Improving Sleep Quality for Critically Ill Patients in a Cardiovascular Intensive Care Unit

Background: Intensive care unit (ICU) care entails the need to continually interact with the patient for medically necessary assessments and interruptions creating increased levels in noise during sleeping hours. Sleep deprivation is harmful to critically ill patients leading to increased hospital length of stay, changes in their cognition, and numerous other physiologic consequences. It is not well characterized how ICU noise impacts the patient experience leading to poor sleep quality. We propose a quality improvement study to identify the correlation between sleep quality and noise in the ICU.Methods: This was a Prospective Quality Improvement Cohort Study.Patients were enrolled after admission to a 20-bed cardiovascular intensive care unit (CVICU), at a single center, following cardiac and vascular surgeries. Participating patients had a decibel meter placed in their room. Noise levels were measured continuously in decibels (dB) between 2200 and 0500 The primary outcome was patient-reported sleep quality. Sleep quality was measured by administering the Richards-Campbell Sleep Questionnaire (RCSQ) the following morning. Standard descriptive statistics were applied, and pairwise correlations were conducted to compare patient RCSQ scores with changes in noise level.Results: Data was collected from 14 patients during the study period. The majority were monitored for ൒2 nights. There were 33 RCSQ completed overall with most patients completing 2 RCSQ. An average of 31 interruptions of at least a change of 15 dBs per second per night (2200 to 0500) for each patient. The correlation of these with the total RCSQ score was 0.0166 (p = <.93). The maximum sound level was 115.2 dBs, the lowest levels was 34 dBs, and the average sound level was 52.9 dBs.Conclusions: This was the initial stage in a multi-staged sleep quality improvement study. The next step in this phased study is to implement interventions to reduce noise to promote sleep quality. This study demonstrates that this ICU is well above the recommended noise levels made by the WHO and Environmental Protection agency. We also demonstrated that noise levels are highly variable with 31 interruptions of 15 dB/second which have a higher potential to wake ICU patients compared high levels of sustained noise, but at this time more research is needed. Given this finding, we propose that variations in noise may be more likely to cause poor sleep quality rather than continuous elevated noise levels