Sleep Disturbance and Disorders within Adult Inpatient Rehabilitation Settings: A Systematic Review to Identify Both the Prevalence of Disorders and the Efficacy of Existing Interventions

"The Days Are Long But the Nights Are Even Longer": A Mixed-Method Study of Sleep Disturbances Among Patients in an Inpatient Rehabilitation Program

Objective

To assess sleep quality of patients on a rehabilitation ward and to identify staff practices and beliefs about management of sleep disturbance.

Design

Mixed-methods design including patient surveys and staff interviews.

Setting

Inpatient rehabilitation ward in a tertiary teaching hospital in Adelaide, Australia.

Participants

Of the 345 screened inpatients who had been in a mixed post-acute rehabilitation ward for at least 5 days, 120 (43% women) were included. The mean age was 67.7 years and the main admission reason was functional decline (40%). Patients with stroke or traumatic brain injury were excluded. Eleven (n = 11) staff (a mix of doctors, nurses, and allied health) were interviewed.

Main Outcome Measures

The surveys comprised of the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Flinders Fatigue Scale, and the Sleep Inertia Questionnaire. The survey results were compared with functional outcomes using the functional independence measure (FIM). Staff interviews delved into barriers to good sleep, ward practices, and knowledge about sleep hygiene.

Results

43% of the surveyed patients reported having healthy amount of sleep. Sleep quality was not significantly correlated with rehabilitation outcomes (assessed using FIM). Staff reported having a good awareness of sleep hygiene; however, acknowledged limitations about the environment and routine which were not conducive to healthy sleep. They identified several actions which could be taken to improve patients' sleep hygiene.

Conclusions

Sleep disturbance is common for patients in rehabilitation. Rehabilitation wards should address this often-neglected critical component of rehabilitation to improve patient experience and potential participation in therapy. Introducing a systematic approach for assessing sleep during admission, establishing clear roles regarding sleep assessment and intervention among staff, and ensuring that patients and staff are aware of good sleep hygiene practices may promote better sleep during inpatient rehabilitation.

Development and validation of a nomogram for postoperative sleep disturbance in adults: a prospective survey of 640 patients undergoing spinal surgery

BACKGROUND

Postoperative sleep disturbance (PSD) is a prevalent clinical complication that may arise due to various factors. The purpose of this investigation is to identify the risk factors for PSD in spinal surgery and establish a risk prediction nomogram.

METHODS

The clinical records of individuals who underwent spinal surgery from January 2020 to January 2021 were gathered prospectively. The least absolute shrinkage and selection operator (LASSO) regression, along with multivariate logistic regression analysis, was employed to establish independent risk factors. A nomogram prediction model was devised based on these factors. The nomogram's effectiveness was evaluated and verified via the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA).

RESULTS

A total of 640 patients who underwent spinal surgery were analyzed in this investigation, among which 393 patients experienced PSD with an incidence rate of 61.4%. After conducting LASSO regression and logistic regression analyses using R software on the variables in training set, 8 independent risk factors associated to PSD were identified, including female, preoperative sleep disorder, high preoperative anxiety score, high intraoperative bleeding volume, high postoperative pain score, dissatisfaction with ward sleep environment, non-use of dexmedetomidine and non-use of erector spinae plane block (ESPB). The nomogram and online dynamic nomogram were constructed after incorporating these variables. In the training and validation sets, the area under the curve (AUC) in the receiver operating characteristic (ROC) curves were 0.806 (0.768-0.844) and 0.755 (0.667-0.844), respectively. The calibration plots indicated that the mean absolute error (MAE) values in both sets were respectively 1.2% and 1.7%. The decision curve analysis demonstrated the model had a substantial net benefit within the range of threshold probabilities between 20% and 90%.

CONCLUSIONS

The nomogram model proposed in this study included eight frequently observed clinical factors and exhibited favorable accuracy and calibration.

TRIAL REGISTRATION

The study was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2200061257, 18/06/2022).

COVID-19 pandemic: demographic and clinical correlates of disturbed sleep among 6,041 Canadians

OBJECTIVES

Psychological burdens of the COVID-19 pandemic are likely to impact sleep negatively. We investigate prevalence and correlates of disturbed sleep among subscribers to Text4Hope a daily supportive text message program launched in Alberta to support residents to deal with stress, anxiety, and depression.

METHODS

A survey link was sent to Text4Hope subscribers to assess demographic and clinical variables, including disturbed sleep, stress, anxiety, and depression using the third question on the Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale, Generalised Anxiety Disorder 7-item scale, and PHQ-9, respectively. Data were analysed using univariate and logistic regression analyses.

RESULTS

Overall, 6041 out of 32,805 Text4Hope subscribers completed the survey (18.4% response rate). Prevalence of disturbed sleep was 77.8%. Subscribers aged 41-60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27-2.81). Individuals with moderate/high anxiety and stress symptoms and those with passive death wish/suicidal ideation had higher probability for sleep disturbance [(OR 4.05, 95% CI: 3.33-4.93), (OR 2.42, 95% CI: 1.99-2.94), and (OR 2.39, 95% CI: 1.69-3.38)], respectively.

CONCLUSION

As the pandemic continues, more Canadians are likely to develop sleep problems, an important consideration for planning mental health services.KEY POINTSThis is the first study to examine the prevalence rates and demographic and clinical correlates of disturbed sleep in a large sample (n = 6041) of Canadians during the COVID-19 pandemic.Prevalence of disturbed sleep was high at 77.8%.Individuals aged 41-60 years were twice as likely to present with sleep disturbance compared to individuals ≤25 years (OR 1.89, 95% CI: 1.27-2.81).Individuals with moderate/high anxiety symptoms, moderate/high stress symptoms, and suicidal ideation/thoughts of self-harm had higher likelihood of developing sleep disturbance, compared to individuals lacking these symptoms [(OR 4.05, 95% CI: 3.33-4.93) and (OR 2.42, 95% CI: 1.98-2.94)], respectively.As the pandemic continues, with fear of multiple waves, more Canadians are likely to develop sleep problems, an important consideration for planning the provision of mental health services.

The Impact of Sleep Disorders on Functional Recovery and Participation Following Stroke: A Systematic Review and Meta-Analysis

Background

Adequate sleep is vital for health and quality of life. People with stroke and a concomitant sleep disorder may have poorer outcomes than those without a sleep disorder.

Objective

To systematically evaluate the published literature to determine the impact of sleep disorders on physical, functional recovery at the activity and participation level after stroke.

Methods

A systematic review was conducted using PubMed, CINAHL, Scopus, and PsycINFO. Studies were selected that reported outcomes on physical, functional recovery at the activity and participation levels in participants with stroke and a diagnosed sleep disorder. A meta-analysis was performed on included studies that reported Barthel Index (BI) and modified Rankin Scale (mRS) scores. Results: A total of 33 studies were included in the systematic review with 9 of them in the meta-analysis. The mean mRS score was 0.51 points higher in participants with stroke and sleep disorders versus participants with stroke without sleep disorder [95% CI: 0.23-0.78]. The mean BI score was 10.2 points lower in participants with stroke and sleep disorders versus participants with stroke without sleep disorder [95% CI: −17.9 to −2.6].

Conclusions

People with stroke and a sleep disorder have greater functional limitations and disability than those without a sleep disorder. Rehabilitation professionals should screen their patients with stroke for potential sleep disorders and further research is needed to develop sleep and rehabilitation interventions that can be delivered in combination. PROSPERO registration number: CRD42019125562.