Sleep and Sleep Disordered Breathing in Hospitalized Patients

Abstract

Sleep is a fundamental physiological process necessary for recovery from acute illness. Unfortunately for hospitalized patients, sleep is often short, fragmented, and poor in quality, and may be associated with adverse outcomes including inpatient delirium. Many factors contribute to poor sleep in the hospital setting, including preexisting sleep deprivation, sleep disordered breathing, environmental noise and light, patient care activities, and medications. Sleep disordered breathing increases the risk of potentially life-threatening cardiovascular, respiratory, and metabolic consequences, and therefore should be diagnosed and treated in hospitalized patients. Mitigating the sequelae associated with poor sleep quality and sleep disordered breathing requires early identification of modifiable factors impacting a patient's sleep, including engagement of a multidisciplinary team. In this article, we review the current knowledge of sleep in hospitalized patients with a detailed focus on patients with sleep disordered breathing.

Keywords

sleep deprivation - hospitalization - intensive care unit - critical illness - obstructive sleep apnea

• References

• 1 Elliott R, McKinley S, Cistulli P, Fien M. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study. Crit Care 2013; 17 (2) R46
• 2 Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 2001; 163 (2) 451-457
• 3 Kamdar BB, King LM, Collop NA , et al. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Crit Care Med 2013; 41 (3) 800-809
• 4 Thomason JW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely EW. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 2005; 9 (4) R375-R381
• 5 Ely EW, Gautam S, Margolin R , et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27 (12) 1892-1900
• 6 Ely EW, Shintani A, Truman B , et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291 (14) 1753-1762
• 7 Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009; 180 (11) 1092-1097
• 8 Girard TD, Jackson JC, Pandharipande PP , et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38 (7) 1513-1520
• 9 Kiely DK, Bergmann MA, Jones RN, Murphy KM, Orav EJ, Marcantonio ER. Characteristics associated with delirium persistence among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci 2004; 59 (4) 344-349
• 10 Thomason JW, Ely EW. Delirium in the intensive care unit is bad: what is the confusion?. Crit Care Med 2004; 32 (11) 2352-2354
• 11 Krumholz HM. Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 2013; 368 (2) 100-102
• 12 Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med 2012; 27 (2) 97-111
• 13 Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004; 27 (7) 1255-1273
• 14 Carskadon MA, Dement WC. Normal human sleep. In: Kryger MH, Roth T, Dement WC, , eds. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2011
• 15 Iber C, Ancoli-Israel S, Chesson Jr AL. Quan SFftAAoSM. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; 2007
• 16 Beecroft JM, Ward M, Younes M, Crombach S, Smith O, Hanly PJ. Sleep monitoring in the intensive care unit: comparison of nurse assessment, actigraphy and polysomnography. Intensive Care Med 2008; 34 (11) 2076-2083
• 17 Sadeh A. The role and validity of actigraphy in sleep medicine: an update. Sleep Med Rev 2011; 15 (4) 259-267
• 18 Sleigh JW, Andrzejowski J, Steyn-Ross A, Steyn-Ross M. The bispectral index: a measure of depth of sleep?. Anesth Analg 1999; 88 (3) 659-661
• 19 Richards KC, Gibson R, Overton-McCoy AL. Effects of massage in acute and critical care. AACN Clin Issues 2000; 11 (1) 77-96
• 20 Freedman NS, Kotzer N, Schwab RJ. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med 1999; 159 (4, Pt 1) 1155-1162
• 21 Watson PL. Measuring sleep in critically ill patients: beware the pitfalls. Crit Care 2007; 11 (4) 159
• 22 Drouot X, Roche-Campo F, Thille AW , et al. A new classification for sleep analysis in critically ill patients. Sleep Med 2012; 13 (1) 7-14
• 23 Watson PL, Pandharipande P, Gehlbach BK , et al. atypical sleep in ventilated patients: empirical electroencephalography findings and the path toward revised ICU sleep scoring criteria. Crit Care Med 2013; 41 (8) 1958-1967
• 24 Douglas NJ, White DP, Pickett CK, Weil JV, Zwillich CW. Respiration during sleep in normal man. Thorax 1982; 37 (11) 840-844
• 25 Douglas NJ, White DP, Weil JV , et al. Hypoxic ventilatory response decreases during sleep in normal men. Am Rev Respir Dis 1982; 125 (3) 286-289
• 26 Douglas NJ, White DP, Weil JV, Pickett CK, Zwillich CW. Hypercapnic ventilatory response in sleeping adults. Am Rev Respir Dis 1982; 126 (5) 758-762
• 27 Collop NA, Salas RE, Delayo M, Gamaldo C. Normal sleep and circadian processes. Crit Care Clin 2008; 24 (3) 449-460 , v
• 28 Dickerson LW, Huang AH, Thurnher MM, Nearing BD, Verrier RL. Relationship between coronary hemodynamic changes and the phasic events of rapid eye movement sleep. Sleep 1993; 16 (6) 550-557
• 29 Griffin JE, Ojeda SR. Textbook of Endocrine Physiology. 5th ed. New York: Oxford University Press; 2004
• 30 Schüssler P, Uhr M, Ising M , et al. Nocturnal ghrelin, ACTH, GH and cortisol secretion after sleep deprivation in humans. Psychoneuroendocrinology 2006; 31 (8) 915-923
• 31 Lee-Chiong TL. Sleep Medicine: Essentials and Review. New York: Oxford University Press; 2008
• 32 Bonnet MH. Acute sleep deprivation. In: Kryger MH, Roth T, Dement WC, , eds. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2011
• 33 Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep 1996; 19 (4) 318-326
• 34 Kahn-Greene ET, Killgore DB, Kamimori GH, Balkin TJ, Killgore WDS. The effects of sleep deprivation on symptoms of psychopathology in healthy adults. Sleep Med 2007; 8 (3) 215-221
• 35 White DP, Douglas NJ, Pickett CK, Zwillich CW, Weil JV. Sleep deprivation and the control of ventilation. Am Rev Respir Dis 1983; 128 (6) 984-986
• 36 Phillips BA, Cooper KR, Burke TV. The effect of sleep loss on breathing in chronic obstructive pulmonary disease. Chest 1987; 91 (1) 29-32
• 37 Roche Campo F, Drouot X, Thille AW , et al. Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure. Crit Care Med 2010; 38 (2) 477-485
• 38 Brown R, Pang G, Husband AJ, King MG. Suppression of immunity to influenza virus infection in the respiratory tract following sleep disturbance. Reg Immunol 1989; 2 (5) 321-325
• 39 Renegar KB, Crouse D, Floyd RA, Krueger J. Progression of influenza viral infection through the murine respiratory tract: the protective role of sleep deprivation. Sleep 2000; 23 (7) 859-863
• 40 Benca RM, Kushida CA, Everson CA, Kalski R, Bergmann BM, Rechtschaffen A. Sleep deprivation in the rat: VII. Immune function. Sleep 1989; 12 (1) 47-52
• 41 Faraut B, Boudjeltia KZ, Vanhamme L, Kerkhofs M. Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery. Sleep Med Rev 2012; 16 (2) 137-149
• 42 Faraut B, Touchette E, Gamble H , et al. Short sleep duration and increased risk of hypertension: a primary care medicine investigation. J Hypertens 2012; 30 (7) 1354-1363
• 43 Wang F, Yeung KL, Chan WC , et al. A meta-analysis on dose-response relationship between night shift work and the risk of breast cancer. Ann Oncol 2013; 24 (11) 2724-2732
• 44 Gabor JY, Cooper AB, Hanly PJ. Sleep disruption in the intensive care unit. Curr Opin Crit Care 2001; 7 (1) 21-27
• 45 Parthasarathy S, Tobin MJ. Sleep in the intensive care unit. Intensive Care Med 2004; 30 (2) 197-206
• 46 Drouot X, Cabello B, d'Ortho MP, Brochard L. Sleep in the intensive care unit. Sleep Med Rev 2008; 12 (5) 391-403
• 47 Andersen JH, Boesen HC, Skovgaard Olsen K. Sleep in the intensive care unit measured by polysomnography. Minerva Anestesiol 2013; 79 (7) 804-815
• 48 Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ. Sleep in critically ill patients requiring mechanical ventilation. Chest 2000; 117 (3) 809-818
• 49 Trompeo AC, Vidi Y, Locane MD , et al. Sleep disturbances in the critically ill patients: role of delirium and sedative agents. Minerva Anestesiol 2011; 77 (6) 604-612
• 50 Adachi M, Staisiunas PG, Knutson KL, Beveridge C, Meltzer DO, Arora VM. Perceived control and sleep in hospitalized older adults: a sound hypothesis?. J Hosp Med 2013; 8 (4) 184-190
• 51 Missildine K. Sleep and the sleep environment of older adults in acute care settings. J Gerontol Nurs 2008; 34 (6) 15-21
• 52 Miyajima K, Fujisawa D, Hashiguchi S , et al. Symptoms overlooked in hospitalized cancer patients: Impact of concurrent symptoms on overlooked by nurses-ERRATUM. Palliat Support Care 2014; 12 (2) 95-100
• 53 Baker CF. Sensory overload and noise in the ICU: sources of environmental stress. CCQ 1984; 6 (4) 66-80
• 54 Xie H, Kang J. The acoustic environment of intensive care wards based on long period nocturnal measurements. Noise Health 2012; 14 (60) 230-236
• 55 Falk SA, Woods NF. Hospital noise—levels and potential health hazards. N Engl J Med 1973; 289 (15) 774-781
• 56 Snyder-Halpern R. The effect of critical care unit noise on patient sleep cycles. CCQ 1985; 7 (4) 41-51
• 57 Balogh D, Kittinger E, Benzer A, Hackl JM. Noise in the ICU. Intensive Care Med 1993; 19 (6) 343-346
• 58 Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP. Adverse environmental conditions in the respiratory and medical ICU settings. Chest 1994; 105 (4) 1211-1216
• 59 Tsiou C, Eftymiatos D, Theodossopoulou E, Notis P, Kiriakou K. Noise sources and levels in the Evgenidion Hospital intensive care unit. Intensive Care Med 1998; 24 (8) 845-847
• 60 Akansel N, Kaymakçi S. Effects of intensive care unit noise on patients: a study on coronary artery bypass graft surgery patients. J Clin Nurs 2008; 17 (12) 1581-1590
• 61 Lawson N, Thompson K, Saunders G , et al. Sound intensity and noise evaluation in a critical care unit. Am J Crit Care 2010; 19 (6) e88-e98 , quiz e99
• 62 Cordova AC, Logishetty K, Fauerbach J, Price LA, Gibson BR, Milner SM. Noise levels in a burn intensive care unit. Burns 2013; 39 (1) 44-48
• 63 Redding JS, Hargest TS, Minsky SH. How noisy is intensive care?. Crit Care Med 1977; 5 (6) 275-276
• 64 Kornfeld DS. Psychiatric view of the intensive care unit. BMJ 1969; 1 (5636) 108-110
• 65 Gelling L. Causes of ICU psychosis: the environmental factors. Nurs Crit Care 1999; 4 (1) 22-26
• 66 Ballard KS. Identification of environmental stressors for patients in a surgical intensive care unit. Issues Ment Health Nurs 1981; 3 (1-2) 89-108
• 67 Hannich HJ, Wendt M, Bertlich P. [Specific stress of intensive therapy: its analysis and suggestions for changes]. Anaesthesist 1982; 31 (11) 615-620
• 68 Gabor JY, Cooper AB, Crombach SA , et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003; 167 (5) 708-715
• 69 Dyer I. Preventing the ITU syndrome or how not to torture an ITU patient! Part 2. Intensive Crit Care Nurs 1995; 11 (4) 223-232
• 70 Dyer I. Preventing the ITU syndrome or how not to torture an ITU patient! Part I. Intensive Crit Care Nurs 1995; 11 (3) 130-139
• 71 Topf M, Thompson S. Interactive relationships between hospital patients' noise-induced stress and other stress with sleep. Heart Lung 2001; 30 (4) 237-243
• 72 Bunzel B, Benzer H, Gollner C, Pauser G. [Psychological stress factors in intensive care]. Anaesthesist 1982; 31 (12) 693-698
• 73 Simini B. Patients' perceptions of intensive care. Lancet 1999; 354 (9178) 571-572
• 74 Uğraş GA, Oztekin SD. Patient perception of environmental and nursing factors contributing to sleep disturbances in a neurosurgical intensive care unit. Tohoku J Exp Med 2007; 212 (3) 299-308
• 75 Ma PL, Wang Y, Xi XM , et al. [Epidemiology of unpleasant experiences in conscious critically ill patients during intensive care unit stay]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2008; 20 (9) 553-557
• 76 Hofhuis JG, Spronk PE, van Stel HF, Schrijvers AJ, Rommes JH, Bakker J. Experiences of critically ill patients in the ICU. Intensive Crit Care Nurs 2008; 24 (5) 300-313
• 77 Spence J, Murray T, Tang AS, Butler RS, Albert NM. Nighttime noise issues that interrupt sleep after cardiac surgery. J Nurs Care Qual 2011; 26 (1) 88-95
• 78 Simpson T, Lee ER, Cameron C. Relationships among sleep dimensions and factors that impair sleep after cardiac surgery. Res Nurs Health 1996; 19 (3) 213-223
• 79 Aaron JN, Carlisle CC, Carskadon MA, Meyer TJ, Hill NS, Millman RP. Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep 1996; 19 (9) 707-710
• 80 Topf M, Davis JE. Critical care unit noise and rapid eye movement (REM) sleep. Heart Lung 1993; 22 (3) 252-258
• 81 Topf M, Bookman M, Arand D. Effects of critical care unit noise on the subjective quality of sleep. J Adv Nurs 1996; 24 (3) 545-551
• 82 Büyükyilmaz FE, Şendir M, Acaroğlu R. Evaluation of night-time pain characteristics and quality of sleep in postoperative Turkish orthopedic patients. Clin Nurs Res 2011; 20 (3) 326-342
• 83 Campbell SS, Dawson D, Anderson MW. Alleviation of sleep maintenance insomnia with timed exposure to bright light. J Am Geriatr Soc 1993; 41 (8) 829-836
• 84 Shochat T, Martin J, Marler M, Ancoli-Israel S. Illumination levels in nursing home patients: effects on sleep and activity rhythms. J Sleep Res 2000; 9 (4) 373-379
• 85 Wakamura T, Tokura H. Influence of bright light during daytime on sleep parameters in hospitalized elderly patients. J Physiol Anthropol Appl Human Sci 2001; 20 (6) 345-351
• 86 Riemersma-van der Lek RF, Swaab DF, Twisk J, Hol EM, Hoogendijk WJ, Van Someren EJ. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA 2008; 299 (22) 2642-2655
• 87 Walder B, Francioli D, Meyer JJ, Lançon M, Romand JA. Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Crit Care Med 2000; 28 (7) 2242-2247
• 88 Dennis CM, Lee R, Woodard EK, Szalaj JJ, Walker CA. Benefits of quiet time for neuro-intensive care patients. J Neurosci Nurs 2010; 42 (4) 217-224
• 89 Kamdar BB, Shah PA, King LM , et al. Patient-nurse interrater reliability and agreement of the Richards-Campbell sleep questionnaire. Am J Crit Care 2012; 21 (4) 261-269
• 90 Castro R, Angus DC, Rosengart MR. The effect of light on critical illness. Crit Care 2011; 15 (2) 218
• 91 Tamburri LM, DiBrienza R, Zozula R, Redeker NS. Nocturnal care interactions with patients in critical care units. Am J Crit Care 2004; 13 (2) 102-112 , quiz 114–115
• 92 Celik S, Oztekin D, Akyolcu N, Işsever H. Sleep disturbance: the patient care activities applied at the night shift in the intensive care unit. J Clin Nurs 2005; 14 (1) 102-106
• 93 Le A, Friese RS, Hsu CH, Wynne JL, Rhee P, O'Keeffe T. Sleep disruptions and nocturnal nursing interactions in the intensive care unit. J Surg Res 2012; 177 (2) 310-314
• 94 Hacker ED, Patel P, Stainthorpe M. Sleep interrupted: nocturnal care disturbances following hematopoietic stem cell transplantation. Clin J Oncol Nurs 2013; 17 (5) 517-523
• 95 Roussos M, Parthasarathy S, Ayas NT. Can we improve sleep quality by changing the way we ventilate patients?. Lung 2010; 188 (1) 1-3
• 96 Parthasarathy S. Effects of sleep on patient-ventilator interaction. Respir Care Clin N Am 2005; 11 (2) 295-305
• 97 Parthasarathy S, Tobin MJ. Effect of ventilator mode on sleep quality in critically ill patients. Am J Respir Crit Care Med 2002; 166 (11) 1423-1429
• 98 Cabello B, Thille AW, Drouot X , et al. Sleep quality in mechanically ventilated patients: comparison of three ventilatory modes. Crit Care Med 2008; 36 (6) 1749-1755
• 99 Bosma K, Ferreyra G, Ambrogio C , et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med 2007; 35 (4) 1048-1054
• 100 Alexopoulou C, Kondili E, Plataki M, Georgopoulos D. Patient-ventilator synchrony and sleep quality with proportional assist and pressure support ventilation. Intensive Care Med 2013; 39 (6) 1040-1047
• 101 Delisle S, Ouellet P, Bellemare P, Tétrault JP, Arsenault P. Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes. Ann Intensive Care 2011; 1 (1) 42
• 102 Roche-Campo F, Thille AW, Drouot X , et al. Comparison of sleep quality with mechanical versus spontaneous ventilation during weaning of critically III tracheostomized patients. Crit Care Med 2013; 41 (7) 1637-1644
• 103 Flaherty JH. Insomnia among hospitalized older persons. Clin Geriatr Med 2008; 24 (1) 51-67 , vi
• 104 Dolan-Sewell RT, Riley WT, Hunt CE. NIH State-of-the-Science Conference on Chronic Insomnia. J Clin Sleep Med 2005; 1 (4) 335-336
• 105 Bourne RS, Mills GH. Sleep disruption in critically ill patients—pharmacological considerations. Anaesthesia 2004; 59 (4) 374-384
• 106 Schweitzer PK. Drugs that disturb sleep and wakefulness. In: Kryger MH, Roth T, Dement WC, , eds. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2011
• 107 Buysse D. Clinical pharmacology of other drugs used as hypnotics. In: Kryger MH, Roth T, Dement WC, , eds. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2011
• 108 Achermann P, Borbély AA. Dynamics of EEG slow wave activity during physiological sleep and after administration of benzodiazepine hypnotics. Hum Neurobiol 1987; 6 (3) 203-210
• 109 Borbély AA, Mattmann P, Loepfe M, Strauch I, Lehmann D. Effect of benzodiazepine hypnotics on all-night sleep EEG spectra. Hum Neurobiol 1985; 4 (3) 189-194
• 110 Morin CM, Koetter U, Bastien C, Ware JC, Wooten V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 2005; 28 (11) 1465-1471
• 111 Cronin AJ, Keifer JC, Davies MF, King TS, Bixler EO. Postoperative sleep disturbance: influences of opioids and pain in humans. Sleep 2001; 24 (1) 39-44
• 112 Kay DC, Eisenstein RB, Jasinski DR. Morphine effects on human REM state, waking state and NREM sleep. Psychopharmacology (Berl) 1969; 14 (5) 404-416
• 113 Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med 2007; 3 (1) 33-36
• 114 Wang D, Teichtahl H. Opioids, sleep architecture and sleep-disordered breathing. Sleep Med Rev 2007; 11 (1) 35-46
• 115 Kolla BP, Lovely JK, Mansukhani MP, Morgenthaler TI. Zolpidem is independently associated with increased risk of inpatient falls. J Hosp Med 2013; 8 (1) 1-6
• 116 Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005; 331 (7526) 1169
• 117 Zisberg A, Shadmi E, Sinoff G, Gur-Yaish N, Srulovici E, Shochat T. Hospitalization as a turning point for sleep medication use in older adults: prospective cohort study. Drugs Aging 2012; 29 (7) 565-576
• 118 Gehlbach BK, Chapotot F, Leproult R , et al. Temporal disorganization of circadian rhythmicity and sleep-wake regulation in mechanically ventilated patients receiving continuous intravenous sedation. Sleep 2012; 35 (8) 1105-1114
• 119 Hardin KA, Seyal M, Stewart T, Bonekat HW. Sleep in critically ill chemically paralyzed patients requiring mechanical ventilation. Chest 2006; 129 (6) 1468-1477
• 120 Oto J, Yamamoto K, Koike S, Imanaka H, Nishimura M. Effect of daily sedative interruption on sleep stages of mechanically ventilated patients receiving midazolam by infusion. Anaesth Intensive Care 2011; 39 (3) 392-400
• 121 Oto J, Yamamoto K, Koike S, Onodera M, Imanaka H, Nishimura M. Sleep quality of mechanically ventilated patients sedated with dexmedetomidine. Intensive Care Med 2012; 38 (12) 1982-1989
• 122 Kondili E, Alexopoulou C, Xirouchaki N, Georgopoulos D. Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study. Intensive Care Med 2012; 38 (10) 1640-1646
• 123 Barr J, Fraser GL, Puntillo K , et al; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41 (1) 263-306
• 124 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177 (9) 1006-1014
• 125 Hetzenecker A, Buchner S, Greimel T , et al. Cardiac workload in patients with sleep-disordered breathing early after acute myocardial infarction. Chest 2013; 143 (5) 1294-1301
• 126 Schober AK, Neurath MF, Harsch IA. Prevalence of sleep apnoea in diabetic patients. Clin Respir J 2011; 5 (3) 165-172
• 127 Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB. Investigating the relationship between stroke and obstructive sleep apnea. Stroke 1996; 27 (3) 401-407
• 128 Shahar E, Whitney CW, Redline S , et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163 (1) 19-25
• 129 Young T, Palta M, Dempsey J, Peppard PE, Nieto FJ, Hla KM. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. WMJ 2009; 108 (5) 246-249
• 130 Kuna ST, Gurubhagavatula I, Maislin G , et al. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med 2011; 183 (9) 1238-1244
• 131 Parthasarathy S, Wendel C, Haynes PL, Atwood C, Kuna S. A pilot study of CPAP adherence promotion by peer buddies with sleep apnea. J Clin Sleep Med 2013; 9 (6) 543-550
• 132 Lindenauer PK, Stefan MS, Johnson KG, Priya A, Pekow PS, Rothberg MB. Prevalence, treatment and outcomes associated with OSA among patients hospitalized with pneumonia. Chest 2014; 145 (5) 1032-1038
• 133 Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995; 96 (4) 1897-1904
• 134 Narkiewicz K, Montano N, Cogliati C, van de Borne PJ, Dyken ME, Somers VK. Altered cardiovascular variability in obstructive sleep apnea. Circulation 1998; 98 (11) 1071-1077
• 135 Wilczynska M, Rice S, Davies G, Lewis KE. Endothelial injury markers before and after nasal continuous positive airway pressure treatment for obstructive sleep apnoea hypopnoea syndrome. Sleep Breath 2013;
• 136 Koshino Y, Villarraga HR, Orban M , et al. Changes in left and right ventricular mechanics during the Mueller maneuver in healthy adults: a possible mechanism for abnormal cardiac function in patients with obstructive sleep apnea. Circ Cardiovasc Imaging 2010; 3 (3) 282-289
• 137 Sanner BM, Konermann M, Doberauer C, Weiss T, Zidek W. Sleep-Disordered breathing in patients referred for angina evaluation—association with left ventricular dysfunction. Clin Cardiol 2001; 24 (2) 146-150
• 138 Mooe T, Rabben T, Wiklund U, Franklin KA, Eriksson P. Sleep-disordered breathing in men with coronary artery disease. Chest 1996; 109 (3) 659-663
• 139 Schäfer H, Koehler U, Ewig S, Hasper E, Tasci S, Lüderitz B. Obstructive sleep apnea as a risk marker in coronary artery disease. Cardiology 1999; 92 (2) 79-84
• 140 Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 2002; 166 (2) 159-165
• 141 Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365 (9464) 1046-1053
• 142 Milleron O, Pillière R, Foucher A , et al. Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 2004; 25 (9) 728-734
• 143 Doherty LS, Kiely JL, Swan V, McNicholas WT. Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 2005; 127 (6) 2076-2084
• 144 Peker Y, Kraiczi H, Hedner J, Löth S, Johansson A, Bende M. An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J 1999; 14 (1) 179-184
• 145 Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009; 373 (9657) 82-93
• 146 Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation 2012; 126 (12) 1495-1510
• 147 Somers VK, White DP, Amin R , et al; American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology; American Heart Association Stroke Council; American Heart Association Council on Cardiovascular Nursing; American College of Cardiology Foundation. Sleep apnea and cardiovascular disease: an American Heart Association/American College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 2008; 118 (10) 1080-1111
• 148 Bitter T, Faber L, Hering D, Langer C, Horstkotte D, Oldenburg O. Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. Eur J Heart Fail 2009; 11 (6) 602-608
• 149 Yumino D, Wang H, Floras JS , et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail 2009; 15 (4) 279-285
• 150 Kaneko Y, Floras JS, Usui K , et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003; 348 (13) 1233-1241
• 151 Kasai T, Usui Y, Yoshioka T , et al; JASV Investigators. Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration. Circ Heart Fail 2010; 3 (1) 140-148
• 152 Joho S, Oda Y, Ushijima R, Hirai T, Inoue H. Effect of adaptive servoventilation on muscle sympathetic nerve activity in patients with chronic heart failure and central sleep apnea. J Card Fail 2012; 18 (10) 769-775
• 153 Dziewas R, Humpert M, Hopmann B , et al. Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims. J Neurol 2005; 252 (11) 1394-1398
• 154 Cherkassky T, Oksenberg A, Froom P, Ring H. Sleep-related breathing disorders and rehabilitation outcome of stroke patients: a prospective study. Am J Phys Med Rehabil 2003; 82 (6) 452-455
• 155 Turkington PM, Allgar V, Bamford J, Wanklyn P, Elliott MW. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months. Thorax 2004; 59 (5) 367-371
• 156 Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 2006; 37 (4) 967-972
• 157 Barlinn K, Alexandrov AV. Sleep-disordered breathing and arterial blood flow steal represent linked therapeutic targets in cerebral ischaemia. Int J Stroke 2011; 6 (1) 40-41
• 158 Martínez-García MA, Galiano-Blancart R, Román-Sánchez P, Soler-Cataluña JJ, Cabero-Salt L, Salcedo-Maiques E. Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest 2005; 128 (4) 2123-2129
• 159 Cormick W, Olson LG, Hensley MJ, Saunders NA. Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease. Thorax 1986; 41 (11) 846-854
• 160 López-Acevedo MN, Torres-Palacios A, Elena Ocasio-Tascón M, Campos-Santiago Z, Rodríguez-Cintrón W. Overlap syndrome: an indication for sleep studies? A pilot study. Sleep Breath 2009; 13 (4) 409-413
• 161 Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 1996; 109 (2) 380-386
• 162 Chaouat A, Weitzenblum E, Krieger J , et al. Prognostic value of lung function and pulmonary haemodynamics in OSA patients treated with CPAP. Eur Respir J 1999; 13 (5) 1091-1096
• 163 Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23 (6) 932-946
• 164 O'Donoghue FJ, Catcheside PG, Jordan AS, Bersten AD, McEvoy RD. Effect of CPAP on intrinsic PEEP, inspiratory effort, and lung volume in severe stable COPD. Thorax 2002; 57 (6) 533-539
• 165 Fessler HE, Brower RG, Permutt S. CPAP reduces inspiratory work more than dyspnea during hyperinflation with intrinsic PEEP. Chest 1995; 108 (2) 432-440
• 166 Appendini L, Patessio A, Zanaboni S , et al. Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994; 149 (5) 1069-1076
• 167 Gardner G, Collins C, Osborne S, Henderson A, Eastwood M. Creating a therapeutic environment: a non-randomised controlled trial of a quiet time intervention for patients in acute care. Int J Nurs Stud 2009; 46 (6) 778-786
• 168 Maidl CA, Leske JS, Garcia AE. The influence of “quiet time” for patients in critical care. Clin Nurs Res 2013;
• 169 Olson DM, Borel CO, Laskowitz DT, Moore DT, McConnell ES. Quiet time: a nursing intervention to promote sleep in neurocritical care units. Am J Crit Care 2001; 10 (2) 74-78
• 170 Faraklas I, Holt B, Tran S, Lin H, Saffle J, Cochran A. Impact of a nursing-driven sleep hygiene protocol on sleep quality. J Burn Care Res 2013; 34 (2) 249-254
• 171 Monsén MG, Edéll-Gustafsson UM. Noise and sleep disturbance factors before and after implementation of a behavioural modification programme. Intensive Crit Care Nurs 2005; 21 (4) 208-219
• 172 Richardson A, Allsop M, Coghill E, Turnock C. Earplugs and eye masks: do they improve critical care patients' sleep?. Nurs Crit Care 2007; 12 (6) 278-286
• 173 Scotto CJ, McClusky C, Spillan S, Kimmel J. Earplugs improve patients' subjective experience of sleep in critical care. Nurs Crit Care 2009; 14 (4) 180-184
• 174 Jones C, Dawson D. Eye masks and earplugs improve patient's perception of sleep. Nurs Crit Care 2012; 17 (5) 247-254
• 175 Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care 2012; 16 (3) R73
• 176 Wallace CJ, Robins J, Alvord LS, Walker JM. The effect of earplugs on sleep measures during exposure to simulated intensive care unit noise. Am J Crit Care 1999; 8 (4) 210-219
• 177 Hu RF, Jiang XY, Zeng YM, Chen XY, Zhang YH. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care 2010; 14 (2) R66
• 178 de Niet G, Tiemens B, Lendemeijer B, Hutschemaekers G. Music-assisted relaxation to improve sleep quality: meta-analysis. J Adv Nurs 2009; 65 (7) 1356-1364
• 179 Richards KC. Effect of a back massage and relaxation intervention on sleep in critically ill patients. Am J Crit Care 1998; 7 (4) 288-299
• 180 Chen JH, Chao YH, Lu SF, Shiung TF, Chao YF. The effectiveness of valerian acupressure on the sleep of ICU patients: a randomized clinical trial. Int J Nurs Stud 2012; 49 (8) 913-920
• 181 Moeini M, Khadibi M, Bekhradi R, Mahmoudian SA, Nazari F. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res 2010; 15 (4) 234-239
• 182 Li SY, Wang TJ, Vivienne Wu SF, Liang SY, Tung HH. Efficacy of controlling night-time noise and activities to improve patients' sleep quality in a surgical intensive care unit. J Clin Nurs 2011; 20 (3-4) 396-407
• 183 Foster J, Kelly M. A pilot study to test the feasibility of a nonpharmacologic intervention for the prevention of delirium in the medical intensive care unit. Clin Nurse Spec 2013; 27 (5) 231-238
• 184 Kahn DM, Cook TE, Carlisle CC, Nelson DL, Kramer NR, Millman RP. Identification and modification of environmental noise in an ICU setting. Chest 1998; 114 (2) 535-540
• 185 Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep adn delirium in medical and surgical intensive care patients. Anaesthesia 2014; 69 (6) 540-549
• 186 Tamrat R, Huynh-Le MP, Goyal M. Non-pharmacologic interventions to improve the sleep of hospitalized patients: a systematic review. J Gen Intern Med 2014; 29 (5) 788-795