title: Positive and negative effects of mechanical ventilation on sleep in the ICU: a review with clinical recommendations.
abstract: OBJECTIVE
  Sleep is an essential physiologic process that helps to restore normal body homeostasis. Sleep disturbances have been shown to be associated with poor clinical outcomes, such as a greater risk of cardiovascular disease and increasing mortality. Critically ill patients, particularly those receiving mechanical ventilation, may be more susceptible to sleep disruption.
  
  
  RESULTS
  Mechanical ventilation is an important factor influencing sleep in critically ill patients as it may have positive or negative effects, depending on patient population, mode, and specific settings. Other causes of sleep disruption include the acute illness itself, the daily routine care, and the effects of medications. Improving sleep in patients admitted to an intensive care unit has the potential to improve both short- and long-term clinical outcomes. In this article we review the specific aspects of sleep in critically ill mechanically ventilated patients, including abnormal sleep patterns and loss of circadian rhythm, as well as the effects of mechanical ventilation and intravenous sedatives on sleep quality and quantity.
  
  
  CONCLUSIONS
  We provide recommendations for clinicians regarding optimal ventilatory settings and discuss fields for future research.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.|Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.|Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
authors.forename: Nuttapol
authors.initials: N
authors.lastname: Rittayamai
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.|Division of Respirology (Critical Care), Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wilcox
authors.affiliation: CHU de Poitiers, Service de Neurophysiologie Clinique, Poitiers, France.|Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France.|INSERM CIC 1402, Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Drouot
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.|Department of Medicine, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.|Division of Respirology (Critical Care), Department of Medicine, University Health Network, Toronto, Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Goffi
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. BrochardL@smh.ca.|Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. BrochardL@smh.ca.|Department of Medicine, University of Toronto, Toronto, Canada. BrochardL@smh.ca.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D016638:Critical Illness; D020920:Dyssomnias / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000009:adverse effects*
keywords: Intensive care unit; Mechanical ventilation; Noninvasive ventilation; Sedatives; Sleep