Evaluating Sleep Characteristics in Intensive Care Unit and Non-Intensive Care Unit Physicians

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.

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The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Critical Care ◽

10.1186/s13054-020-03447-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

L. J. Delaney ◽

E. Litton ◽

K. L. Melehan ◽

H.-C. C. Huang ◽

V. Lopez ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Total Sleep Time ◽

Sleep Time ◽

Moderate Level ◽

Sleep Monitoring ◽

Clinical Trial Registration ◽

Wake Time ◽

Intensive Care Patients

Abstract Background Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

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The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: An observational study

10.21203/rs.3.rs-66768/v1 ◽

2020 ◽

Author(s):

L.J. Delaney ◽

E. Litton ◽

K.L Melehan ◽

H-C.C Huang ◽

V Lopez ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Total Sleep Time ◽

Sleep Time ◽

Moderate Level ◽

Sleep Monitoring ◽

Clinical Trial Registration ◽

Wake Time ◽

Intensive Care Patients

Abstract Background: Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods: Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-hour duration to assess agreement between the two methods; total sleep time and wake time. Results: We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371 p < 0.05). Bland-Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions: Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number: ACTRN12615000945527 (Registered 9/9/2015)

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Effects of Noninvasive Versus Invasive Mechanical Ventilation on Sleep in the Intensive Care Unit – A Pilot Study

EMJ Respiratory ◽

10.33590/emjrespir/20-00011 ◽

2020 ◽

pp. 127-136

Author(s):

Aylin Ozsancak Ugurlu ◽

Karthik Jothianandan ◽

Carolyn M. D'Ambrosio ◽

Samy Sidhom ◽

Eric Garpestad ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Total Sleep Time ◽

Invasive Mechanical Ventilation ◽

Environmental Parameters ◽

Sleep Time ◽

Mask Type ◽

Medical Intensive Care ◽

Stage 1

Rationale: Use of noninvasive ventilation (NIV) has increased in intensive care units, but sleep during NIV has received little attention. The authors surmised that due to frequent air leaks and mask discomfort, patients receiving NIV would manifest poorer sleep quality than those receiving invasive mechanical ventilation (INV). Methods: A prospective observational study on patients receiving NIV or INV for respiratory failure in a medical intensive care unit or coronary care unit. Patients were monitored by polysomnography for 24 hours with simultaneous collection of data on ventilator and environmental parameters. Results: Eight subjects in each group were studied. Mean total sleep time was 7.29 +1.78 hours (range: 0.57–13.82) in the NIV versus 11.74 +0.65 hours (8.95–15.19) in the INV group (p=0.034). Sleep efficiency was lower in NIV than INV group (30.4% versus 53.3%, respectively; p=0.013). The NIV group had lighter sleep than the INV group (mean % of Stage 1: 36.9% versus 17.2% of total sleep time, respectively; p=0.000), whereas no significant differences were found for other stages. Median total arousal and awakening indexes were higher in the NIV group (16.8/hour versus 4.4/hour and 5.3/hour versus 2.1/hour, respectively; p=0.005), as well as spontaneous arousals and awakenings (p=0.006 and p=0.005, respectively). Sedation was provided mostly by intermittent bolus in the NIV group whereas often by infusion in the INV group. Conclusion: Compared to INV, NIV in critically ill patients was associated with poorer quality and quantity of sleep. Future studies should determine whether adjustments in ventilator settings, mask type or fit, or use of sedation/analgaesia can improve sleep in patients receiving NIV.

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The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: An observational study

10.21203/rs.3.rs-66768/v2 ◽

2020 ◽

Author(s):

L.J. Delaney ◽

E. Litton ◽

K.L Melehan ◽

H-C.C Huang ◽

V Lopez ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Total Sleep Time ◽

Sleep Time ◽

Moderate Level ◽

Sleep Monitoring ◽

Wake Time ◽

Intensive Care Patients ◽

Epoch Analysis

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1059 Sleep Parameters In People With Type 2 Diabetes With And Without Insomnia Symptoms

SLEEP ◽

10.1093/sleep/zsaa056.1055 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A402-A403

Author(s):

M Alshehri ◽

A Alkathiry ◽

A Alenazi ◽

S Alothman ◽

J Rucker ◽

...

Keyword(s):

Type 2 Diabetes ◽

Total Sleep Time ◽

Sleep Onset ◽

Sleep Time ◽

Circular Data ◽

Objective Measures ◽

Subjective Measures ◽

Sleep Parameters ◽

Insomnia Symptoms

Abstract Introduction There is an increasing awareness of the high prevalence of insomnia symptoms in people with type 2 diabetes (T2D). Past studies have demonstrated the importance of measuring sleep parameters in both averages and variabilities using subjective and objective methods. Thus, we aimed to compare the averages and variability of sleep parameters in people with T2D with and without insomnia symptoms. Methods Actigraph measurements and sleep diaries were used in 59 participants to assess sleep parameters, including sleep efficiency (SE), sleep latency, total sleep time, and wake after sleep onset over seven nights. Validated instruments were used to assess the symptoms of depression, anxiety, and pain. Circular data were used to describe the distribution of bed distribution with SE as a magnitude for both groups. Mann Whitney U test was utilized to compare averages and variability of sleep parameters between the two groups. Multivariable general linear model to control for demographic and clinical variables. For the secondary aim, multiple linear regression tests were utilized to assess the association between averages and variability values for both groups. Results SE was found to be lower in average and higher in variability for participants with T2D and insomnia symptoms, than those with T2D only subjectively and objectively. SE variability was also the only sleep parameter higher in people with T2D and insomnia symptoms, with psychological symptoms potentially playing a role in this difference. We observed that people in T2D+Insomnia tend to go to bed earlier compared to the T2D only group based on objective measures, but no difference was observed between groups in subjective measures. The only significant relationship in both objective and subjective measures was between the averages and variability of SE. Conclusion Our findings suggest a discrepancy between subjective and objective measures in only average of total sleep time, as well as agreement in measures of variability in sleep parameters. Also, the relationship between averages and variabilities suggested the importance of improving SE to minimize its variability. Further research is warranted to investigate the complex relationship between sleep parameters and psychological factors in people with T2D and insomnia symptoms. Support None

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0409 The Efficacy of Afternoon-Evening Sleep Following Night Shifts on Sleep and Alertness in Nurses with Rotating Shift Work Schedule: Real World Data

SLEEP ◽

10.1093/sleep/zsaa056.406 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A156-A157

Author(s):

J Kim ◽

S Han ◽

S Kim ◽

J Duffy

Keyword(s):

Sleep Duration ◽

Shift Work ◽

Total Sleep Time ◽

Sleep Time ◽

Hospital Nurses ◽

Sleep Timing ◽

Time In Bed ◽

Shift Schedules ◽

Sleep Schedule ◽

Night Shifts

Abstract Introduction The aim of this study was to investigate the efficacy of changing sleep timing to afternoon-evening following nightshifts in hospital nurses with three rapid rotating shift schedules. Methods Hospital nurses with three rotating shift schedules were enrolled for a 1-month pre-intervention and a 1-month intervention study. During the Intervention, sleep timing following nightshifts was directed to afternoon-evening sleep for 8h time-in-bed (TIB) after 1 PM, and ad-lib sleep schedule for other shifts. Baseline and follow-up evaluation included sleep schedule, sleep duration, Epworth sleepiness scale (ESS), insomnia severity index (ISI) for each shift, Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Sleep was assessed by sleep diary and actigraphy. Alertness during the night shift was evaluated using the Karolinska sleepiness scale (KSS) in the beginning and at the end of the shift by texts sent to their cell phones. The participants were asked to give feedback and a willingness to continue this intervention. Results A total of 26 subjects (30.7±8.5years, 25 female) finished the study among 29 nurses who participated in the study. The shift work was 6.5±8.0years. The mean morningness-eveningness scale was 42.1±8.0(31-62). TIB following nightshifts were 379.9±91.2 and 478.4±48.7 min for preintervention and intervention, respectively (p=0.001). Total sleep time (TST) was 328.0±91.0 vs. 361.0±70.4min, respectively following nightshifts (p=0.187, Cohen’s drm = 0.467). BDI, BAI, ESS, and ISI were significantly improved after the intervention. 60.7% and 49% of the participants reported improved alertness, and work efficiency during the nightshift. 17.9% and 42.9% of the participants reported increased sleep duration, and improved sleep quality after nightshift, respectively. Only eight participants were willing to continue the afternoon-evening sleep schedule following night shifts. KSS was not different between pre-intervention and intervention. Conclusion The afternoon-evening sleep schedule modestly increased total sleep time following nightshift. The overall mood, sleepiness and insomnia scale improved after the intervention although the alertness assessed by KSS failed to show the difference. The individual difference should be considered for applying afternoon-evening sleep for rapid rotating shift schedules. Support 2018 Research award grants from the Korean sleep research society and NRF-2019R1A2C1090643 funded by the Korean national research foundation

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Sleep and Circadian Rhythm Disturbance in Remitted Schizophrenia and Bipolar Disorder: A Systematic Review and Meta-analysis

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa024 ◽

2020 ◽

Vol 46 (5) ◽

pp. 1126-1143 ◽

Cited By ~ 4

Author(s):

Nicholas Meyer ◽

Sophie M Faulkner ◽

Robert A McCutcheon ◽

Toby Pillinger ◽

Derk-Jan Dijk ◽

...

Keyword(s):

Bipolar Disorder ◽

Circadian Rhythm ◽

Motor Activity ◽

Sleep Latency ◽

Total Sleep Time ◽

Sleep Time ◽

Mean Difference ◽

Effect Sizes ◽

Time In Bed ◽

Modifiable Factors

Abstract Background Sleep and circadian rhythm disturbances in schizophrenia are common, but incompletely characterized. We aimed to describe and compare the magnitude and heterogeneity of sleep-circadian alterations in remitted schizophrenia and compare them with those in interepisode bipolar disorder. Methods EMBASE, Medline, and PsycINFO were searched for case–control studies reporting actigraphic parameters in remitted schizophrenia or bipolar disorder. Standardized and absolute mean differences between patients and controls were quantified using Hedges’ g, and patient–control differences in variability were quantified using the mean-scaled coefficient of variation ratio (CVR). A wald-type test compared effect sizes between disorders. Results Thirty studies reporting on 967 patients and 803 controls were included. Compared with controls, both schizophrenia and bipolar groups had significantly longer total sleep time (mean difference [minutes] [95% confidence interval {CI}] = 99.9 [66.8, 133.1] and 31.1 [19.3, 42.9], respectively), time in bed (mean difference = 77.8 [13.7, 142.0] and 50.3 [20.3, 80.3]), but also greater sleep latency (16.5 [6.1, 27.0] and 2.6 [0.5, 4.6]) and reduced motor activity (standardized mean difference [95% CI] = −0.86 [−1.22, −0.51] and −0.75 [−1.20, −0.29]). Effect sizes were significantly greater in schizophrenia compared with the bipolar disorder group for total sleep time, sleep latency, and wake after sleep onset. CVR was significantly elevated in both diagnoses for total sleep time, time in bed, and relative amplitude. Conclusions In both disorders, longer overall sleep duration, but also disturbed initiation, continuity, and reduced motor activity were found. Common, modifiable factors may be associated with these sleep-circadian phenotypes and advocate for further development of transdiagnostic interventions that target them.

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0683 CPAP Adherence Relative To Sleep Duration And Sleep Period In Different Study Populations

SLEEP ◽

10.1093/sleep/zsaa056.679 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A260-A261

Author(s):

S Deering ◽

T Shumard ◽

T Zamora ◽

S Martinez ◽

C J Stepnowsky

Keyword(s):

Pittsburgh Sleep Quality Index ◽

Total Sleep Time ◽

Total Sample ◽

Sleep Time ◽

Overlap Syndrome ◽

Clinical Population ◽

Sleep Period ◽

Cpap Adherence ◽

Combined Data ◽

Do So

Abstract Introduction CPAP is intended for use during sleep to alleviate disordered breathing. Most patients who use CPAP do so for only a portion of their sleep period, although anecdotally it is known that some also use CPAP while awake. We compared the unusually high levels of CPAP adherence found in a recent study of patients with Overlap Syndrome to a VA clinical population and to participants from the APPLES study. Methods CPAP adherence levels were taken from three sources: (1) The O2VERLAP Study, a large comparative effectiveness trial that used two different methods of providing information and support to current CPAP users diagnosed with both OSA and COPD. (2) Combined data from the four most recent clinical CPAP trials conducted at VA San Diego Healthcare System. (3) The APPLES study. Total sample sizes were 332, 957, and 405, respectively. Total sleep time (TST) and total sleep period (TSP) were assessed via the Pittsburgh Sleep Quality Index (PSQI) for (1) and (2) and via polysomnography for (3). Results Mean CPAP use, TST, and TSP for each source were: (1) 6.7, 6.8, & 8.1; (2) 4.0, 6.1, & 7.5; (3) 4.5, 6.6, & 8.0. We examined the ratios of adherence over either TST or TSP, and the ratios for each source were: (1) 98% & 83%; (2) 66% & 55%; (3) 68% & 56%. Conclusion This comparison demonstrates that unlike many CPAP users who tend to use therapy for only a fraction of time spent asleep, patients with COPD and OSA exhibit higher levels of adherence which often exceed sleep time and may be obtaining additional benefits from CPAP use during non-sleep periods. More research is needed both to improve CPAP delivery and support for patients who are using CPAP sub optimally and to understand the factors that account for the heightened levels of CPAP adherence in COPD. Support PPRND #1507-31666; IIR 02-275; IIR 07-163; IIR 12-069; PULM-028-12F.

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“Shift Work” Improves Survival and Reduces Intensive Care Unit Use in Seriously Injured Patients

The American Surgeon ◽

10.1177/000313480707300220 ◽

2007 ◽

Vol 73 (2) ◽

pp. 185-191

Author(s):

Luke Y. Shen ◽

Stephen D. Helmer ◽

Jennifer Huang ◽

Gerayu Niyakorn ◽

R. Stephen Smith

Keyword(s):

Intensive Care Unit ◽

Multivariate Analysis ◽

Intensive Care ◽

Hospital Mortality ◽

Shift Work ◽

Continuity Of Care ◽

Injury Severity ◽

Severely Injured ◽

Trauma Service ◽

Injured Patients

We assessed whether a trauma service model with an emphasis on continuity of care by using “shift work” will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n = 4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. During Period I (May 1, 2002 to April 30, 2003), a rotating off-service team provided initial management between 5:00 PM and 7:00 AM. The “day team” provided all other care and was responsible for continuity of care. In Period II (May 1, 2003 to April 30, 2004), a dedicated trauma service consisting of two resident teams evaluated all injured patients. Variables included hospital and intensive care unit length of stay (LOS), mechanical ventilation requirements, hospital mortality, and hospital care costs. Demographics and injury mechanism for both periods were similar, but Injury Severity Score (ISS) in Period II was greater (ISS, 8.2% vs 7.2%, P < 0.0001; ISS > 15, 18.5% vs 15.4%). In the more severely injured (ISS > 15), patients in Period II had shorter hospital LOS (8.6 vs 9.7 days, P = 0.98), a shorter ICU LOS (5.5 vs 7.7 days, P = 0.039), shorter mechanical ventilator requirements (5.5 vs 7.7 days, P = 0.32), improved hospital mortality rate (19.9% vs 26.8%, P = 0.029), and decreased hospital costs ($19,146 vs $21,274, P = 0.36). On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.

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