Sleep in Acute Care Settings: An Integrative Review

PURPOSE: To report an integrative review about sleep patterns, factors that influence sleep, and sleep interventions in acutely ill hospitalized adults; discuss methodological challenges associated with studying sleep in this population; and propose future research. ORGANIZING FRAMEWORK: Research literature on sleep patterns of acutely ill hospitalized adults, obtained using computerized searches of Medline and CINAHL, was reviewed. Studies of patients on intensive care and medical-surgical units conducted in a range of health disciplines over a span of almost 30 years were included. Studies were organized into the following categories: descriptive studies of sleep using objective and subjective measures; correlational studies of personal, health status, and environmental variables and sleep; and intervention studies. FINDINGS: Sleep disturbance is a common but highly variable experience during acute care hospitalization. Multiple personal, health status, and environmental factors are related to sleep disturbance. Behavioral interventions show promise as a means to modify factors related to sleep. Few studies have shown the outcomes of sleep disturbance in acute care settings. CONCLUSIONS: More systematic research is needed to determine correlates of sleep disturbance in acutely ill hospitalized adults. Such studies can help investigators to identify patients who are most at risk for sleep disturbance and to provide the theoretical and conceptual bases for sleep-promoting interventions. Methodological challenges include characteristics of acute care patients and hospital environments, as well as the complexity of measuring sleep.