(1464) Impact of a Pharmacist-Led Sleep Bundle Intervention in the Critically Ill

Introduction: Sleep in the intensive care unit (ICU) is often fragmented with the proportion of time spent in deep sleep lower than in healthy individuals. Poor sleep affects many ICU patients and is associated with increased delirium, anxiety, and prolonged mechanical ventilation. Fitness trackers have the capability to evaluate objective sleep measures. While commercially available fitness trackers have assessed total sleep time in non-intubated patients, this has not been evaluated in mechanically ventilated critically ill patients. This study tested the feasibility of tracking sleep with FitBits in this patient population.

Methods: This was a single center, prospective observational feasibility study at the University of Kentucky Chandler Medical Center, a 945-bed quaternary care academic medical center in Lexington, Kentucky. Adult patients ≥ 18 years old admitted to the Medical Intensive Care Unit (MICU) from January 2022 to February 2024 on mechanical ventilation receiving propofol were screened for the first phase of the study. Patients were excluded if they were on extracorporeal membrane oxygenation, tested positive for Covid-19, receiving neuromuscular blockade, death anticipated in next 48 hours or on a sleep aid prior to admission. The pre-intervention arm observed sleep time utilizing a FitBit under normal standard of care procedures in the MICU.

Results: During the study period, fifteen patients were enrolled in the pre-intervention group. The primary reason for patient exclusion was that the patient was not mechanically ventilated. The patients in this first phase had a median of 420 minutes (IQR 250 – 741) of sleep per study day. The median REM sleep per day was 70 minutes (IQR 35 – 137), 210 minutes (IQR 171 – 542) of light sleep, and 66 minutes (IQR 24 – 97) of deep sleep. Two patients had at least one day of delirium documented.

Conclusions: In this pre-intervention arm, a total of fifteen critically ill patients in the MICU had a median sleep duration of 420 minutes under normal institutional care. This phase further validates that sleep duration and quality is affected in critical illness. The post-intervention phase is ongoing to assess the impact of a sleep bundle on sleep in the ICU.