The Nexus Between Sleep Disturbance and Delirium Among Intensive Care Patients

Sleep disturbance and delirium have a variety of negative sequelae having an impact on patient outcomes, inclusive of physiologic and somatic effects. It is unclear, however, if sleep disturbance leads to delirium, or if delirium is the precipitating cause of sleep disturbance among intensive care patients. The bidirectional relationship between sleep disturbance and delirium may be attributed to their neurobiological effects, which have an impact on the function of the prefrontal cortex. Neurohormonal changes exhibited in sleep disturbance and delirium are identified to affect the dopaminergic systems, leading to alterations in acetylcholine levels, which are important for attention, motor activity, and memory. Nonpharmacologic interventions that have endeavored to address sleep disturbance may have a concurrent positive effect on reducing incidences and duration of delirium, because they seek to normalize the sleep-wake patterns through reduced exposure to light and noise disturbance. Effective clinical management for both sleep disturbance and delirium may require a combination of interventions to reduce the adverse effects of the clinical environment, whereby the regulation and normalization of sleep-wake patterns may exert important clinical effects in reducing incidences of delirium.