Boyko Yuliya, Jennum Poul, Nikolic Miki, Holst René, Oerding Helle, Toft Palle
Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, Odense C, Denmark.
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, & Faculty of Health, University of Copenhagen, Glostrup, Denmark.
J Crit Care. 2017 Feb;37:99-105. doi: 10.1016/j.jcrc.2016.09.005. Epub 2016 Sep 10.
To determine if improving intensive care unit (ICU) environment would enhance sleep quality, assessed by polysomnography (PSG), in critically ill mechanically ventilated patients.
Randomized controlled trial, crossover design. The night intervention "quiet routine" protocol was directed toward improving ICU environment between 10pm and 6am. Noise levels during control and intervention nights were recorded. Patients on mechanical ventilation and able to give consent were eligible for the study. We monitored sleep by PSG.The standard (American Association of Sleep Medicine) sleep scoring criteria were insufficient for the assessment of polysomnograms. Modified classification for sleep scoring in critically ill patients, suggested by Watson et al. (Crit Care Med 2013;41:1958-1967), was used.
Sound level analysis showed insignificant effect of the intervention on noise reduction (P=.3). The analysis of PSGs revealed that only 53% of the patients had identifiable characteristics of normal sleep, whereas 47% showed only pathologic patterns.
Characteristics of normal sleep were absent in many of the PSG recordings in these critically ill patients. We were not able to further reduce the already existing low noise levels in the ICU and did not find any association between the environmental intervention and the presence of normal sleep characteristics in the PSG.
通过多导睡眠图（PSG）评估，确定改善重症监护病房（ICU）环境是否能提高重症机械通气患者的睡眠质量。
随机对照试验，交叉设计。夜间干预“安静程序”方案旨在改善晚上10点至早上6点之间的ICU环境。记录对照夜和干预夜的噪音水平。接受机械通气且能够给予知情同意的患者符合研究条件。我们通过PSG监测睡眠。美国睡眠医学协会的标准睡眠评分标准不足以评估多导睡眠图。采用了Watson等人（《危重病医学》2013年；41:1958 - 1967）建议的重症患者睡眠评分改良分类法。
声级分析显示干预对降低噪音无显著效果（P = 0.3）。对PSG的分析表明，只有53%的患者具有正常睡眠的可识别特征，而47%的患者仅表现出病理模式。
这些重症患者的许多PSG记录中缺乏正常睡眠特征。我们无法进一步降低ICU中已有的低噪音水平，且未发现环境干预与PSG中正常睡眠特征的存在之间存在任何关联。
