ICU Environmental Factors and Quality of Sleep in Critically III Patients

  • Grasso S. 
  • Mascia L. 
  • Ranieri V.M. 
Conference paper
Part of the Update in Intensive Care Medicine book series (UICMSOFT, volume 39)


The intensive care unit (ICU) represents a hostile environment for the patient, the family and all personnel. Pain, forced positioning, physical constraints, nursing and medical procedures, noise, light pollution and sleep deprivation are the most common sources of patient discomfort [1], representing a major source of physical and psychological stress that heightens the depersonalizing effects of the ICU environment and potentially leads to anxiety and depression [2].


Sleep Quality Intensive Care Unit Patient Sleep Deprivation Respir Crit Total Sleep Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Simini B (1999) Patients’ perceptions of intensive care Lancet 354571–572PubMedCrossRefGoogle Scholar
  2. 2.
    McGuire BE, Basten CJ, Ryan CJ, Gallagher J (2000) Intensive care unit syndrome: a dangerous misnomer Arch Intern Med 160–906PubMedCrossRefGoogle Scholar
  3. 3.
    Treggiari-Venzi M, Borgeat A, Fuchs-Buder T, Gachoud J-P, Suter PM (1996) Overnight sedation with midazolam or propofol in the IGU: effects on sleep quality, anxiety and depression Intensive Care Med 221186–1190PubMedCrossRefGoogle Scholar
  4. 4.
    Weber RI, Oszko MA, Bolender BJ (1985) The IGU syndrome: causes, treatment and prevention Drug Intelligence Glin Pharm 1913–20Google Scholar
  5. 5.
    Benca RM, Quintans I (1997) Sleep and host defenses: a review Sleep 201027–1037PubMedGoogle Scholar
  6. 6.
    Association ASD (1992) EEG arousals: scoring rules and examples Sleep 15173–184Google Scholar
  7. 7.
    Garkskadon M, Dement W (1994) Normal human sleep, an overview In: Kryger MH, Roth T, Dement WG (eds) Principles and Practice of Sleep Medicine WB Saunders Gompany, Philadelphia, pp 16–25Google Scholar
  8. 8.
    Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ (2000) Sleep in critically ill patients requiring mechanical ventilation Chest 117809–819PubMedCrossRefGoogle Scholar
  9. 9.
    Dlin BM, Rosen H, Dickstein K, Lyons JW, Fischer HK (1971) The problem of sleep and rest in the intensive care unit Psychosomatics 12241–249Google Scholar
  10. 10.
    Broughton R, Baron R (1978) Sleep pattern in the intensive care unit and on the ward after acute myocardial infarction Electroencephalogr Clin Neurophysiol 45348–360PubMedCrossRefGoogle Scholar
  11. 11.
    Aurell T, Elmquist D (1985) Sleep in the surgical intensive care unit: continuous polygraphic recording of sleep in nine patients receiving postoperative care Br Med J 2901029–1032CrossRefGoogle Scholar
  12. 12.
    Young GB, McLachlan RS, Kreeft JH, Demelo JD (1997) An electroencelographic classification for coma Can J Neurol Sei 24320–325Google Scholar
  13. 13.
    Rosemberg J, Wildschodtz M, Pedersen MH, Von Jessen F, Kelhet H (1994) Late postoperative nocturnal episodic hypoxemia and associated sleep pattern Br J Anaesth 72145–150CrossRefGoogle Scholar
  14. 14.
    Freedman NS, Gazednam J, Levan L, Pack A, Schwab RJ (2001) Abnormal sleep-wake cycles and the effects of environmental noise on sleep disruption in the intensive care unit Am J Respir Grit Gare Med 163451–457Google Scholar
  15. 15.
    Schwab RJ (1994) Disturbances of sleep in the intensive care unit Crit Care Clin 10681–694PubMedGoogle Scholar
  16. 16.
    Mejer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP (1994) Adverse environmental conditions in the respiratory and medical IGU settings Chest 1051211–1216CrossRefGoogle Scholar
  17. 17.
    Balogh D, Kittinger E, Benzer A, Hackl JM. (1993) Noise in the IGU Intensive Care Med 19343–346PubMedCrossRefGoogle Scholar
  18. 18.
    Topf M, Bookman M, Arand D (1996) Effects of critical care unit noise on the subjective quality of sleep I Adv Nurs 24: 545–551CrossRefGoogle Scholar
  19. 19.
    Topf M, Davis JE (1993) Critical care unit noise and rapid eye movement (REM) sleep Heart Lung 22: 252–258PubMedGoogle Scholar
  20. 20.
    Walder B, Francioh D, Meyer JJ, Lancon M, Romand JA (2000) Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise level Crit Care Med 282242–2247PubMedCrossRefGoogle Scholar
  21. 21.
    Freedman NS, Kotzer N, Schwab RJ (1999) Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit Am J Respir Crit Care Med 1591155–1162PubMedGoogle Scholar
  22. 22.
    Wooten V (1995) Sleep disorders in psychiatrie illness In: Chokroverty S In: (ed) Sleep Disorders Medicine: Basic Science, Technical Considerations and Clinical Aspects Butterworth-Heineman, Boston, pp 337–347Google Scholar
  23. 23.
    Meza S, Giannouli E, Younes M (1998) Control of breathing during sleep assessed by proportional assist ventilation J Appl Physiol 84: 3–12PubMedGoogle Scholar
  24. 24.
    Meza S, Mendez M, Ostrowski M, Younes M (1998) Susceptibility to periodic breathing with assisted ventilation during sleep in normal subjects J Appl Physiol 851929–1940PubMedGoogle Scholar
  25. 25.
    Mcintyre NR (1996) New modes of mechanical ventilation Clin Chest Med 17411–421CrossRefGoogle Scholar
  26. 26.
    Grasso S, Ancona G, Ranieri VM (1998) New modes of mechanical ventilation Curr Opin Crit Care 41–5CrossRefGoogle Scholar
  27. 27.
    Ranieri VM (1997) Optimization of patient-ventilator interactions: closed-loop technology to turn the century Intensive Care Med 23936–939PubMedCrossRefGoogle Scholar
  28. 28.
    Cooper AB, Stewart TE, Thornley K (1998) Sleep patterns in critically ill, mechanically ventilated patients Am J Respir Grit Care Med 157A108 (abst)Google Scholar
  29. 29.
    Parthasarathy S, Malik I, lubran A, Tobin MJ (2001) Does ventilator mode influence sleep quality in critically ill patients? Am J Respir Crit Care Med 163A180 (Abst)Google Scholar
  30. 30.
    Parthasarathy S, Jubran A, Tobin MJ (2001) Does addition of dead space alter sleep quality during pressure support ventilation Am J Respir Crit Care Med 163A483 (abst)Google Scholar
  31. 31.
    Parker JS, Liming JD, Gorbett WS, Nishiyama H, Wexler L, Roselle GA (1999) Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalence, consequences, and presentations Girculation 992711–2712Google Scholar
  32. 32.
    Brown LK (1988) Sleep-related disorders and chronic obstructive pulmonary disease Respir Care Clin N Am 3493–512Google Scholar
  33. 33.
    Uthgenannt D, Schoolmann D, Pietrowsky R, Fehm HL, Born (1955) Effects of sleep on the production of cytokines in humans J. Psychosom Med 57: 97–104Google Scholar
  34. 34.
    Mullington I, Korth G, Hermann DM, et al (2000) Dose-dependent effects of endotoxin on human sleep Am J Physiol 278:R947-R955Google Scholar
  35. 35.
    Bradley CM, Nicholson AN, Viveash JP (1991) Opioids and non-opioids In: Klepper ID, Saunders LD, Rosen M (eds) Ambulatory Anaesthesia and Sedation Blackwell Science, Oxford, pp 218–34Google Scholar
  36. 36.
    Gallard JM, Blois R (1983) Effect of benzodiazepine antagonist R:15–1788 on flunitazepaminduced sleep changes Br J Clin Pharmacol 15: 529–536Google Scholar
  37. 37.
    Moote GA, Knill RL (1988) Isoflurane anesthesia causes a transient alteration in nocturnal sleep Anesthesiology 69: 327–331PubMedCrossRefGoogle Scholar
  38. 38.
    Knill RL, Moote GA, Skinner MI, Rose EA (1990) Anesthesia and abdominal surgery leads to intense REM sleep during the first postoperative week Anesthesiology 7352–61PubMedCrossRefGoogle Scholar
  39. 39.
    White DP, Douglas NJ, Pickett CK, et al (1983) Sleep deprivation and the control of ventilation Am Rev Respir Dis 128: 984–986PubMedGoogle Scholar
  40. 40.
    Bonnet MH, Berry RB, Arand DL (1991) Metabolism during normal, fragmented and recovery sleep J Appl Physiol 711112–1118PubMedGoogle Scholar
  41. 41.
    Bonnet LH (1989) Infrequent periodic sleep disruption: effects on sleep, performance and mood Physiol Behav 451049–1055PubMedCrossRefGoogle Scholar
  42. 42.
    Helton MC, Gordon SH, Nunnery SL (1980) The correlation between sleep deprivation and the intensive care unit syndrome Heart Lung 9464–468PubMedGoogle Scholar
  43. 43.
    Rechtschaffen A, Bergmann BM (1995) Sleep deprivation in the rat with the disk-over-water method Behav Brain Res 6955–63PubMedCrossRefGoogle Scholar
  44. 44.
    Brown R, Pang G, Husband AJ, King MG (1989) Suppression of immunity to influenza virus in the respiratory tract following sleep disturbance Reg Immunol 2321–325PubMedGoogle Scholar
  45. 45.
    Brown R, Price RI, King MG, Husband AJ (1989) Interleukin 1 and muramil peptide can prevent decreased antibody response associated with sleep deprivation Brain Behav Immun 3320–330PubMedCrossRefGoogle Scholar
  46. 46.
    Madden KS, Feiten DL (1995) Experimental basis for neural-immune interactions Physiol Rev 7577–106PubMedGoogle Scholar
  47. 47.
    Everson CA, Toth LA (2000) Systemic bacterial invasion induced by sleep deprivation Am J Physiol 278: R905–R916Google Scholar
  48. 48.
    Dinges DE, Douglas SD, Zaugg L, et al (1994) Leukocytosis and natural killer cells functions parallel neurobehavioural fatigue induced by 64 hours of sleep deprivation J Clin Invest 931930–1939PubMedCrossRefGoogle Scholar
  49. 49.
    Scheen AJ, Byrne MM, Plat L, Leproult R, Van Cauter E (1996) Relationships between sleep quality and glucose regulation in normal humans Am J Physiol 271: E261–E270PubMedGoogle Scholar
  50. 50.
    Everson CA, Wehr TA (1993) Nutritional and metabohc adaptations to prolonged sleep deprivation in the rat Am J Physiol 264R376–E387PubMedGoogle Scholar
  51. 51.
    Schule C, Baghai T, Zwanzger P, Minov C, Padberg F, Rupprecht R (2001) Sleep deprivation and hypothalamic-pituitary-adrenal (HPA) axis activity in depressed patients J Psychiatr Res 35239–47PubMedCrossRefGoogle Scholar
  52. 52.
    Taishi P, Sanchez C, Wang Y, Fang J, Harding JW, Krueger JM (2001) Conditions that affect sleep alter the expression of molecules associated with synaptic plasticity Am J Physiol 281: R839–R845Google Scholar
  53. 53.
    Horner RL (1996) Autonomic consequences of arousal from sleep: mechanisms and implications Sleep 19S193–S195PubMedGoogle Scholar
  54. 54.
    Launois SH, Abraham JH, Weiss JW, Kirby DA (1998) Patterned cardiovascular responses to sleep and non-respiratory arousals in a porcine model J Appl Physiol 851285–1291PubMedGoogle Scholar
  55. 55.
    Cianci T, Zoccoli G, Lenzi P, Franzini C (1991) Loss of integrative control of peripheral circulation during desynchronized sleep Am J Physiol 261R373–R377PubMedGoogle Scholar
  56. 56.
    Chen H, Tang Y (1989) Sleep loss impairs inspiratory muscle endurance Am Rev Respir Dis 140907–909PubMedCrossRefGoogle Scholar
  57. 57.
    Leiter JC, Knuth SL, Bartlett D (1985) The effect of sleep deprivation on the activity of the genioglossus muscle Am Rev Respir Dis 1321242–1245PubMedGoogle Scholar
  58. 58.
    White DP, Douglas NJ, Pickett CK, Zwillich CW, Weil JV (1983) Sleep deprivation and the control of ventilation Am Rev Respir Dis 128984–986PubMedGoogle Scholar
  59. 59.
    Ely EW, Inouye SK, Bernard GR, et al (2001) Delirium in mechanically ventilated patients. Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU) JAMA 2862703–2710PubMedCrossRefGoogle Scholar
  60. 60.
    Ely EW, Gautam S, Margolin R, et al (2001) The impact of delirium in the intensive care unit on hospital length of stay Intensive Care Med 271892–1900PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • Grasso S. 
    • 1
  • Mascia L. 
    • 2
  • Ranieri V.M. 
    • 3
  1. 1.Dept of Intensive Care and Intensive Care MedicineOspedale DiVenereBariItaly
  2. 2.Anesthesiology and Intensive Care Section Ospedale S. Giovanni BattistaUniversity of TurinTurinItaly
  3. 3.Dept of AnesthesiologyOspedale S. Giovanni BattistaTurinItaly

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