Richards Kathy C, Wang Yan-Yan, Jun Jeehye, Ye Lichuan
University of Texas at Austin School of Nursing, Austin, TX, United States.
West China Hospital, Sichuan University, Chengdu, China.
Front Neurol. 2020 Nov 6;11:542529. doi: 10.3389/fneur.2020.542529. eCollection 2020.
Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice. CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients. Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep. Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.
临床试验人员和临床医生使用了多种睡眠质量测量方法，以确定改善重症患者睡眠及减轻睡眠剥夺所致神经行为后果的干预措施的效果，但研究结果并不总是一致。为了阐明这些不一致的根源，一个重要的考虑因素是现有睡眠测量方法的反应性。评估性测量的目的是描述特定人群中感兴趣的结构，并测量该结构随时间的变化程度。本系统文献综述确定了重症监护病房（ICU）住院成年重症患者的睡眠质量测量方法，并评估了它们的测量特性、优缺点、临床实用性和反应性。我们还建议进行改进，包括采用新技术，这可能会提高这些测量方法在研究和实践中的临床实用性和反应性。检索了2000年1月1日至2020年2月1日期间的CINAHAL、PubMed/Medline和Cochrane图书馆，以确定评估重症患者睡眠质量的研究。共识别并评估了62项使用多导睡眠图（PSG）及其他基于脑电图的方法、活动记录仪、临床医生观察或问卷调查患者感知的研究。主要建议如下：对于脑电波常不典型的ICU患者，需要有PSG评分的标准准则；关于基于脑电图的测量方法和活动记录仪的研究数量太少、样本量太小且研究持续时间太短，无法给出相关建议；使用睡眠观察工具进行临床医生对睡眠的观察；使用理查兹·坎贝尔睡眠问卷来测量患者对睡眠的感知。测量预防睡眠剥夺干预措施的影响需要可靠且有效的睡眠测量方法，研究人员在ICU中开发、测试和应用这些测量方法方面已取得了良好进展。我们建议未来开展大型、多中心干预研究，测量睡眠的多个维度，并提供关于仪器可靠性、有效性、可行性和反应性的更多证据。我们还鼓励测试新技术，以增强现有测量方法，提高其可行性和准确性。
