Laboratory of Sleep and Biological Rhythms, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Walter Cantidio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil.
Sleep Breath. 2020 Mar;24(1):25-35. doi: 10.1007/s11325-019-01902-7. Epub 2019 Jul 31.
Although it is generally recognized that poor sleep is common in the intensive care unit (ICU), it is still unclear which interventions can effectively improve sleep in this setting. In this review, we critically analyze the various pharmacological and non-pharmacological measures that have been proposed to tackle this problem.
A search of MEDLINE/PubMed, SciELO, and the Brazilian Virtual Library in Health (LILACS and BNDEF) databases was performed. Results were reviewed and 41 articles on pharmacological and non-pharmacological interventions to promote sleep in ICU were analyzed.
Non-pharmacological interventions including eye mask and earplugs, bundles to reduce noise and lighting, and organization of patient care were shown to improve subjective and objective sleep quality, although the level of evidence was considered low. Assist-control ventilation was associated with a greater objective sleep quality than spontaneous modes, such as pressure support ventilation and proportional assist ventilation. Among pharmacological interventions, a moderate level of evidence was found for oral melatonin, with increases in both objective and subjective sleep quality. Continuous nocturnal infusion of dexmedetomidine was reported to increase sleep efficiency and favorably modify the sleep pattern, although evidence level was moderate to low.
Several non-pharmacological and pharmacological measures can be helpful to improve sleep in critical patients. Further high-quality studies are needed to strengthen the evidence base.
尽管普遍认为重症监护病房（ICU）中普遍存在睡眠质量差的问题，但仍不清楚哪些干预措施可以有效地改善这种情况。在本综述中，我们批判性地分析了为解决这一问题而提出的各种药物和非药物措施。
在 MEDLINE/PubMed、SciELO 和巴西虚拟健康图书馆（LILACS 和 BNDEF）数据库中进行了搜索。对结果进行了审查，并对 41 篇关于 ICU 中促进睡眠的药物和非药物干预的文章进行了分析。
非药物干预措施，包括眼罩和耳塞、减少噪音和照明的套件以及患者护理的组织，被证明可以改善主观和客观的睡眠质量，尽管证据水平被认为较低。辅助控制通气与自发通气模式（如压力支持通气和比例辅助通气）相比，与更高的客观睡眠质量相关。在药物干预措施中，口服褪黑素被发现具有中等水平的证据，可以提高客观和主观的睡眠质量。连续夜间输注右美托咪定被报道可以提高睡眠效率并有利地改变睡眠模式，尽管证据水平为中等到低。
一些非药物和药物措施有助于改善重症患者的睡眠。需要进一步进行高质量的研究来加强证据基础。
