Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Erasmus University Rotterdam, Rotterdam, the Netherlands.
J Crit Care. 2022 Oct;71:154102. doi: 10.1016/j.jcrc.2022.154102. Epub 2022 Jul 15.
To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients.
We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible.
132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ).
Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.
系统回顾睡眠评估，描述睡眠障碍，并探讨睡眠障碍对成人 ICU 患者结局的影响。
我们系统地检索了 1969 年 5 月至 2021 年 6 月的数据库（PROSPERO 方案编号：CRD42020175581）。纳入研究为观察性研究，研究对象为重症成人患者的睡眠情况，排除睡眠或精神障碍患者。可行时采用元回归方法进行分析。
共纳入 132 项研究（8797 例患者）。确定了 15 种睡眠评估方法，仅有两种方法经过验证。患者存在明显的睡眠障碍，睡眠时间短，快速眼动（REM）睡眠恢复比例低。镇静与睡眠效率和睡眠时间的提高相关。手术患者比非手术患者睡眠质量差。接受通气治疗的患者浅睡眠时间较长。元回归仅提示总睡眠时间与谵妄发生之间存在关联（p<0.001，15 项研究，519 例患者）。由于数据稀缺，无法进一步分析。多导睡眠图（PSG）记录的睡眠特征与活动记录仪和 Richards Campbell 睡眠问卷（RCSQ）相关性良好。
重症患者的睡眠严重紊乱，活动记录仪和 RCSQ 似乎是 PSG 的可靠替代方法。未来的研究应评估睡眠障碍对结局的影响。
