Patient–Ventilator Interaction During Sleep

Sleep in the ICU is subjectively and objectively poor. Patients in the ICU have short sleep duration and highly fragmented sleep. Poor sleep in the ICU is associated with worse outcomes, particularly the development of ICU delirium. Patients undergoing noninvasive or invasive mechanical ventilation struggle with sleep. For those patients on noninvasive ventilation, settings may need to be adjusted compared to wake to account for the physiological changes that occur with the sleep state. Specifically, upper airway collapsibility (ie, obstructive sleep apnea) must be considered as do changes in respiratory muscle function and ventilatory control. During invasive mechanical ventilation, ventilator dyssynchrony can contribute to sleep fragmentation and reduced sleep quantity and quality. Excessive ventilator support can lead to periodic breathing, whereas insufficient support can lead to fragmented sleep from excessive work of breathing. Although much work remains to be done, attention to ventilator mode and settings might improve sleep and outcomes in those with critical illness and respiratory failure.