Sleep quality and disruptive factors in intensive care units: A comparison between mechanically ventilated and spontaneously breathing patients

Abstract

Background Sleep disturbances are common in intensive care units (ICUs) and negatively impact patient outcomes. Understanding differences in sleep quality and disrupting factors between patients receiving mechanical ventilation (MV) and spontaneously breathing patients (SBP) is essential for improving ICU care. Aim To compare sleep quality and sleep-disrupting factors between patients receiving MV and SBP during their ICU stay. Study Design This observational study was conducted in a 16-bed ICU in T & uuml;rkiye. A total of 186 ICU patients (62 receiving MV and 124 SBP) were included. Sleep quality and disrupting factors were assessed using the Modified Freedman Sleep Quality Questionnaire (mFSQQ) and Richards-Campbell Sleep Questionnaire (RCSQ) at 24-h admission (T0) and pre-discharge (T1). Results Sleep quality scores were significantly lower in patients receiving MV than in SBP (p < 0.05). At T0, patients receiving MV experienced greater sleep disruptions due to pain and vital sign monitoring, while SBP had more disturbances from nursing interventions, medication administration and alarms (p < 0.05). By T1, sleep disturbances from pain, medical interventions and diagnostic procedures had significantly decreased in both groups (p < 0.05); however, environmental factors such as noise, lighting and staff conversations remained major disruptors. Repeated measures analysis showed a significant time effect for sleep disruptions from pain, nursing interventions, vital sign monitoring and medication administration (p < 0.001), while no time effect was found for noise, light or staff conversations. Conclusion Although patients receiving MV had lower sleep quality, ICU environmental factors were a major source of sleep fragmentation for all patients. These findings emphasise the need for ICU-wide and targeted interventions to optimise sleep quality. Relevance to Clinical Practice Implementing tailored sleep protocols and optimising ICU care can reduce sleep disruptions, enhance patient comfort and improve recovery by addressing both patient-specific and environmental factors.