleep quality
• suvorexant

• Humans
• Intensive Care Units
• Melatonin/therapeutic use
• Sleep Aids, Pharmaceutical/therapeutic use
• Dexmedetomidine/therapeutic use
• Dexmedetomidine/adverse effects
• Propofol/adverse effects
• Propofol/administration & dosage
• Indenes/therapeutic use
• Randomized Controlled Trials as Topic
• Sleep Quality
• Triazoles/therapeutic use
• Azepines/therapeutic use
• Hypnotics and Sedatives/therapeutic use
• Hypnotics and Sedatives/adverse effects
• Male
• Female
• Critical Care/methods
• Middle Aged
• Adult
• Polysomnography

• extubation
• mechanical ventilation
• scoping review
• sleep-weaning

• Dexmedetomidine
• pain
• perioperative medicine
• pharmacological therapy
• sleep disturbances
• surgery

• Acute illness
• Circadian
• Critical illness
• Environment
• Light
• Sleep deficiency
• Sound

• Humans
• Hospitalization
• Sleep Deprivation/complications
• Inpatients
• Sleep Wake Disorders/therapy
• Sleep Wake Disorders/physiopathology

• Cardiac surgery
• Dexmedetomidine
• Propofol
• Sleep quality

• dexmedetomidine
• functional connectivity
• phase-amplitude coupling
• propofol
• rat
• sedation
• sevoflurane
• sleep homeostasis

• Animals
• Rats, Sprague-Dawley
• Sevoflurane/pharmacology
• Sevoflurane/administration & dosage
• Propofol/pharmacology
• Propofol/administration & dosage
• Dexmedetomidine/pharmacology
• Dexmedetomidine/administration & dosage
• Homeostasis/drug effects
• Hypnotics and Sedatives/pharmacology
• Hypnotics and Sedatives/administration & dosage
• Midazolam/pharmacology
• Midazolam/administration & dosage
• Male
• Sleep/drug effects
• Rats
• Electroencephalography/drug effects
• Anesthetics, Inhalation/pharmacology
• Anesthetics, Inhalation/administration & dosage
• Wakefulness/drug effects

• R01 GM121919 NIGMS NIH HHS

• Dexmedetomidine
• Geriatric anesthesia
• Hip fracture surgery
• Postoperative delirium
• Propofol

• Male
• Humans
• Young Adult
• Adult
• Propofol/adverse effects
• Dexmedetomidine/therapeutic use
• Anesthesia
• Anesthetics
• Sleep

• circadian rhythm
• critical care
• dexmedetomidine
• intensive care
• melatonin
• ramelteon
• sleep
• systematic review

• Adult
• Humans
• Dexmedetomidine/therapeutic use
• Dexmedetomidine/pharmacology
• Melatonin/therapeutic use
• Systematic Reviews as Topic
• Sleep/physiology
• Hypnotics and Sedatives/therapeutic use
• Intensive Care Units
• Delirium/drug therapy
• Critical Illness

• EEG
• delta waves
• non-rapid eye movement sleep
• sleep
• slow wave oscillations
• spindles
• stroke

• R00 NS097620 NINDS NIH HHS
• R01 NS128469 NINDS NIH HHS

• circadian rhythm
• odds ratio product
• post–intensive care unit syndrome

• Humans
• Critical Illness
• Retrospective Studies
• Sleep
• Polysomnography/methods
• Survivors
• Intensive Care Units

• COVID-19
• ICU – intensive care unit
• circadian disruption
• critical illness
• delirium
• sleep
• sleep disturbances

• acute encephalopathy
• delirium
• intensive care unit
• network meta-analysis
• systematic review

• Humans
• Critical Illness/therapy
• Critical Illness/psychology
• Network Meta-Analysis
• Delirium/prevention & control
• Delirium/psychology
• Intensive Care Units
• Critical Care

• JP19K24234 Japan Society for the Promotion of Science

Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.

• Critical illness
• Critical care
• Sleep
• Sleep deprivation
• Polysomnography
• Melatonin

• Analgesia
• ERAS
• Gynecological Laparoscopic surgery
• Non-inferiority
• Opioid-free anesthesia

• critically ill
• dexmedetomidine
• polysomnography
• sleep-quality
• sleep-quantity

• Humans
• Dexmedetomidine
• Hypnotics and Sedatives/therapeutic use
• Polysomnography
• Sleep Quality
• Critical Illness
• Respiration, Artificial
• Intensive Care Units
• Delirium/drug therapy

• Odense University Hospital and Rigshospitalet common research fund
• Orion Corporation

• Critical Illness
• Delirium
• Electroencephalography
• Humans
• Intensive Care Units
• Prognosis
• Sleep/physiology

• Acute illness
• Circadian
• Critical illness
• Environment
• Light
• Sleep deficiency
• Sound

• Humans
• Patients
• Sleep

• K23 HL138229 NHLBI NIH HHS
• UL1 TR001863 NCATS NIH HHS

• Administration, Intravenous
• Aged
• Central Nervous System Depressants/administration & dosage
• Enteral Nutrition/methods
• Female
• Humans
• Hypnotics and Sedatives/administration & dosage
• Indenes/administration & dosage
• Intensive Care Units/statistics & numerical data
• Length of Stay
• Male
• Melatonin/administration & dosage
• Middle Aged
• Propofol/administration & dosage
• Respiration, Artificial/methods
• Retrospective Studies
• Sleep/drug effects

Patients in the intensive care unit (ICU) have increased risks of delirium, which is associated with worse outcomes. As pharmacologic treatments for delirium are ineffective, prevention is important. Nonpharmacologic preventive strategies include exposure to natural light and restoring circadian rhythm. We investigated the effect of exposure to natural light through windows on delirium in the ICU.

This retrospective cohort study assessed all patients admitted to the medical ICU of a university-affiliated hospital between January and June 2020 for eligibility. The ICU included 12 isolation rooms, six with and six without windows. Patients with ICU stays of >48 hours were included and were divided into groups based on their admission to a single room with (window group) or without windows (windowless group). The primary outcome was the cumulative incidence of delirium. The secondary outcomes were the numbers of delirium- and mechanical ventilation-free days, ICU and hospital length of stay, and in-ICU and 28-day mortalities.

Of the 150 included patients (window group: 83 [55.3%]; windowless group: 67 [44.7%]), the cumulative incidence of delirium was significantly lower in the window group than in the windowless group (21.7% vs. 43.3%; relative risk, 1.996; 95% confidence interval [CI], 1.220–3.265). Other secondary outcomes did not differ between groups. Admission to a room with a window was independently associated with a decreased risk of delirium (adjusted odds ratio, 0.318; 95% CI, 0.125–0.805).

Exposure to natural light through windows was associated with a lower incidence of delirium in the ICU.

• delirium
• intensive care unit
• light

• PICU
• Pediatric intensive care units
• actigraphy
• circadian rhythm
• hypnotics and sedatives
• mechanical ventilation
• polysomnography
• sleep
• validation

• clinical pharmacy
• critical illness
• sleep
• sleep disorders

• benzodiazepine
• cognitive dysfunction
• delirium
• neurodevelopment
• opioid
• pediatric intensive care outcomes
• pediatric post-intensive care syndrome
• sedative neurotoxicity

• K23 HL150229 NHLBI NIH HHS

Supplemental Digital Content is available in the text.

Evaluation of sleep quality in critically ill patients is difficult using conventional scoring criteria. The aim of this study was to examine sleep in critically ill patients with and without light sedation using the odds ratio product, a validated continuous metric of sleep depth (0 = deep sleep; 2.5 = full wakefulness) that does not rely on the features needed for conventional staging.

Retrospective study.

A 16-bed medical-surgical ICU.

Twenty-three mechanically ventilated patients who had previously undergone two nocturnal sleep studies, one without and one with sedation (propofol, n = 12; dexmedetomidine, n = 11).

None.

Sleep architecture was evaluated with odds ratio product analysis by the distribution of 30-second epochs with different odds ratio product values. Electroencephalogram spectral patterns and frequency of wake intrusions (3-s odds ratio product > 1.75) were measured at different odds ratio product levels. Thirty-seven normal sleepers were used as controls. Compared with normal sleepers, unsedated critically ill patients spent little time in stable sleep (percent odds ratio product < 1.0: 31% vs 63%; p < 0.001), whereas most of the time were either in stage wake (odds ratio product > 1.75) or in a transitional state (odds ratio product 1.0–1.75), characterized by frequent wake intrusions. Propofol and dexmedetomidine had comparable effects on sleep. Sedation resulted in significant shift in odds ratio product distribution toward normal; percent odds ratio product less than 1.0 increased by 54% (p = 0.006), and percent odds ratio product greater than 1.75 decreased by 48% (p = 0.013). In six patients (26%), sedation failed to improve sleep.

In stable critically ill unsedated patients, sleep quality is poor with frequent wake intrusions and little stable sleep. Light sedation with propofol or dexmedetomidine resulted in a shift in sleep architecture toward normal in most, but not all, patients.

• dexmedetomidine
• mechanical ventilation
• propofol
• sleep quality

• ICU
• circadian rhythms
• sleep disorders

Sleep had never been assessed immediately after extubation in patients still in the ICU. However, sleep deprivation may alter respiratory function and may promote respiratory failure. We hypothesized that sleep alterations after extubation could be associated with an increased risk of post-extubation respiratory failure and reintubation. We conducted a prospective observational cohort study performed at the medical ICU of the university hospital of Poitiers in France. Patients at high-risk of extubation failure (> 65 years, with any underlying cardiac or lung disease, or intubated > 7 days) were included. Patients intubated less than 24 h, with central nervous or psychiatric disorders, continuous sedation, neuroleptic medication, or uncooperative were excluded. Sleep was assessed by complete polysomnography just following extubation including the night. The main objective was to compare sleep between patients who developed post-extubation respiratory failure or required reintubation and the others.

Over a 3-year period, 52 patients had complete polysomnography among whom 12 (23%) developed post-extubation respiratory failure and 8 (15%) required reintubation. Among them, 10 (19%) had atypical sleep, 15 (29%) had no deep sleep, and 33 (63%) had no rapid eye movement (REM) sleep. Total sleep time was 3.2 h in median [interquartile range, 2.0–4.4] in patients who developed post-extubation respiratory failure vs. 2.0 [1.1–3.8] in those who were successfully extubated (p = 0.34). Total sleep time, and durations of deep and REM sleep stages did not differ between patients who required reintubation and the others. Reintubation rates were 21% (7/33) in patients with no REM sleep and 5% (1/19) in patients with REM sleep (difference, − 16% [95% CI − 33% to 6%]; p = 0.23).

Sleep assessment by polysomnography after extubation showed a dramatically low total, deep and REM sleep time. Sleep did not differ between patients who were successfully extubated and those who developed post-extubation respiratory failure or required reintubation.

The online version contains supplementary material available at 10.1186/s13613-021-00863-z.

• Airway extubation
• Intensive care unit
• Mechanical ventilation
• Sleep
• Ventilator weaning

• Critical care
• Insomnia
• Medications
• Pharmacology
• Sleep

• End of life
• Epidemiology
• Mechanical ventilation
• Neurorehabilitation
• Pathophysiology
• Prolonged weaning
• Pulmonary rehabilitation

Background: Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice.

Methods: CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients.

Results: Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep.

Conclusions: Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.

• ICU—intensive care unit
• actigraphy
• critically ill patient
• polysomnography
• sleep measurement
• sleep questionnaire

Delirium is a syndrome characterized by acute brain failure resulting in neurocognitive disturbances affecting attention, awareness, and cognition. It is highly prevalent among critically ill patients and is associated with increased morbidity and mortality. A core domain of delirium is represented by behavioral disturbances in sleep-wake cycle probably related to circadian rhythm disruption. The relationship between sleep, circadian rhythm and intensive care unit (ICU)-acquired delirium is complex and likely bidirectional. In this review, we explore the proposed pathophysiological mechanisms of sleep disruption and circadian dysrhythmia as possible contributing factors in transitioning to delirium in the ICU and highlight some of the most relevant caveats for understanding the relationship between these complex phenomena. Specifically, we will (1) review the physiological consequences of poor sleep quality and efficiency; (2) explore how the neural substrate underlying the circadian clock functions may be disrupted in delirium; (3) discuss the role of sedative drugs as contributors to delirium and chrono-disruption; and, (4) describe the association between abnormal sleep-pathological wakefulness, circadian dysrhythmia, delirium and critical illness. Opportunities to improve sleep and readjust circadian rhythmicity to realign the circadian clock may exist as therapeutic targets in both the prevention and treatment of delirium in the ICU. Further research is required to better define these conditions and understand the underlying physiologic relationship to develop effective prevention and therapeutic strategies.

• ICU acquired delirium
• circadian rhythm
• intervention
• mechanisms
• sleep

• ICU
• critical care
• delirium
• sleep

• intensive care unit
• mechanical ventilation
• sedation
• sleep

• delirium
• drug therapy
• intensive care unit
• sedation
• sleep

• Critical care
• Delirium
• Melatonin
• Neuroprotection
• Sepsis
• Sleep

• Adult
• Aged
• Aged, 80 and over
• Central Nervous System Depressants/therapeutic use
• Circadian Rhythm/drug effects
• Critical Care/methods
• Delirium/drug therapy
• Female
• Humans
• Male
• Melatonin/therapeutic use
• Middle Aged
• Sleep/drug effects

• intensive care unit
• mechanical ventilation
• quality of sleep

• Chronobiology
• Chronotherapy
• Circadian rhythm
• Critical illness
• Intensive care units

• Chronobiology Phenomena/physiology
• Circadian Rhythm/physiology
• Critical Care/methods
• Humans
• Sleep Disorders, Circadian Rhythm/etiology
• Time Factors