A meta-analysis of sleep-promoting interventions during critical Illness

Chithra Poongkunran, Santosh G. John, Arun S. Kannan, Safal Shetty, Christian Bime, Sairam Parthasarathy

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with a potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients. Methods We included RCTs that objectively measured sleep with electroencephalography or its derivatives and excluded observational studies and those that measured sleep by subjective reports. The research was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of 6022 studies identified, 13 met eligibility criteria involving 296 critically ill patients. Eight trials looked at different modes of mechanical ventilation as sleep interventions, and the remaining 5 involved pharmacologic, nonpharmacologic, or environmental interventions. Meta-analysis of the studies revealed that sleep-promoting interventions improved sleep quantity (pooled standardized mean difference [SMD], 0.37; 95% confidence interval [CI], 0.05-0.69; P =.02) and sleep quality through reduction in sleep fragmentation (SMD, -0.31; 95% CI, -0.60 to -0.01; P =.04). Subgroup analysis revealed that timed modes of ventilation improved sleep quantity when compared with spontaneous modes of ventilation (SMD, 0.45; 95% CI, 0.10-0.81; P =.01). Nonmechanical ventilation interventions tended to improve sleep quantity (SMD, 0.65; 95% CI, -0.03 to 1.33; P =.06) and to reduce sleep fragmentation (SMD, -0.29; 95% CI, -0.61 to 0.03; P =.07). Conclusions The synthesized evidence suggests that both mechanical ventilation- and nonmechanical ventilation-based therapies improve sleep quantity and quality in critically ill patients, but the clinical significance is unclear. In the future, adequately powered multicenter RCTs involving pharmacologic interventions to promote sleep in critically ill patients are warranted.

Original languageEnglish (US)
Pages (from-to)1126-1137.e1
JournalAmerican Journal of Medicine
Volume128
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Critical Illness
Meta-Analysis
Sleep
Ventilation
Confidence Intervals
Artificial Respiration
Sleep Deprivation
Randomized Controlled Trials
Observational Studies
Electroencephalography
Guidelines

Keywords

  • Artificial respiration
  • Critical care
  • Critical illness
  • Hypnotics and sedatives
  • Polysomnography
  • Positive-pressure respiration
  • Sleep

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A meta-analysis of sleep-promoting interventions during critical Illness. / Poongkunran, Chithra; John, Santosh G.; Kannan, Arun S.; Shetty, Safal; Bime, Christian; Parthasarathy, Sairam.

In: American Journal of Medicine, Vol. 128, No. 10, 01.10.2015, p. 1126-1137.e1.

Research output: Contribution to journalArticle

Poongkunran, Chithra ; John, Santosh G. ; Kannan, Arun S. ; Shetty, Safal ; Bime, Christian ; Parthasarathy, Sairam. / A meta-analysis of sleep-promoting interventions during critical Illness. In: American Journal of Medicine. 2015 ; Vol. 128, No. 10. pp. 1126-1137.e1.
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abstract = "Background Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with a potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients. Methods We included RCTs that objectively measured sleep with electroencephalography or its derivatives and excluded observational studies and those that measured sleep by subjective reports. The research was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of 6022 studies identified, 13 met eligibility criteria involving 296 critically ill patients. Eight trials looked at different modes of mechanical ventilation as sleep interventions, and the remaining 5 involved pharmacologic, nonpharmacologic, or environmental interventions. Meta-analysis of the studies revealed that sleep-promoting interventions improved sleep quantity (pooled standardized mean difference [SMD], 0.37; 95{\%} confidence interval [CI], 0.05-0.69; P =.02) and sleep quality through reduction in sleep fragmentation (SMD, -0.31; 95{\%} CI, -0.60 to -0.01; P =.04). Subgroup analysis revealed that timed modes of ventilation improved sleep quantity when compared with spontaneous modes of ventilation (SMD, 0.45; 95{\%} CI, 0.10-0.81; P =.01). Nonmechanical ventilation interventions tended to improve sleep quantity (SMD, 0.65; 95{\%} CI, -0.03 to 1.33; P =.06) and to reduce sleep fragmentation (SMD, -0.29; 95{\%} CI, -0.61 to 0.03; P =.07). Conclusions The synthesized evidence suggests that both mechanical ventilation- and nonmechanical ventilation-based therapies improve sleep quantity and quality in critically ill patients, but the clinical significance is unclear. In the future, adequately powered multicenter RCTs involving pharmacologic interventions to promote sleep in critically ill patients are warranted.",
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N2 - Background Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with a potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients. Methods We included RCTs that objectively measured sleep with electroencephalography or its derivatives and excluded observational studies and those that measured sleep by subjective reports. The research was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of 6022 studies identified, 13 met eligibility criteria involving 296 critically ill patients. Eight trials looked at different modes of mechanical ventilation as sleep interventions, and the remaining 5 involved pharmacologic, nonpharmacologic, or environmental interventions. Meta-analysis of the studies revealed that sleep-promoting interventions improved sleep quantity (pooled standardized mean difference [SMD], 0.37; 95% confidence interval [CI], 0.05-0.69; P =.02) and sleep quality through reduction in sleep fragmentation (SMD, -0.31; 95% CI, -0.60 to -0.01; P =.04). Subgroup analysis revealed that timed modes of ventilation improved sleep quantity when compared with spontaneous modes of ventilation (SMD, 0.45; 95% CI, 0.10-0.81; P =.01). Nonmechanical ventilation interventions tended to improve sleep quantity (SMD, 0.65; 95% CI, -0.03 to 1.33; P =.06) and to reduce sleep fragmentation (SMD, -0.29; 95% CI, -0.61 to 0.03; P =.07). Conclusions The synthesized evidence suggests that both mechanical ventilation- and nonmechanical ventilation-based therapies improve sleep quantity and quality in critically ill patients, but the clinical significance is unclear. In the future, adequately powered multicenter RCTs involving pharmacologic interventions to promote sleep in critically ill patients are warranted.

AB - Background Sleep quality and quantity are severely reduced in critically ill patients receiving mechanical ventilation with a potential for adverse consequences. Our objective was to synthesize the randomized controlled trials (RCTs) that measured the efficacy of sleep-promoting interventions on sleep quality and quantity in critically ill patients. Methods We included RCTs that objectively measured sleep with electroencephalography or its derivatives and excluded observational studies and those that measured sleep by subjective reports. The research was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of 6022 studies identified, 13 met eligibility criteria involving 296 critically ill patients. Eight trials looked at different modes of mechanical ventilation as sleep interventions, and the remaining 5 involved pharmacologic, nonpharmacologic, or environmental interventions. Meta-analysis of the studies revealed that sleep-promoting interventions improved sleep quantity (pooled standardized mean difference [SMD], 0.37; 95% confidence interval [CI], 0.05-0.69; P =.02) and sleep quality through reduction in sleep fragmentation (SMD, -0.31; 95% CI, -0.60 to -0.01; P =.04). Subgroup analysis revealed that timed modes of ventilation improved sleep quantity when compared with spontaneous modes of ventilation (SMD, 0.45; 95% CI, 0.10-0.81; P =.01). Nonmechanical ventilation interventions tended to improve sleep quantity (SMD, 0.65; 95% CI, -0.03 to 1.33; P =.06) and to reduce sleep fragmentation (SMD, -0.29; 95% CI, -0.61 to 0.03; P =.07). Conclusions The synthesized evidence suggests that both mechanical ventilation- and nonmechanical ventilation-based therapies improve sleep quantity and quality in critically ill patients, but the clinical significance is unclear. In the future, adequately powered multicenter RCTs involving pharmacologic interventions to promote sleep in critically ill patients are warranted.

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KW - Polysomnography

KW - Positive-pressure respiration

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