Sleep Patterns and Quality Among Inpatients Recovering From Elective Surgery: A Mixed-Method Study

Effects of Footbath on Pain, Anxiety, Sleep, and Comfort Levels in Patients With Postlaparoscopic Cholecystectomy: A Randomized Controlled Study

PURPOSE

The aim of the study is to determine the effect of of hot footbaths on the pain, anxiety, sleep, and comfort levels of patients who underwent laparoscopic cholecystectomy.

DESIGN

The study is a randomized controlled designed.

METHODS

This study was conducted in surgery clinic of a university hospital between January 2022 and November 2022. The research was completed with 54 patients in the experimental group and 54 patients in the control group.

FINDINGS

The mean state anxiety score and VAS-Sleep score of the patients in the experimental group 120 minutes after the application was 31.07±4.70 and 612.62±82.37, respectively, which was statistically significantly lower than that of the patients in the control group (P<0.05). On the other hand, at the 120th minutes after the application, the mean VAS-Comfort scores of the patients in the experimental group were statistically significantly higher than those of the patients in the control group (P<0.05). A positive relationship was found between the mean VAS-Pain and VAS-Sleep scores of the patients in the experimental group, and a significant negative relationship was found between the mean VAS-Comfort and state anxiety scores.

CONCLUSIONS

Foot bath is effective in reducing the pain and anxiety levels of patients undergoing laparoscopic cholecystectomy surgery.

Assessment of Perioperative Sleep Characteristics Using Subjective and Objective Methods: A Secondary Analysis of Prospective Cohort Study

Perioperative sleep disturbances may impact healing and negatively affect the patient's perception of well-being. Therefore, accurately assessing postoperative sleep characteristics is necessary to treat sleep disturbances. This study is a secondary data analysis of research investigating the association between sleep and cognition in a perioperative setting. This study compares sleep characteristics between the St. Mary's Hospital Sleep Questionnaire and WatchPAT, a portable sleep apnea testing device. The goal of this study is to compare an objective measurement of sleep quality (WatchPAT) with a traditional questionnaire. One hundred and one patients who underwent elective, noncardiac surgical procedures wore a WatchPAT and completed the St. Mary's Hospital Sleep Questionnaire for three nights: two preoperative and one postoperative night. In the preoperative period, a Bland-Altman analysis showed an agreement Watch PAT and the St Mary's hospital sleep questionnaire except for sleep fragmentation. A good to fair correlation during the preoperative period was observed with both sleep latency and total sleep time. In the postoperative period, no correlation was observed between the St. Mary's Hospital Sleep Questionnaire data and WatchPAT data. Our study indicates that some potential factors affecting sleep and cognition such as admission type, depression, anesthesia type, and sleep apnea may limit patients' ability to report their sleep characteristics after surgery. Therefore, relying solely on one sleep assessment method is not advisable.

Society of Anesthesia and Sleep Medicine Position Paper on Patient Sleep During Hospitalization

This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it.

Sleep in hospitalized pediatric and adult patients – A systematic review and meta-analysis

Background

Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing.

Objective

The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors.

Methods

A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep’ and 'hospitalization’. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines.

Results

Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6–1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep.

Conclusion

Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7–3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3–3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery.

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An overview of the magnitude of sleep deprivation in hospitalized patients.

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A meta-analysis of studies reporting on some of the main sleep outcomes.

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An overview of internal and external factors affecting sleep in hospitalized patients.

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Guidance for potential interventions to improve sleep during clinical admission.

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Uncovers a knowledge gap regarding the sleep quality of hospitalized children and daytime sleep of hospitalized adults.

Evaluation of Preoperative Sleep Quality and Factors Affecting Pain Intensity of Patients Hospitalized in Surgical Services

PURPOSE

The aim of this study was to determine the preoperative sleep quality and pain intensity of patients hospitalized in the surgical services of a university hospital, and to evaluate the relationship between sleep quality and pain intensity and the factors affecting it.

DESIGN

The study was a descriptive cross-sectional study.

METHODS

The study was conducted on 139 patients over the age of 18 who were hospitalized in the surgical services of Eskişehir Osmangazi University Health Practice and Research Hospital between March 1, 2019 and July 31, 2019, and agreed to participate in the study. The "Visual Analog Scale for Pain (VASP)" was used to evaluate the pain intensity of the patients, and the "Visual Analog Sleep Scale (VASS)" to determine the quality of sleep.

FINDINGS

The sleep quality of women, those who had sleep problems before hospitalization and those who had sleep problems in the preoperative period was worse (P <.001). Patients who had a companion and had sleep problems in the preoperative period had higher pain levels (P <.001 for each). As the pain levels of the patients increased, their sleep quality deteriorated (P <.001). Multiple linear regression analysis revealed that for each unit increase in the variable of having sleep problems in the preoperative period increases the VASS score by 180.422 points and the VASP score by 1.788. Being a woman increased the VASS score by 91.469 points, and the presence of a companion increased the VASP score by 1.644 points.

CONCLUSIONS

The preopertive sleep quality and pain intensity of surgery patients were interrelated. Having sleep problems in the preoperative period affected both the sleep quality and pain intensity of the patients. While female gender affected the sleep quality of the patients hospitalized in surgical services, the presence of a companion was found to affect the severity of pain.