Multidisciplinary approaches including nursing care to improve sleep in critically ill patients: a review

Introduction:
The aim was to analyze pharmacological and non-pharmacological methods for improving sleep parameters in adult patients hospitalized in intensive care units (ICU) during the perioperative period.

Material and methods:
We formulated the research question based on the PICO(TS) framework: population – ICU patients > 18, regardless of sedation level; interventions – pharmacological and non-pharmacological methods aimed at enhancing sleep or reducing circadian rhythm disturbances; comparison – no intervention/comparison between two interventions; outcome – changes in quantitative and qualitative indicators of sleep and circadian rhythm. We searched the PubMed, EBSCO, Polish Medical Bibliography, Cochrane databases, and medical publishers’ resources from 2015 to 2024. The following keywords were used in combination: “circadian rhythm” or “circadian rhythm disorders” or “circadian dysregulation” and “ICU” or “intensive care unit”.

Results:
The initial search yielded 442 citations, of which 12 studies were included in the final analysis. The analysis covered 577 postoperative ICU patients, including 443 subjected to non-pharmacological sleep-improving interventions (light exposure, use of eye masks and/or earplugs, listening to relaxing music, modification of hospital environment and sleep-disturbing factors, and combined interventions) and 134 after pharmacological interventions (melatonin, ramelteon, or dexmedetomidine).

Conclusions:
This review confirmed that both environmental and pharmacological interventions improve sleep quality in ICU patients, but no clear superiority of either approach was demonstrated. Sleep disturbances in the ICU are multifactorial, so effective improvement requires a comprehensive medical team approach, including optimization of the environment, pharmacotherapy, and medical procedures. Despite challenges related to life-saving measures, the role of nurses in protecting and promoting patients’ sleep is increasingly important.