Friese Randall S
Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Crit Care Med. 2008 Mar;36(3):697-705. doi: 10.1097/CCM.0B013E3181643F29.
The objectives of this article were to describe the deleterious effects of sleep deprivation, characterize sleep in patients cared for in an intensive care unit (ICU) environment, and propose an integrated strategy to improve sleep in critical care units.
Clinical trials and review articles assessing sleep deprivation, sleep in a critical care setting, and interventions to improve sleep in the critical care environment were identified through an in depth PubMed search.
Sleep deprivation and disruption are particularly prevalent in patients cared for in the critical care environment. Although numerous observational studies during the past several decades have demonstrated that sleep in patients cared for in ICUs is highly abnormal, little is known about the effects of poor sleep quality on outcomes from critical illness or injury. Reasons for sleep deprivation during recovery from illness and injury in the ICU are multifactorial. Major contributing factors in this patient population are type and severity of underlying illness, the pathophysiology of acute illness/injury, pain from surgical procedures, and perhaps most importantly, the ICU environment itself. Sleep in ICU patients is characterized by prolonged sleep latencies, sleep fragmentation, decreased sleep efficiency, frequent arousals, a predominance of stage 1 and 2 nonrapid eye movement sleep, decreased or absent stage 3 and 4 nonrapid eye movement sleep, and decreased or absent rapid eye movement sleep. Optimizing patient comfort and ensuring that patients achieve adequate restorative sleep while cared for in the ICU is an arduous task. However, environmental alterations in the ICU may reliably improve sleep quality and subsequently alter outcomes during recovery from critical illness and injury.
本文的目的是描述睡眠剥夺的有害影响，描述重症监护病房（ICU）环境中患者的睡眠特征，并提出一项改善重症监护病房睡眠的综合策略。
通过深入的PubMed搜索，确定了评估睡眠剥夺、重症监护环境中的睡眠以及改善重症监护环境中睡眠的干预措施的临床试验和综述文章。
睡眠剥夺和睡眠中断在重症监护环境中的患者中尤为普遍。尽管在过去几十年中，大量观察性研究表明，ICU中患者的睡眠非常异常，但对于睡眠质量差对危重病或损伤预后的影响知之甚少。ICU中疾病和损伤恢复期间睡眠剥夺的原因是多因素的。该患者群体的主要促成因素是基础疾病的类型和严重程度、急性疾病/损伤的病理生理学、手术疼痛，也许最重要的是ICU环境本身。ICU患者的睡眠特点是入睡时间延长、睡眠碎片化、睡眠效率降低、频繁觉醒、以1期和2期非快速眼动睡眠为主、3期和4期非快速眼动睡眠减少或缺失、快速眼动睡眠减少或缺失。在ICU中优化患者舒适度并确保患者获得充足的恢复性睡眠是一项艰巨的任务。然而，ICU环境的改变可能可靠地改善睡眠质量，并随后改变危重病和损伤恢复期间的预后。
