Sleep in Critical Illness: Future Directions

Sleep deficiency, including circadian disruption, is pervasive in patients admitted to the intensive care unit (ICU). However, sleep is critically important to human health, and leveraging the tremendous potential of sleep promotion to improve critical care outcomes is a goal of ICU clinicians and investigators alike. The risks and mechanisms for ICU sleep and circadian disruption are numerous and include broad categories of patient, environmental, and acute illness factors. However, methodologic limitations, particularly the lack of feasible and rigorous sleep measures, have slowed research progress and limited evidence in support of sleep interventions. Many questions remain regarding the natural history of sleep disruption during the acute and recovery phases of critical illness. Furthermore, it is uncertain which aspects of sleep during critical illness are most tightly linked to patient outcomes. Thus, multicomponent bundles which attempt to address the diverse factors causing ICU sleep disruption are complex, challenging to implement, and possibly focused on domains of ICU sleep disruption that are less relevant to improving critical illness outcomes. With the advent of novel measurement technologies, investigators are poised to overcome the listed challenges, answer these key questions, and translate the promise of ICU sleep promotion into clinical practice.