Risk factors for sleep disorders in ICU patients: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

JIANG Lingjie ^1,2 , HAN Lulu ¹ , YANG Liping ³ ,  ZHANG Zhigang ³ , JIANG Biantong ^1,2 , DING Nannan ^1,2 , YAO Li ^1,2 , WU Yuchen ³ , ZHANG Caiyun ⁴

1. College of Nursing, Lanzhou University, Lanzhou, 730000, P.R.China;
2. The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
3. Department of Special Surgery, First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
4. Department of Nursing, First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding?author：

ZHANG Zhigang, Email: zzg3444@163.com

Keywords：

Intensive care unit; Sleep disorder; Influencing factor; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.201812135

Video：

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Objective To systematically review the risk factors associated with sleep disorders in ICU patients.Methods We searched The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP and CBM databases to collect cohort studies, case-control studies and cross-sectional studies on the risk factors associated with sleep disorders in ICU patients from inception to October, 2018. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 9 articles were included, with a total of 1 068 patients, including 12 risk factors. The results of meta-analysis showed that the combined effect of equipment noise (OR=0.42, 95%CI 0.26 to 0.68, P=0.000 4), patients’ talk (OR=0.53, 95%CI 0.42 to 0.66, P<0.000 01), patients’ noise (OR=0.39, 95%CI 0.21 to 0.74, P=0.004), light (OR=0.29, 95%CI 0.18 to 0.45, P<0.000 01), night treatment (OR=0.36, 95%CI 0.26 to 0.50, P<0.000 01), diseases and drug effects (OR=0.17,95%CI 0.08 to 0.36, P<0.000 01), pain (OR=0.37, 95%CI 0.17 to 0.82, P=0.01), comfort changes (OR=0.34,95%CI 0.17 to 0.67,P=0.002), anxiety (OR=0.31,95%CI 0.12 to 0.78, P=0.01), visit time (OR=0.72, 95%CI 0.53 to 0.98, P=0.04), economic burden (OR=0.63, 95%CI 0.48 to 0.82, P=0.000 5) were statistically significant risk factors for sleep disorders in ICU patients.Conclusion Current evidence shows that the risk factors for sleep disorders in ICU patients are environmental factors (talking voices of nurses, patient noise, and light), treatment factors (night treatment), disease factors (disease itself and drug effects, pain,) and psychological factors (visiting time, economic burden). Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.

Citation： JIANG Lingjie, HAN Lulu, YANG Liping, ZHANG Zhigang, JIANG Biantong, DING Nannan, YAO Li, WU Yuchen, ZHANG Caiyun. Risk factors for sleep disorders in ICU patients: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(7): 803-810. doi: 10.7507/1672-2531.201812135 Copy

1.	鄭瑞雙, 李樂之. ICU 病人的睡眠狀況研究現狀. 中華現代護理雜志, 2010, 16(5): 611-613.
2.	Little A, Ethier C, Ayas N, et al. A patient survey of sleep quality in the Intensive Care Unit. Minerva Anestesiol, 2012, 78(4): 406-414.
3.	Elliott R, McKinley S, Cistulli P, et al. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care, 2013, 17(2): R46.
4.	Sterniczuk R, Rusak B, Rockwood K. Sleep disturbance in older ICU patients. Clin Interv Aging, 2014, 9: 969-977.
5.	邵樂文, 黃夏薇, 黃麗華. ICU 患者睡眠障礙的現況及相關因素分析. 護理與康復, 2017, 16(5): 422-426.
6.	曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學志, 2012, 4(4): 297-299.
7.	Cooper AB, Thornley KS, Young GB, et al. Sleep in critically ill patients requiring mechanical ventilation. Chest, 2000, 117(3): 809-818.
8.	Jones J, Hoggart B, Withey J, et al. What the patients say: a study of reactions to an intensive care unit. Intensive Care Med, 1979, 5(2): 89-92.
9.	Freedman NS, Kotzer N, Schwab RJ. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med, 1999, 159(4 Pt 1): 1155-1162.
10.	劉鶯鶯. ICU 患者的睡眠情況調查及其影響因素分析. 世界睡眠醫學雜志, 2017, 4(6): 358-361.
11.	房麗麗, 孫桂霞. ICU 患者發生睡眠障礙的相關因素及對策. 中國實用護理雜志, 2004, 20(18): 14-15.
12.	趙麗杰, 董保霞, 王海云, 等. ICU 病人睡眠障礙的相關因素分析及護理對策. 護理研究, 2006, 20(11): 971-972.
13.	董秀云. ICU 患者睡眠狀況的相關因素分析. 蚌埠醫學院學報, 2010, 35(1): 44-45.
14.	周瑜利, 謝國紅. ICU 病人睡眠障礙的相關因素調查. 當代護士 (學術版), 2011, (7): 134-136.
15.	Gabor JY, Cooper AB, Crombach SA, et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med, 2003, 167(5): 708-715.
16.	Kalfon P, Mimoz O, Auquier P, et al. Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med, 2010, 36(10): 1751-1758.
17.	Honkus VL. Sleep deprivation in critical care units. Crit Care Nurs Q, 2003, 26(3): 179-189.
18.	Matthews EE. Sleep disturbances and fatigue in critically ill patients. AACN Adv Crit Care, 2011, 22(3): 204-224.
19.	Bihari S, Doug McEvoy R, Matheson E, et al. Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med, 2012, 8(3): 301-307.
20.	褚友艾. ICU 機械通氣病人睡眠障礙的管理. 大連: 全國外科護理學術交流暨專題講座會議論文匯編, 2003.
21.	Elbaz M, Léger D, Sauvet F, et al. Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels. Ann Intensive Care, 2017, 7(1): 25.
22.	Salandin A, Arnold J, Kornadt O. Noise in an intensive care unit. J Acoust Soc Am, 2011, 130(6): 3754-3760.
23.	Hu RF, Jiang XY, Zeng YM, et al. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care, 2010, 14(2): R66.
24.	Pisani MA, Friese RS, Gehlbach BK, et al. Sleep in the intensive care unit. Am J Respir Crit Care Med, 2015, 191(7): 731-738.
25.	Weinhouse GL, Schwab RJ. Sleep in the critically ill patient. Sleep, 2006, 29(5): 707-716.
26.	Le A, Friese RS, Hsu CH, et al. Sleep disruptions and nocturnal nursing interactions in the intensive care unit. J Surg Res, 2012, 177(2): 310-314.
27.	Li SY, Wang TJ, Vivienne Wu SF, et al. Efficacy of controlling night-time noise and activities to improve patients' sleep quality in a surgical intensive care unit. J Clin Nurs, 2011, 20(3-4): 396-407.
28.	Roussos M, Parthasarathy S, Ayas NT. Can we improve sleep quality by changing the way we ventilate patients? Lung, 2010, 188(1): 1-3.
29.	Andrejak C, Monconduit J, Rose D, et al. Does using pressure-controlled ventilation to rest respiratory muscles improve sleep in ICU patients? Respir Med, 2013, 107(4): 534-541.
30.	Meza S, Mendez M, Ostrowski M, et al. Susceptibility to periodic breathing with assisted ventilation during sleep in normal subjects. J Appl Physiol (1985), 1998, 85(5): 1929-1940.
31.	Hotchkiss JR Jr, Adams AB, Stone MK, et al. Oscillations and noise: inherent instability of pressure support ventilation? Am J Respir Crit Care Med, 2002, 165(1): 47-53.
32.	Drouot X, Cabello B, d'Ortho MP, et al. Sleep in the intensive care unit. Sleep Med Rev, 2008, 12(5): 391-403.
33.	Pulak LM, Jensen L. Sleep in the intensive care unit: a review. J Intensive Care Med, 2016, 31(1): 14-23.
34.	Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med, 2012, 27(2): 97-111.
35.	Weinhouse GL. Pharmacology I: effects on sleep of commonly used ICU medications. Crit Care Clin, 2008, 24(3): 477-491.
36.	Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep Med Rev, 2006, 10(5): 357-369.
37.	Zhang L, Sha YS, Kong QQ, et al. Factors that affect sleep quality: perceptions made by patients in the intensive care unit after thoracic surgery. Support Care Cancer, 2013, 21(8): 2091-2096.
38.	張振宇, 安友仲, 馮藝. ICU 腹部外科術后患者疼痛與睡眠關系的研究. 中國疼痛醫學雜志, 2012, 18(2): 95-98.
39.	Eliassen KM, Hopstock LA. Sleep promotion in the intensive care unit-a survey of nurses' interventions. Intensive Crit Care Nurs, 2011, 27(3): 138-142.
40.	Parthasarathy S, Tobin MJ. Sleep in the intensive care unit. Intensive Care Med, 2004, 30(2): 197-206.
41.	徐文亞. 外科監護病房患者術后睡眠障礙的相關因素分析及對策. 護理實踐與研究, 2008, 5(22): 8-9.
42.	Day A, Haj-Bakri S, Lubchansky S, et al. Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study. Crit Care, 2013, 17(3): R91.
43.	Friese RS, Diaz-Arrastia R, McBride D, et al. Quantity and quality of sleep in the surgical intensive care unit: are our patients sleeping? J Trauma, 2007, 63(6): 1210-1214.

1. 鄭瑞雙, 李樂之. ICU 病人的睡眠狀況研究現狀. 中華現代護理雜志, 2010, 16(5): 611-613.
2. Little A, Ethier C, Ayas N, et al. A patient survey of sleep quality in the Intensive Care Unit. Minerva Anestesiol, 2012, 78(4): 406-414.
3. Elliott R, McKinley S, Cistulli P, et al. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care, 2013, 17(2): R46.
4. Sterniczuk R, Rusak B, Rockwood K. Sleep disturbance in older ICU patients. Clin Interv Aging, 2014, 9: 969-977.
5. 邵樂文, 黃夏薇, 黃麗華. ICU 患者睡眠障礙的現況及相關因素分析. 護理與康復, 2017, 16(5): 422-426.
6. 曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學志, 2012, 4(4): 297-299.
7. Cooper AB, Thornley KS, Young GB, et al. Sleep in critically ill patients requiring mechanical ventilation. Chest, 2000, 117(3): 809-818.
8. Jones J, Hoggart B, Withey J, et al. What the patients say: a study of reactions to an intensive care unit. Intensive Care Med, 1979, 5(2): 89-92.
9. Freedman NS, Kotzer N, Schwab RJ. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med, 1999, 159(4 Pt 1): 1155-1162.
10. 劉鶯鶯. ICU 患者的睡眠情況調查及其影響因素分析. 世界睡眠醫學雜志, 2017, 4(6): 358-361.
11. 房麗麗, 孫桂霞. ICU 患者發生睡眠障礙的相關因素及對策. 中國實用護理雜志, 2004, 20(18): 14-15.
12. 趙麗杰, 董保霞, 王海云, 等. ICU 病人睡眠障礙的相關因素分析及護理對策. 護理研究, 2006, 20(11): 971-972.
13. 董秀云. ICU 患者睡眠狀況的相關因素分析. 蚌埠醫學院學報, 2010, 35(1): 44-45.
14. 周瑜利, 謝國紅. ICU 病人睡眠障礙的相關因素調查. 當代護士 (學術版), 2011, (7): 134-136.
15. Gabor JY, Cooper AB, Crombach SA, et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med, 2003, 167(5): 708-715.
16. Kalfon P, Mimoz O, Auquier P, et al. Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med, 2010, 36(10): 1751-1758.
17. Honkus VL. Sleep deprivation in critical care units. Crit Care Nurs Q, 2003, 26(3): 179-189.
18. Matthews EE. Sleep disturbances and fatigue in critically ill patients. AACN Adv Crit Care, 2011, 22(3): 204-224.
19. Bihari S, Doug McEvoy R, Matheson E, et al. Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med, 2012, 8(3): 301-307.
20. 褚友艾. ICU 機械通氣病人睡眠障礙的管理. 大連: 全國外科護理學術交流暨專題講座會議論文匯編, 2003.
21. Elbaz M, Léger D, Sauvet F, et al. Sound level intensity severely disrupts sleep in ventilated ICU patients throughout a 24-h period: a preliminary 24-h study of sleep stages and associated sound levels. Ann Intensive Care, 2017, 7(1): 25.
22. Salandin A, Arnold J, Kornadt O. Noise in an intensive care unit. J Acoust Soc Am, 2011, 130(6): 3754-3760.
23. Hu RF, Jiang XY, Zeng YM, et al. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care, 2010, 14(2): R66.
24. Pisani MA, Friese RS, Gehlbach BK, et al. Sleep in the intensive care unit. Am J Respir Crit Care Med, 2015, 191(7): 731-738.
25. Weinhouse GL, Schwab RJ. Sleep in the critically ill patient. Sleep, 2006, 29(5): 707-716.
26. Le A, Friese RS, Hsu CH, et al. Sleep disruptions and nocturnal nursing interactions in the intensive care unit. J Surg Res, 2012, 177(2): 310-314.
27. Li SY, Wang TJ, Vivienne Wu SF, et al. Efficacy of controlling night-time noise and activities to improve patients' sleep quality in a surgical intensive care unit. J Clin Nurs, 2011, 20(3-4): 396-407.
28. Roussos M, Parthasarathy S, Ayas NT. Can we improve sleep quality by changing the way we ventilate patients? Lung, 2010, 188(1): 1-3.
29. Andrejak C, Monconduit J, Rose D, et al. Does using pressure-controlled ventilation to rest respiratory muscles improve sleep in ICU patients? Respir Med, 2013, 107(4): 534-541.
30. Meza S, Mendez M, Ostrowski M, et al. Susceptibility to periodic breathing with assisted ventilation during sleep in normal subjects. J Appl Physiol (1985), 1998, 85(5): 1929-1940.
31. Hotchkiss JR Jr, Adams AB, Stone MK, et al. Oscillations and noise: inherent instability of pressure support ventilation? Am J Respir Crit Care Med, 2002, 165(1): 47-53.
32. Drouot X, Cabello B, d'Ortho MP, et al. Sleep in the intensive care unit. Sleep Med Rev, 2008, 12(5): 391-403.
33. Pulak LM, Jensen L. Sleep in the intensive care unit: a review. J Intensive Care Med, 2016, 31(1): 14-23.
34. Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med, 2012, 27(2): 97-111.
35. Weinhouse GL. Pharmacology I: effects on sleep of commonly used ICU medications. Crit Care Clin, 2008, 24(3): 477-491.
36. Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep Med Rev, 2006, 10(5): 357-369.
37. Zhang L, Sha YS, Kong QQ, et al. Factors that affect sleep quality: perceptions made by patients in the intensive care unit after thoracic surgery. Support Care Cancer, 2013, 21(8): 2091-2096.
38. 張振宇, 安友仲, 馮藝. ICU 腹部外科術后患者疼痛與睡眠關系的研究. 中國疼痛醫學雜志, 2012, 18(2): 95-98.
39. Eliassen KM, Hopstock LA. Sleep promotion in the intensive care unit-a survey of nurses' interventions. Intensive Crit Care Nurs, 2011, 27(3): 138-142.
40. Parthasarathy S, Tobin MJ. Sleep in the intensive care unit. Intensive Care Med, 2004, 30(2): 197-206.
41. 徐文亞. 外科監護病房患者術后睡眠障礙的相關因素分析及對策. 護理實踐與研究, 2008, 5(22): 8-9.
42. Day A, Haj-Bakri S, Lubchansky S, et al. Sleep, anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study. Crit Care, 2013, 17(3): R91.
43. Friese RS, Diaz-Arrastia R, McBride D, et al. Quantity and quality of sleep in the surgical intensive care unit: are our patients sleeping? J Trauma, 2007, 63(6): 1210-1214.

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