Acta anaesthesiologica ScandinavicaJul 21, 2015

Sleep and confusion in awake patients in the intensive care unit

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Updated Mar 30, 2026

Abstract

Only one of the four delirium-free patients showed identifiable sleep on polysomnography (PSG).

Sleep was disrupted in mechanically ventilated ICU patients with loss of circadian rhythm and diminished REM sleep.
In patients with delirium, atypical PSGs were observed, making sleep quantification impossible.
Clinical total sleep time (ClinTST) ranged from 2.0 to 13.1 hours in patients without delirium, with a median of 8.5 hours.
Four patients were deemed unassessable using the confusion assessment method for the intensive care unit (CAM-ICU) due to unresponsiveness.
Paroxystic EEG activity occurred frequently in unsedated patients who were unresponsive to voice, though its significance remains unclear.

Simplified

BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients.

METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients. Delirium assessment was done using the confusion assessment method for the intensive care unit (CAM-ICU).

RESULTS: Of four patients who were delirium free, only one had identifiable sleep on PSG. Sleep was disrupted with loss of circadian rhythm, and diminished REM sleep. In the remaining three patients the PSGs were atypical, meaning that no sleep signs were found, and sleep could not be quantified from the PSGs. Clinical total sleep time (ClinTST) ranged from 2.0-13.1 h in patients without delirium. Six patients with delirium all had atypical PSGs, so sleep could not be quantified. Short periods of REM sleep were found. ClinTST was median 8.5 h (range 0.4-13.8 h). EEG reactivity and wakefulness was found in all but one PSG. Four patients were CAM-ICU "unassessable" (unresponsive to voice). PSGs were atypical without reactivity or wakefulness, even though clinical wakefulness was documented. ClinTST was median 18.3 h (range 3.7-19.8 h). Paroxystic EEG activity was found in this subgroup.

CONCLUSIONS: The objective signs of sleep were absent in all but one PSG, so even though patients were not sedated, sleep could not be quantified. Even in patients without delirium, sleep could only be quantified in one of four patients. Paroxystic activity is frequent in unsedated patients, unresponsive to voice, but the implication is unknown.

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Sleep and confusion in awake patients in the intensive care unit

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