Andrea Tanner

Research Analysis Paper

I. Introduction:
In intensive care units, along with acute illnesses and life-threatening conditions, sleep
deprivation is an issue for most patients on these units. Sleep deprivation has a great affect on the
body and the healing process that needs to take place for the patients in this type of setting. With
hourly assessments, vital signs, bright lights and noises that can take place in the intensive care
units at night, can contribute to the quality of sleep of a patient. The problem in the intensive care
units is that sleep deprivation could contribute to the length of stay for patients in these units
from the delayed body healing process. Does sleep deprivation influence the length of hospital
stay within the intensive care unit? This is an important incidence in these units because although
caring for the patients diagnosis is important, it is just as important to holistically treat the
patient and allow their body to heal and recover from the diagnosis to achieve an earlier
discharge. This study could impact nurses and how and when interventions are performed to
allow for a more restful sleep for the patients.

II. Comparison of Articles

There are several similarities that run between the articles that were analyzed. One of the
main similarities that were constant in almost all of the articles is that quality sleep is almost
always disturbed in critically ill ICU patients. Several non pharmacological interventions were
implemented to be able to determine if they provided better quality sleep for those who were in
the intensive care unit. Another main similarity that was seen in the studies was how the
environment of the ICU played into disturbances of sleep. The noises, lighting, number of

patient- nursing interactions played into if the patient was able to rest and to the quality of that
sleep. In almost all of the studies, it was found that if those disturbances were reduced, then
patients subjective report of their quality of sleep is improved.

III. Contrasting Articles

The majority of our studies were very similar in nature however there were also
significant differences. Some of our studies included pretty large participant groups while others
only looked at around 10-12 patients. The majority of our studies tried to identify factors that
influence patients sleep while in the ICU setting. These studies found that while on the intensive
care unit patients did in fact have a shorter night sleep and experienced a decrease quality of
sleep. We also looked at some studies that included possible factors that could improve sleep
quality. These studies found that sleep quality on the ICU unit could be improved with ear plugs,
soothing music, eye masks, and even the use of melatonin. We found that multiple studies used a
questionnaire or interview type process when determining sleep quality, which could be very
subjective. There were two studies however that used polysomnography so we also had an
objective point of view. All in all even though some of the studies purposes and methods were
different they all came up with the similar idea in that sleep during the ICU is negatively
impacted.

IV. Limitations
Many patterns of limitations existed throughout each of the studies used to gather
research on the topic. Although many studies exceeded the necessary sample size, a select few of
them simply included 12 to 34 participants or no sample of any kind. By using small sample

sizes in the studies, it is difficult to conclude if the results would be relevant to larger population
sizes. Several studies selected participants solely based upon the fact that the participant was
admitted to the ICU, without factoring in the time they spent in the hospital or their diagnosis.
Also, various studies tended to use ICUs all around the world, but the researchers did not take
into account the different demographics of the patients in each area. Each person has a slightly
different perspective on how they perceived their sleep patterns during their stay in the ICU,
therefore many of the responses were subjective findings. Lastly, self-reporting methods were
used in many of the studies. Results were compiled based upon questionnaires and structured
interviews, limiting the standardization of the responses.

V. Implications for Nursing

Sleep deprivation has been linked to negatively affect the immune, metabolic and
cognitive functions of the body; which in turn leads to complications with patient recovery.
Patients must have quality sleep for their health and wellbeing. This can be achieved by
reducing the amount of excess noise in the critical care unit. Implementing certain interventions
such as: dimming the main unit lights at night, providing earplugs to patients, decreasing volume
of the phone-rings, providing melatonin, and limiting the amount of unnecessary interruptions
into the patients room; have shown to improve the quality of the patients sleep.

VI. Conclusion
Through analysis of many different studies, which looked at the effects of sleep
deprivation on patients in intensive care units, we found many similar findings as well as many
differences. Overall, we found that patients in the ICU were not satisfied with the sleep quality

that they had received during their stay. Poor sleep quality has been shown to have negative
effects on both patient psychosocial and physical health, which can persist beyond their hospital
stay. In general, the largest factors contributing to this lack of sleep or decreased quality
included environmental noise, human interventions, pains levels, and medication use all which
interrupt patient circadian rhythm. Methods to help reduce these disturbances by staff members
can have major benefits on patient sleep quality and, therefore, overall health and wellness.

VII. References
Bihari, S., Doug McEvoy, R., Matheson, E., Kim, S., Woodman, R. J., & Bersten, A. D. (2012).
Factors Affecting Sleep Quality of Patients in Intensive Care Unit. Journal of Clinical
Sleep Medicine, 8(3), 301307. doi: 10.5664/jcsm.1920
Chianca, T., Souza, C., & Hamze, F. (2015). The influence of care interventions on the continuity
of sleep of intensive care unit patients. US National Library of Medicine National
Institutes of Health, 23(5), 789-796. doi:10.1590/0104-1169.0514.2616.
Ehlers, V., Watson, H., & Moleki, M. (2013). Factors contributing to sleep deprivation in a
multidisciplinary intensive care unit in South Africa. Journal of the Democratic Nursing
Organization of South Africa, 36(1). doi:10.4102/curationis.v36i1.72
Freedman, N.S., Kotzer, N., Schwab, R.J. (1999). Patient perception of sleep quality and etiology
of sleep disruption in the intensive care unit. American Journal of Respiratory and
Critical Care Medicine, 159(4), 1155-1162. doi: 10.1164/ajrccm.159.4.9806141
Frisk, U., Nordstrom, G. (2003). Patients sleep in an intensive care unitpatients and nurses
perception. Intensive and Critical Care Nursing, 19(6), 342-349. doi:10.1016/S09643397(03)00076-4

Hardin, K. A. (2009). Sleep in the ICU: potential mechanisms and clinical implications. CHEST
Journal, 136(1), 284-294. doi:10.1378/chest.08-1546
Huang, H.-W., Zheng, B.-L., Jiang, L., Lin, Z.-T., Zhang, G.-B., Shen, L., & Xi, X.-M. (2015).
Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in
healthy subjects in a simulated intensive care unit environment: which might be a more
promising strategy for ICU sleep deprivation? Critical Care, 19(1), 124. doi:
10.1186/s13054-015-0842-8
Hu, R., Jiang, X., Chen, J., Zeng, Z., Chen, X., Li, Y., ... Evans, D. (2014). Non-pharmacological
interventions for sleep promotion in the intensive care unit. The Cochrane Library, (10).
doi: 10.1002/14651858.CD008808.pub2
Pilkington, S. (2013). Causes and consequences of sleep deprivation in hospitalised patients.
Nursing Standard, 27(49), 35-42. doi: 10.7748/ns2013.08.27.49.35.e7649
Podgorski, T., & Wise, C. (2015). Sleep deprivation in the intensive care unit: promoting sleep in
the patients who need it most. Critical Care Nurse, 35(2), 73-74. Retrieved from
http://eds.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=85564a8a-22a2-4da2-9fd05c2544a986c7%40sessionmgr4003&vid=7&hid=4103
Scott, L., Arslanian-Engoren, C., & Engoren, M. (2014). Association of sleep and fatigue with
decision regret among critical care nurses. American Journal of Critical Care, 23(1), 1323. doi: 10.4037/ajcc2014191
Timbo, A.C., Parker, V., Higgins, I. (2013). The experience of sleep deprivation in intensive care
patients. Intensive and Critical Care Nursing, 19(6), 310-316. doi:
10.1016/j.iccn.2013.05.003