A Systematic Review of Sleep Measurement in Critically Ill Patients

Authors:

Richards, K. C., Wang, Y. Y., Jun, J., and Ye, L.

Abstract:

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.

DOI:

10.3389/fneur.2020.542529

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677520/pdf/fneur-11-542529.pdf

Journal:

Front Neurol

issn:

1664-2295 (Print)

Publication year:

2020

pages:

542529

Biological and physiological variables:

Biological and physiological variables

Symptom status:

Physical state

Age:

Adults (18-65)
Seniors (65+)

Disease:

Codes for special purposes
Factors influencing health status and contact with health services
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

PRO / non-PRO:

Non-patient Reported Outcome
Patient Reported Outcome

Type of measurement instrument:

1 - Questionnaires
6 - Clinical rating scales
7 - Observations
9 - Laboratory tests

Instrument:

Actigraphy (versions: Actigraph GT3X; ActiGraph GT1M; Actilog; ActiGraph GT9X; Motionlogger Watch; Move 3 Actigraphs; AMA-32; Actiheart; uniaxial ActiGraph)
CCUQ - Coronary Care Unit Questionnaire
ECG - electrocardiogram
EEG - electroencephalogram
EOG - electrooculogram
NRS-Sleep - Numerical Rating Scale-Sleep
PSG - Polysomnography
RCSQ - Richards Campbell Sleep Questionnaire
SOT - Sleep Observation Tool
VSH Sleep Scale - Verran and Snyder-Halpern Sleep Scale