Improving sleep in ICUs through real-time sleep monitoring: a proof-of-concept study

• Sleep alterations are frequent in ICU and associated with poor outcomes. • Nursing care during the night frequently disturb sleep. • Sleep monitoring system can inform caregivers when patients are asleep and awake. • Using a sleep monitoring system allows caregivers to postpone non urgent care. • Sleep monitoring system increases sleep quality and quantity. Sleep disturbances are associated with a poor prognosis in intensive care units (ICUs). Nursing care during the night can further disturb patient sleep. We hypothesized that nursing rounds and care would be less harmful to sleep if guided by a real-time sleep monitoring system. This was a quasi-experimental, prospective, before-after study including non-sedated ICU patients. In the usual care group (first group recruited), nursing rounds and care were performed every four hours as daily practice, regardless of the patient’s sleep/wake status. In the sleep-guided care group (second group recruited), nursing rounds and care were guided by a sleep-EEG monitoring system indicating the patient’s sleep status in real time on a tablet positioned at the entrance of the room. When patients fell asleep, the tablet displayed a symbol asking caregivers to postpone non-urgent care. Otherwise (patient awake), nursing care was encouraged. The number of room entries was measured using an entry-exit counter, synchronized with sleep-EEG recorder. The system stored EEG in both groups. Two experts, blind to the patients’ groups, provided consensual sleep scoring. Primary outcome was continuous sleep (i.e. time spent in long sleep episodes). Forty-six patients mainly admitted for acute respiratory failure (72% of cases) were analysed. Patients’ characteristics did not significantly differ between groups. The proportion of room entries while patients were asleep decreased from 22% 4–32 in usual care group to 6% 0−13 in sleep-guided care group (p = 0.015). Continuous sleep was longer in the sleep-guided care group (20 patients) compared to the usual care group (26 patients): 170 min 75–240 vs. 80 min 53–128 (p = 0.03). Deep sleep was likewise longer in the sleep-guided care group. Our study reports for the first time that real-time sleep monitoring can guide nursing care and improve sleep quality in ICUs.