{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:57:18Z","timestamp":1792112238966,"version":"4.4.0"},"reference-count":48,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Background: The Society of Critical Care Medicine Clinical Practice Guidelines for Management of Pain, Agitation, Delirium, Immobility, and Sleep recommend protocolized non-pharmacologic sleep improvement. Pharmacologic interventions are frequently initiated to promote sleep but the evidence supporting these strategies remains controversial. Purpose: To systematically search and synthesize evidence evaluating pharmacologic sleep promotion modalities in critically ill adults. Methods: A rapid systematic review protocol was used to search Medline, Cochrane Library, and Embase for reports published through October 2022. We included randomized controlled trials (RCTs) and before-and-after cohort studies evaluating pharmacologic modalities intended to improve sleep in adult intensive care unit (ICU) patients. Sleep-related endpoints were the primary outcome of interest. Study and patient characteristics and relevant safety and non-sleep outcome data were also collected. The Cochrane Collaboration Risk of Bias or Risk of Bias in Non-Randomized Studies of Interventions were used to assess the risk of bias for all included studies. Results: Sixteen studies (75% RCTs) enrolling 2573 patients were included; 1207 patients were allocated to the pharmacologic sleep intervention. Most studies utilized dexmedetomidine (7\/16; total n\u2009=\u2009505 patients) or a melatonin agonist (6\/16; total n\u2009=\u2009592 patients). Only half of the studies incorporated a sleep promotion protocol as standard of care. Most (11\/16, 68.8%) studies demonstrated a significant improvement in \u22651 sleep endpoint (n\u2009=\u20095 dexmedetomidine, n\u2009=\u20093 melatonin agonists, n\u2009=\u20092 propofol\/benzodiazepines). Risk of bias was generally low for RCTs and moderate-severe for cohort studies. Conclusions: Dexmedetomidine and melatonin agonists are the most studied pharmacologic sleep promotion modalities, but current evidence does not support their routine administration in the ICU to improve sleep. Future RCTs evaluating pharmacologic modalities for ICU sleep should consider patients\u2019 baseline and ICU risks for disrupted sleep, incorporate a non-pharmacologic sleep improvement protocol, and evaluate the effect of these medication interventions on circadian rhythm, physiologic sleep, patient-perceived sleep quality, and delirium.<\/jats:p>","DOI":"10.1177\/08850666231186747","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T02:34:11Z","timestamp":1688524451000},"page":"28-43","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["A Rapid Systematic Review of Pharmacologic Sleep Promotion Modalities in the Intensive Care Unit"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-7685","authenticated-orcid":false,"given":"Mojdeh S.","family":"Heavner","sequence":"first","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia R.","family":"Louzon","sequence":"additional","affiliation":[{"name":"Critical Care and Emergency Department, AdventHealth Orlando, Orlando, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1210-1082","authenticated-orcid":false,"given":"Emily F.","family":"Gorman","sequence":"additional","affiliation":[{"name":"Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin M.","family":"Landolf","sequence":"additional","affiliation":[{"name":"Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA"},{"name":"University of Maryland Medical Center, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Ventura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AdventHealth Orlando, Orlando, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Devlin","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA"},{"name":"Northeastern University, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,7,4]]},"reference":[{"key":"bibr1-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000463"},{"key":"bibr2-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-06447-0_4"},{"key":"bibr3-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004405"},{"key":"bibr4-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003259"},{"key":"bibr5-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182746442"},{"key":"bibr6-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1177\/1060028020973198"},{"key":"bibr7-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1177\/10600280211043278"},{"key":"bibr8-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000367"},{"key":"bibr9-08850666231186747","doi-asserted-by":"publisher","DOI":"10.2147\/NSS.S284846"},{"key":"bibr10-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-06447-0_9"},{"key":"bibr11-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202301-0184ST"},{"key":"bibr12-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-06447-0_7"},{"key":"bibr13-08850666231186747","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-06447-0_15"},{"key":"bibr14-08850666231186747","unstructured":"Covidence systematic review software, veritas health innovation, Melbourne, Australia. 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