Sleep in the intensive care unit: Sleepy doctors and restless patients

This review focuses on the adverse effects of sleep derangements on physicians and patients in the intensive care unit. Recent evidence suggests that the complexity and level of care delivered in the intensive care unit (ICU) has outstripped a trainee's ability to forego sleep and is compromising both physician and patient safety and thereby threatens the foundation of the profession. Sleepy physicians are not only more capable of committing medical errors, but are also more likely to suffer motor vehicle crashes, workplace conflicts, and occupational injuries. Moreover, critically ill patients may suffer from sleep derangements due to a host of factors that includes mechanical ventilation, ICU noise levels, and healthcare activities, although a majority of sleep disturbances in this population are as yet unexplained. Besides suffering at the hands of sleepy physicians, critically ill patients may experience adverse outcomes due to severe sleep derangements during their ICU stay. In conclusion, both critically ill patients and intensive care physicians are susceptible to sleep deprivation and derangements that may ultimately adversely influence patient outcomes. Administrators of an ICU need to be cognizant of the effect of sleep, or lack thereof, on patient and physician safety. Researchers in the areas of sleep medicine and critical care need to collaborate on furthering our understanding of this emerging area of study.