title: Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series analysis.
abstract: BACKGROUND
  Delirium in critically-ill patients is a common multifactorial disorder that is associated with various negative outcomes. It is assumed that sleep disturbances can result in an increased risk of delirium. This study hypothesized that implementing a protocol that reduces overall nocturnal sound levels improves quality of sleep and reduces the incidence of delirium in Intensive Care Unit (ICU) patients.
  
  
  METHODS
  This interrupted time series study was performed in an adult mixed medical and surgical 24-bed ICU. A pre-intervention group of 211 patients was compared with a post-intervention group of 210 patients after implementation of a nocturnal sound-reduction protocol. Primary outcome measures were incidence of delirium, measured by the Intensive Care Delirium Screening Checklist (ICDSC) and quality of sleep, measured by the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcome measures were use of sleep-inducing medication, delirium treatment medication, and patient-perceived nocturnal noise.
  
  
  RESULTS
  A significant difference in slope in the percentage of delirium was observed between the pre- and post-intervention periods (-3.7% per time period, p=0.02). Quality of sleep was unaffected (0.3 per time period, p=0.85). The post-intervention group used significantly less sleep-inducing medication (p<0.001). Nocturnal noise rating improved after intervention (median: 65, IQR: 50-80 versus 70, IQR: 60-80, p=0.02).
  
  
  CONCLUSIONS
  The incidence of delirium in ICU patients was significantly reduced after implementation of a nocturnal sound-reduction protocol. However, reported sleep quality did not improve.
authors.affiliation: St. Antonius Hospital, Nieuwegein, the Netherlands. Electronic address: i.van.de.pol@antoniusziekenhuis.nl.
authors.forename: Ineke
authors.initials: I
authors.lastname: van de Pol
authors.affiliation: St. Antonius Hospital, Nieuwegein, the Netherlands. Electronic address: m.van.iterson@antoniusziekenhuis.nl.
authors.forename: Mat
authors.initials: M
authors.lastname: van Iterson
authors.affiliation: ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, Academic Medical Center and University of Amsterdam, the Netherlands. Electronic address: j.m.maaskant@amc.uva.nl.
authors.forename: Jolanda
authors.initials: J
authors.lastname: Maaskant
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D016638:Critical Illness / Q000523:psychology; D003693:Delirium / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009622:Noise / Q000009:adverse effects*; D012890:Sleep
keywords: Delirium; Intensive care unit; Noise; Sleep; Sound