1 Division of Pulmonary and Critical Care Medicine, and.
2 Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
Ann Am Thorac Soc. 2018 Sep;15(9):1075-1082. doi: 10.1513/AnnalsATS.201801-004OC.
Poor sleep quality is common in the intensive care unit (ICU) and may be associated with adverse outcomes. Hence, ICU-based efforts to promote sleep are gaining attention, motivating interest in methods to measure sleep in critically ill patients. Actigraphy evaluates rest and activity by algorithmically processing gross motor activity data, usually collected by a noninvasive wristwatch-like accelerometer device. In critically ill patients, actigraphy has been used as a surrogate measure of sleep; however, its use has not been systematically reviewed.
To conduct a systematic review of ICU-based studies that used actigraphy as a surrogate measure of sleep, including its feasibility, validity, and reliability as a measure of sleep in critically ill patients.
We searched PubMed, EMBASE, CINAHL, Proquest, and Web of Science for studies that used actigraphy to evaluate sleep in five or more patients in an ICU setting.
Our search yielded 4,869 citations, with 13 studies meeting eligibility criteria. These 13 studies were conducted in 10 countries, and eight (62%) were published since 2008. Across the 13 studies, the mean total sleep time of patients in the ICU, as estimated using actigraphy, ranged from 4.4 to 7.8 hours at nighttime and from 7.1 to 12.1 hours over a 24-hour period, with 1.4 to 49.0 mean nocturnal awakenings and a sleep efficiency of 61 to 75%. When compared side-by-side with other measures of sleep (polysomnography, nurse assessments, and patient questionnaires), actigraphy consistently yielded higher total sleep time and sleep efficiency, fewer nighttime awakenings (vs. polysomnography), and more overall awakenings (vs. nurse assessment and patient questionnaires). None of the studies evaluated the association between actigraphy-based measures of sleep and outcomes of patients in the ICU.
In critically ill patients, actigraphy is being used more frequently as a surrogate measure of sleep; however, because actigraphy only measures gross motor activity, its ability to estimate sleep is limited by the processing algorithm used. Prior ICU-based studies involving actigraphy were heterogeneous and lacked data regarding actigraphy-based measures of sleep and patient outcomes. Larger, more rigorous and standardized studies are needed to better understand the role of actigraphy in evaluating sleep and sleep-related outcomes in critically ill patients.
在重症监护病房（ICU）中，睡眠质量差很常见，并且可能与不良后果有关。因此，基于 ICU 的促进睡眠的努力正在引起关注，这激发了人们对测量危重病患者睡眠的方法的兴趣。活动记录仪通过算法处理总运动数据来评估休息和活动，通常通过非侵入性的类似手表的加速度计设备进行收集。在危重病患者中，活动记录仪已被用作睡眠的替代测量方法；但是，尚未对其使用进行系统审查。
对使用活动记录仪作为睡眠替代测量方法的 ICU 研究进行系统评价，包括其在 ICU 患者中作为睡眠测量方法的可行性、有效性和可靠性。
我们在 PubMed、EMBASE、CINAHL、Proquest 和 Web of Science 中搜索了使用活动记录仪评估 5 名或 5 名以上 ICU 患者睡眠的研究。
我们的搜索产生了 4869 条引文，其中有 13 项研究符合入选标准。这 13 项研究在 10 个国家进行，其中 8 项（62%）发表于 2008 年之后。在这 13 项研究中，使用活动记录仪估计的 ICU 患者夜间总睡眠时间为 4.4 至 7.8 小时，24 小时内总睡眠时间为 7.1 至 12.1 小时，平均夜间觉醒次数为 1.4 至 49.0 次，睡眠效率为 61%至 75%。与其他睡眠测量方法（多导睡眠图、护士评估和患者问卷）并排比较时，活动记录仪始终产生更高的总睡眠时间和睡眠效率、更少的夜间觉醒（与多导睡眠图相比）和更多的总觉醒（与护士评估和患者问卷相比）。没有一项研究评估了基于活动记录仪的睡眠测量方法与 ICU 患者结局之间的关系。
在危重病患者中，活动记录仪越来越多地被用作睡眠的替代测量方法；但是，由于活动记录仪仅测量总运动活动，因此其估计睡眠的能力受到所使用的处理算法的限制。先前的 ICU 研究涉及活动记录仪，并且存在缺乏关于基于活动记录仪的睡眠测量方法和患者结局的数据的问题。需要进行更大、更严格和标准化的研究，以更好地了解活动记录仪在评估危重病患者睡眠和与睡眠相关的结局中的作用。
