Quality and quantity of sleep in multipatient versus single-room ICUs

Introduction

Sleep fragmentation and deprivation is common in ICU patients [1]. It is assumed that the ICU environment (overexposure to sound and light during night-time) leads to disturbed sleep [2]. In our hospital, a new ICU was built with quiet, single-patient rooms with much daylight. This created an opportunity to study the effects of nursing environment on sleep quality and quantity in ICU patients.

Methods

We included 21 postcardiothoracic surgery patients: 11 subjects were admitted to the old, ward-like ICU, and 10 patients to the new, single-room ICU (see Figure 1). Hypnograms were derived from a polysomnography from 07:00 p.m. to 07:00 a.m.

Figure 1

New, single-room ICU.

Results

Both groups did not differ with respect to age, duration of surgery or use of psychoactive medication. Polysomnography recordings showed no differences in total sleep time and awakenings (63 ± 26 in the old ICU and 56 ± 30 in the new ICU). The mean percentage of sleep stages in the old versus new situation did not essentially different either: N1: 12.9% versus 8.0%, P = 0.21, ANOVA; N2: 80.3% versus 87.2%, P = 0.07, ANOVA; N3: 5.2% versus 2.5%, P = 0.18, ANOVA. Only REM sleep latency was longer in the old ICU: 314.7 versus 633.5 minutes, P = 0.02, ANOVA.

Conclusion

Except for REM onset latency, sleep improvement was not achieved by changing a ward-like into a single-patient-room ICU environment. When striving for more natural sleep, attitudes towards nursing and medication may play a more important role than ICU design.