Sleep medication and sedative use in Dutch intensive care units: a nationwide survey

Background: Intensive care patients often suffer from short, fragmented and low-quality sleep. Poor sleep can cause prolonged mechanical ventilation, delirium and deranged metabolic function. Sound scientific evidence for sleep-promoting treatments is lacking. Benzodiazepines, which are frequently used to treat sleep disturbances, may themselves have a disruptive effect on sleep. This survey describes the current practice of treating sleep disturbances in Dutch intensive care units (ICUs). Methods: For this retrospective cross-sectional survey, we visited Dutch ICUs and used a structured case report form. The primary outcome was the frequency of use of sleep-promoting medication. Secondary outcomes were: type of sleep medication, non-pharmacological treatments, exposure to environmental factors and the presence of protocols on the promotion of sleep. Results: 279 patients from 21 ICUs where included. Of 225 patients who did not receive continuous deep sedation at night, 76 (33.8%) received sleep-promoting medication. Benzodiazepines and zopiclone were most commonly used (60/225, 26.7%). Men received more sleep medication than women. Exposure to mechanical ventilation, noise, patient age and access to an entertainment system did not influence the likelihood of receiving sleep medication. Of the 21 ICUs, 16 had a protocol on sleep disturbances of which 13 advised benzodiazepines. Conclusion: 33.8% of the patients in our survey received at least one sleep-promoting drug, most commonly a benzodiazepine. Nearly all evaluated ICU protocols on sleep promotion advised the use of benzodiazepines. More research on optimal sleep-promoting therapies is needed.