Sleep and Activity Patterns Are Altered During Early Critical Illness in Mechanically Ventilated Adults.
Cindy L Munro, Zhan Liang, Maya N Elías and 3 others
PMID 33560633WHAT IT FOUND
Mechanically ventilated ICU adults spent 6.6 hours asleep at night, but daytime activity was only 66.5% of 24-hour activity and most hourly counts fell below resting thresholds.
Nighttime movement and low daytime activity point to disrupted sleep-wake patterns.
Key findings
01Over five ICU days, mean nighttime sleep efficiency was 83.1% ± 16.1% and mean total sleep time was 6.6 ± 1.3 hours.
02Mean daytime activity ratio was 66.5% ± 19.2%, and only 17.5% of days (14 of 80) had a ratio above 80%.
03Most hourly activity counts were below 1000 counts/hour, under the 1140 counts/hour threshold associated with lying down resting, and higher counts clustered around 11:00-12:00, 17:00-18:00, and 21:00-22:00.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
The analysed sample was small: 31 mechanically ventilated adults. This was a descriptive subset analysis with no control group and no test of whether sleep or activity patterns caused poor outcomes. Day 1 hourly activity counts were excluded, so the first ICU day after enrollment was not fully described. Actigraphy estimates sleep from wrist immobility and can overestimate total sleep time in mechanically ventilated ICU patients. Activity counts cannot distinguish purposeful movement from movement caused by nursing care, repositioning, or non-purposeful motion. There are no published accepted cutpoints for mean activity counts in mechanically ventilated ICU patients, so the meaning of the counts is uncertain.
Declared interests
The authors report no conflicts of interest. The data came from a parent NIH-funded R01 trial.
The easy way to misread this
Do not read these actigraphy patterns as proof that early mobility or sleep interventions improve ICU outcomes. This was a small descriptive subset with no comparison group, and activity counts may reflect nursing care rather than patient movement.