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Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography

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Abstract

Objective

Sleep loss and sleep disruption are common in critically ill patients and may adversely affect clinical outcomes. Although polysomnography remains the most accurate and reliable way to measure sleep, it is costly and impractical for regular use in the intensive care unit. This study evaluates the accuracy of two other methods currently used for measuring sleep, actigraphy (monitoring of gross motor activity) and behavioural assessment by the bedside nurse, by comparing them to overnight polysomnography in critically ill patients.

Design

Observational study with simultaneous polysomnography, actigraphy and behavioural assessment of sleep.

Setting

Medical-surgical intensive care unit.

Patients and participants

Twelve stable, critically ill, mechanically ventilated patients [68 (13) years, Glasgow coma scale 11 (0)].

Interventions

None.

Measurements and results

Sleep was severely disrupted, reflected by decreased total sleep time and sleep efficiency, high frequency of arousals and awakenings and abnormal sleep architecture. Actigraphy overestimated total sleep time and sleep efficiency. The overall agreement between actigraphy and polysomnography was <65%. Nurse assessment underestimated the number of awakenings from sleep. Estimated total sleep time, sleep efficiency and number of awakenings by nurse assessment did not correlate with polysomnographic findings.

Conclusions

Actigraphy and behavioural assessment by the bedside nurse are inaccurate and unreliable methods to monitor sleep in critically ill patients.

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Acknowledgments

This research was performed at the Medical Surgical Intensive Care Unit, St. Michael’s Hospital, Toronto, ON, Canada and was supported by The Physicians Services Incorporated Foundation, ON, Canada. The authors would like to thank D. Lukic and J. Lawrence for their technical assistance.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Calgary, Calgary, AB, Canada

    Jaime M. Beecroft & Patrick J. Hanly

  2. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Michael Ward, Magdy Younes, Shelley Crombach & Orla Smith

  3. 1421 Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, Canada, T2N 4N1

    Patrick J. Hanly

Authors
  1. Jaime M. Beecroft
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  2. Michael Ward
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  3. Magdy Younes
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  4. Shelley Crombach
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  5. Orla Smith
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  6. Patrick J. Hanly
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Corresponding author

Correspondence to Patrick J. Hanly.

Appendix: Nursing questionnaire

Appendix: Nursing questionnaire

Nursing assessment of sleep

  1. 1.

    How many hours did your patient sleep during the study period? ……hours.

  2. 2.

    How many times did your patient wake during the study period? ……times.

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Beecroft, J.M., Ward, M., Younes, M. et al. Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography. Intensive Care Med 34, 2076–2083 (2008). https://doi.org/10.1007/s00134-008-1180-y

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  • DOI: https://doi.org/10.1007/s00134-008-1180-y

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