Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands.
Department of Critical Care, University of Groningen, University Medical Center Groningen, NL-9713AV Groningen, The Netherlands.
Br J Anaesth. 2018 Mar;120(3):443-452. doi: 10.1016/j.bja.2017.09.006. Epub 2017 Nov 23.
Intensive-care-unit (ICU) patients exhibit disturbed sleeping patterns, often attributed to environmental noise, although the relative contribution of noise compared to other potentially disrupting factors is often debated. We therefore systematically reviewed studies of the effects of ICU noise on the quality of sleep to determine to what extent noise explains the observed sleep disruption, using the Cochrane Collaboration method for non-randomized studies. Searches in Scopus, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were conducted until May 2017. Twenty papers from 18 studies assessing sleep of adult patients and healthy volunteers in the ICU environment, whilst recording sound levels, were included and independently reviewed by two reviewers. We found that the numbers of arousals between the baseline and the ICU noise condition in healthy subjects differed significantly (mean difference 9.59; 95% confidence interval 2.48-16.70). However, there was considerable heterogeneity between studies (I 94%, P < 0.00001), and all studies suffered from a considerable risk of bias. The meta-analysis of results was hampered by widely varying definitions of sound parameters between studies and a general lack of detailed description of methods used. It is, therefore, currently impossible to quantify the extent to which noise contributes to sleep disruption among ICU patients, and thus, the potential benefit from noise reduction remains unclear. Regardless, the majority of the observed sleep disturbances remain unexplained. Future studies should, therefore, also focus on more intrinsic sleep-disrupting factors in the ICU environment.
重症监护病房（ICU）的患者常表现出睡眠模式紊乱，这通常归因于环境噪声，但噪声相对于其他潜在的干扰因素的相对贡献常常存在争议。因此，我们系统地回顾了 ICU 噪声对睡眠质量影响的研究，以确定噪声在多大程度上可以解释所观察到的睡眠障碍，我们使用了 Cochrane 协作组针对非随机研究的方法。我们在 Scopus、PubMed、Embase、CINAHL、Web of Science 和 Cochrane 图书馆进行了搜索，直到 2017 年 5 月。纳入了 20 篇论文，这些论文来自 18 项研究，评估了 ICU 环境中成人患者和健康志愿者的睡眠情况，同时记录了声音水平，并由两位评审员独立进行了审查。我们发现，健康受试者在基础状态和 ICU 噪声条件之间的觉醒次数差异显著（平均差异 9.59；95%置信区间 2.48-16.70）。然而，研究之间存在很大的异质性（I 94%，P<0.00001），并且所有研究都存在很大的偏倚风险。由于研究之间的声音参数定义差异很大，并且普遍缺乏对使用方法的详细描述，因此结果的荟萃分析受到阻碍。因此，目前无法量化噪声对 ICU 患者睡眠障碍的程度，因此，减少噪声的潜在益处仍不清楚。无论如何，大部分观察到的睡眠障碍仍然无法解释。因此，未来的研究还应关注 ICU 环境中更内在的睡眠干扰因素。
