A multicentre point prevalence study of nocturnal hours awake and enteral pharmacological sleep aids in patients admitted to Australian and New Zealand intensive care units

Laurie Showler; Adam M Deane; Edward Litton; Melissa J Ankravs; Bradley Wibrow; Deborah Barge; Jeremy Goldin; Naomi Hammond; Manoj K Saxena; Paul J Young; Bala Venkatesh; Mark Finnis; Yasmine Ali Abdelhamid

doi:10.1016/j.ccrj.2024.06.009

A multicentre point prevalence study of nocturnal hours awake and enteral pharmacological sleep aids in patients admitted to Australian and New Zealand intensive care units

Crit Care Resusc. 2024 Jul 31;26(3):192-197. doi: 10.1016/j.ccrj.2024.06.009. eCollection 2024 Sep.

Authors

Laurie Showler^{1

2}, Adam M Deane^{1

2}, Edward Litton^{3

4}, Melissa J Ankravs^{1

2

5}, Bradley Wibrow^{3

6}, Deborah Barge^{1

2}, Jeremy Goldin^{1

7}, Naomi Hammond^{8

9}, Manoj K Saxena^{9

10}, Paul J Young^{9

11

12

13}, Bala Venkatesh^{9

14

15

16

17}, Mark Finnis^{1

13

18

19}, Yasmine Ali Abdelhamid^{1

2}

Affiliations

¹ Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.
² Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
³ University of Western Australia, Perth, Western Australia, Australia.
⁴ Department of Intensive Care, Fiona Stanley Hospital, Western Australia, Australia.
⁵ Department of Pharmacy, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁶ Department of Intensive Care, Sir Charles Gairdner Hospital, Western Australia, Australia.
⁷ Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁸ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
⁹ Critical Care Program, The George Institute for Global Health, UNSW Sydney, Barangaroo, New South Wales, Australia.
¹⁰ Department of Intensive Care, Saint George Hospital, New South Wales, Australia.
¹¹ Department of Intensive Care, Wellington Hospital, Wellington, New Zealand.
¹² Medical Research Institute of New Zealand, Wellington, New Zealand.
¹³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.
¹⁴ Department of Intensive Care, Princess Alexander Hospital, Queensland, Australia.
¹⁵ Department of Intensive Care, Wesley Hospital, Auchenflower, Queensland, Australia.
¹⁶ University of Queensland, Brisbane, Queensland, Australia.
¹⁷ University of New South Wales, Kennington, New South Wales, Australia.
¹⁸ University of Adelaide, Adelaide, South Australia, Australia.
¹⁹ Department of Intensive Care, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Abstract

Objective: Critically ill patients suffer disrupted sleep. Hypnotic medications may improve sleep; however, local epidemiological data regarding the amount of nocturnal time awake and the use of such medications is needed.

Design: Point prevalence study.

Setting: Adult ICUs in Australia and New Zealand.

Participants: All adult patients admitted to participating Intensive Care Units (ICUs) on the study day.

Main outcome measures: Time awake overnight (22:00-06:00) was determined by structured nurse observation. The use of enterally administered sedative-hypnotic drugs prior to and during ICU admission was recorded, as was the use of a unit policy and non-pharmacological sleep promotion strategies.

Results: Data were available for 532 patients admitted to 40 ICUs (median age 60 years, 336 (63.2%) male, and 222 (41.7%) invasively ventilated). Forty-eight patients (9.0%) received an enteral pharmacological sleep aid, of which melatonin (28, 5.2%) was most frequently used. Patients not invasively ventilated were observed to be awake overnight for a median of 4.0 h (interquartile range (IQR): 2.5, 5.5), with no difference in those receiving an enteral hypnotic (p = 0.9). Non-pharmacological sleep aids were reportedly not offered or available for 52% (earplugs) and 63% of patients (eye masks). Only 7 (17.5%) participating ICUs had a policy informing sleep-optimising interventions.

Conclusions: Patients not receiving invasive ventilation appeared to spend many nocturnal hours awake. Pharmacological sleep aid administration was not associated with a greater observed time asleep. Most patients did not receive any non-pharmacological aid, and most ICUs did not have a local guideline or unit policy on sleep promotion.

Keywords: Critical illness; Hypnotics and sedatives; Melatonin; Sleep; Sleep-wake disorders.