Management of sleep disturbances in the ICU: a secondary analysis of the ESPRIT study

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BACKGROUND: Sleep disturbances are frequent in the intensive care unit (ICU) and are associated with delirium or delayed mechanical ventilation weaning. Although international guidelines recommend structured screening and non-pharmacological management, their implementation in daily practice is poorly reported. This study aimed to evaluate the prevalence, screening practices, and management strategies for sleep disturbances in French ICUs. METHODS: This was a secondary analysis of the ESPRIT study, a national, multicenter, cross-sectional study conducted in 128 ICUs. All adult patients admitted on the study day were eligible. Data on unit-level practices and patient-level disturbances were collected. Sleep disturbances were identified by bedside physician. A multivariable multilevel logistic regression identified factors independently associated with sleep disturbances. RESULTS: Among 1,361 patients, 445 (33%) were reported to have sleep disturbances. Only 18% of ICUs conducted routine screening, and no center had implemented a multicomponent protocol. Environmental measures such as light and noise reduction were common, whereas earplugs 51/128 (40%) and eye masks 18/128 (14%) were rarely used. Pharmacological treatments were given to 219 patients (16%), mainly Z-drugs and hydroxyzine. In multivariable analysis, overnight family presence (OR 2.06 [1.12-3.81], p = 0.021) and physical restraints (OR 2.26 [1.39-3.70], p = 0.001) were independently associated with increased risk of sleep disturbances. Optimization of nursing tasks was the only intervention that tended to reduce sleep disturbances (OR 0.57 [0.31-1.04], p = 0.069). CONCLUSION: Sleep disturbances are common in ICUs, yet routine screening and structured management remain rare. Standardized, nurse-led screening and broader adoption of non-pharmacological protocols are needed to improve sleep quality and patient outcomes.