An Investigation of Sleep Monitoring Techniques and the Impact of the Clinical Environment on Intensive Care Patients' Sleep

Abstract

Thesis Overview Background Sleep is an essential biological function necessary for survival and plays a critical role in hormonal regulation and maintenance of physiological homeostasis (Alvarez & Ayas, 2004; Brummel & Girard, 2013; Friese et al., 2009; Knutson et al., 2007). Sleep dysregulation can produce a vast array of adverse physiological and psychological effects in individuals. Patients admitted to the intensive care unit (ICU) are susceptible to extensive sleep disturbance in the form of sleep deprivation, sleep fragmentation or circadian dysrhythmia (Elliott et al., 2013; Friese et al., 2007). Despite these issues and their implications, monitoring sleep within this patient cohort remains problematic and challenging because of the limited sleep monitoring techniques available to clinicians and the acceptability of these to patients. Aims and Objectives This thesis aims to explore the sleep characteristics of patients admitted to an ICU and patients' experience of sleep, and to explore the feasibility of sleep monitoring techniques that may be incorporated as a standard component of clinical care in the intensive care setting to assist clinicians in understanding of sleep disturbance and the effectiveness of sleep promoting interventions. This thesis also integrates an environmental assessment of the clinical environment to explore the impact of external factors such as noise, light and clinical interactions as a potential contribution to sleep disturbance in this cohort. These stressors are commonly reported by patients and staff as factors that impede sleep; investigating the patient perspective offers valuable insights into the patient experience to aid clinicians' awareness of the activities that contribute to poor quality of sleep. These insights can provide a basis on which staff can intervene and consider strategies that could ameliorate their impact. Significance Sleep disturbance is a significant stressor associated with an ICU admission, and up to 50% of patients report disturbed sleep, with 30% continuing to experience sleep disturbance post ICU discharge (Beltrami et al., 2015). Despite its vast physiological and psychological impacts on patients, sleep remains deprioritised within this clinical context. Inadvertently, a lack of attention to the important role sleep plays in a patient's overall recovery may be exposing them to adverse health consequences and increasing their propensity for an increased length of hospital stay and development of delirium (Flannery et al., 2016; Pisani et al., 2015). For sleep to become an integrated component of overall patient assessment and clinical care, there is a need to identify an objective and feasible sleep monitoring method that can provide clinical data on the sleep profile of patients admitted to the ICU. This research builds upon the contemporary knowledge and understanding of sleep architecture and sleep disturbing factors, while attempting to address the deficiency in sleep monitoring within the ICU setting. The findings of this research may provide important insights related to the effective integration of sleep monitoring within the ICU and identify contributing factors that adversely affect sleep. Show more