Non-pharmacological interventions to improve sleep quality and quantity for hospitalized adult patients-co-produced study with surgical patient partners: systematic review

BACKGROUND

Hospitalized patients experience sleep disruption with consequential physiological and psychological effects. Surgical patients are particularly at risk due to surgical stress and postoperative pain. This systematic review aimed to identify non-pharmacological interventions for improving sleep and exploring their effects on sleep-related and clinical outcomes.

METHODS

A systematic literature search was performed in accordance with PRISMA guidelines and was preregistered on the Open Science Framework (doi: 10.17605/OSF.IO/EA6BN) and last updated in November 2023. Studies that evaluated non-pharmacological interventions for hospitalized, adult patients were included. Thematic content analysis was performed to identify hypothesized mechanisms of action and modes of administration, in collaboration with a patient partner. Risk of bias assessment was performed using the Cochrane Risk Of Bias (ROB) or Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools.

RESULTS

A total of 59 eligible studies and data from 14 035 patients were included; 28 (47.5%) were randomized trials and 26 included surgical patients (10 trials). Thirteen unique non-pharmacological interventions were identified, 17 sleep measures and 7 linked health-related outcomes. Thematic analysis revealed two major themes for improving sleep in hospital inpatients: enhancing the sleep environment and utilizing relaxation and mindfulness techniques. Two methods of administration, self-administered and carer-administered, were identified. Environmental interventions, such as physical aids, and relaxation interventions, including aromatherapy, showed benefits to sleep measures. There was a lack of standardized sleep measurement and an overall moderate to high risk of bias across all studies.

CONCLUSIONS

This systematic review has identified several sleep interventions that are likely to benefit adult surgical patients, but there remains a lack of high-quality evidence to support their routine implementation.

The HUSH Project: Using codesign to reduce sleep disruptions for patients in hospital

BACKGROUND

Poor quality sleep in hospitals may be problematic for patients, negatively impacting their recovery and wellbeing. This project aimed to investigate the effectiveness of codesign in addressing key issues affecting sleep disruption in the healthcare setting.

METHODS

Codesign with patients, staff and consumer representatives was conducted in an acute metropolitan tertiary public hospital in Sydney, Australia. Through a four-stage process, a multimodal intervention to address and reduce the impact of sleep disruptions among hospital inpatients was created. Pre- and post-intervention evaluation was used to determine changes in patient-reported sleep disruption.

RESULTS

'The HUSH Project' (Help Us Support Healing) intervention resulted from the codesign process, which included the provision of HUSH Sleep Packs (with earplugs, eye masks and herbal tea), patient information resources, and ward-based Sleep Champions. Survey data from 210 patients revealed a statistically significant decrease in patient-reported noise disturbances for patients in shared rooms following the 4-week intervention period of the HUSH program.

CONCLUSION

The HUSH Project demonstrated that a novel multimodal intervention may be valuable in reducing sleep disruption in hospitals. These findings also indicate the benefits of using codesign methodology to support improvement projects that seek to enhance patient experiences of care.

PATIENT OR PUBLIC CONTRIBUTION

This project utilised codesign methodology, which involved significant contributions from patients and consumer representatives, from research conceptualisation into intervention design, implementation and project evaluation.

The effect of audiobooks on sleep quality and vital signs in intensive care patients

OBJECTIVE

Improving sleep quality in the intensive care unit is significant for the recovery process. This study investigated the effect of listening to audiobooks on sleep quality and vital signs in intensive care patients.

METHODS

This quasi-experimental study utilized the pre-posttest design, involving control and intervention groups. The study was conducted in the internal medicine intensive care unit of a hospital in Turkey between January-June 2022. Standard nursing care was given to both groups on the first night, and the Sleep Evaluation Form and Richard Campbell Sleep Scale were used to measure sleep quality in the morning. On the second day, the intervention group listened to a recorded story, and the control group had standard care. Sleep quality and vital signs were measured again.

RESULTS

Data from 56 participants were analyzed. Noise (96.4%), light (69.6%), unfamiliar environment (64.8%), concerns about illness (33.9%), and care and treatments (58.9%) are the main causes of sleep disruption. The effect of these factors decreased in the intervention group after the Audiobook Listening Practice, which significantly improved the sleep quality of the ICU patients (p < 0.001). Among the vital signs, a significant difference was found in pulse and blood pressure (p < 0.001), while no changes were observed in temperature and respiratory rate in time group interaction (p > 0.05).

CONCLUSIONS

The Audiobook Listening Practice improved sleep quality and life parameters in the ICU. Nurses can use the practice to improve sleep quality in intensive care units.

IMPLICATIONS FOR CLINICAL PRACTICE

Evidence-based studies are needed to improve the sleep quality of patients in intensive care units, to ensure clinical improvement, and to reduce the length of stay at hospital. The practice is effective in manipulating environmental stressors. This low-cost method significantly improves patient care activities. It is recommended to integrate such complementary activities into intensive care units, to train nurses about the practice, and to support the practice with new studies.

"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.

The effectiveness of non-pharmacological sleep interventions for improving inpatient sleep in hospital: A systematic review and meta-analysis

BACKGROUND

Sleep disturbance is common in hospital. The hospital environment can have a negative impact on sleep quality, through factors such as noise, light, temperature, and nursing care disruptions. Poor sleep can lead to delays in recovery, wound healing, and increase risk of post-operative infection.

METHODS

We conducted a systematic review evaluating the effectiveness of non-pharmacological sleep interventions for improving inpatient sleep. The primary outcome was sleep quality, the secondary outcome was length of hospital stay, the harm outcome was adverse events. MEDLINE, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception to 17^th February 2022. Meta-analysis was conducted using a fixed effects model, with narrative synthesis for studies with no useable data. Risk of bias was assessed with the Cochrane tool.

RESULTS

76 studies identified with 5375 people randomised comparing 85 interventions. Interventions focused on physical sleep aids (n = 26), relaxation (n = 25), manual therapy (n = 12), music (n = 9), psychological therapy (n = 5), light therapy (n = 3), sleep protocols (n = 2), milk and honey (n = 1), exercise (n = 1), and nursing care (n = 1). In meta-analysis, medium to large improvements in sleep quality were noted for sleep aids, relaxation, music, and manual therapies. Results were generally consistent in studies at lower risk of bias. Length of hospital stay and adverse events were reported for some studies, with benefit in some trials but this was not consistent across all interventions.

CONCLUSIONS

Physical sleep aids, relaxation, manual therapy and music interventions have a strong evidence base for improving inpatient sleep quality. Research is needed to evaluate how to optimise interventions into routine care.

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.

Evaluation of Nonpharmacologic Interventions and Sleep Outcomes in Hospitalized Medical and Surgical Patients: A Nonrandomized Controlled Trial

IMPORTANCE

Inadequate sleep negatively affects patients' physical health, mental well-being, and recovery. Nonpharmacologic interventions are recommended as first-choice treatment. However, studies evaluating the interventions are often of poor quality and show equivocal results.

OBJECTIVE

To assess whether the implementation of nonpharmacologic interventions is associated with improved inpatient night sleep.

DESIGN, SETTING, AND PARTICIPANTS

In a nonrandomized controlled trial, patients were recruited on the acute medical unit and medical and surgical wards of a Dutch academic hospital. All adults who spent exactly 1 full night in the hospital were recruited between September 1, 2019, and May 31, 2020 (control group), received usual care. Patients recruited between September 1, 2020, and May 31, 2021, served as the intervention group. The intervention group received earplugs, an eye mask, and aromatherapy. Nurses received sleep-hygiene training, and in the acute medical unit, the morning medication and vital sign measurement rounds were postponed from the night shift to the day shift. All interventions were developed in collaboration with patients, nurses, and physicians.

MAIN OUTCOMES AND MEASURES

Sleep was measured using actigraphy and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System sleep disturbance item bank. Other outcomes included patient-reported sleep disturbing factors and the use of sleep-enhancing tools.

RESULTS

A total of 374 patients were included (222 control, 152 intervention; median age, 65 [IQR, 52-74] years). Of these, 331 were included in the analysis (195 [59%] men). Most patients (138 [77%] control, 127 [84%] intervention) were in the acute medical unit. The total sleep time was 40 minutes longer in the intervention group (control: median, 6 hours and 5 minutes [IQR, 4 hours and 55 minutes to 7 hours and 4 minutes]; intervention: 6 hours and 45 minutes [IQR, 5 hours and 47 minutes to 7 hours and 39 minutes]; P < .001). This was mainly due to a 30-minute delay in final wake time (median clock-time: control, 6:30 am [IQR, 6:00 am to 7:22 am]; intervention, 7:00 am [IQR, 6:30-7:30 am]; P < .001). Sleep quality did not differ significantly between groups. For both groups, the main sleep-disturbing factors were noises, pain, toilet visits, and being awakened by hospital staff. Sleep masks (23 of 147 [16%]) and earplugs (17 of 147 [12%]) were used most. Nightly vital sign checks decreased significantly (control: 54%; intervention: 11%; P < .001).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that sleep of hospitalized patients may be significantly improved with nonpharmacologic interventions. Postponement of morning vital sign checks and medication administration rounds from the night to the day shift may be a useful way to achieve this.

TRIAL REGISTRATION

Netherlands Trial Registry Identifier: NL7995.

Sleep Spindles and K-Complexes Are Favorable Prognostic Biomarkers in Critically Ill Patients

SUMMARY

In this narrative review, we summarize recent research on the prognostic significance of biomarkers of sleep in continuous EEG and polysomnographic recordings in intensive care unit patients. Recent studies show the EEG biosignatures of non-rapid eye movement 2 sleep (sleep spindles and K-complexes) on continuous EEG in critically ill patients better predict functional outcomes and mortality than the ictal-interictal continuum patterns. Emergence of more complex and better organized sleep architecture has been shown to parallel neurocognitive recovery and correlate with functional outcomes in traumatic brain injury and strokes. Particularly interesting are studies which suggest intravenous dexmedetomidine may induce a more biomimetic non-rapid eye movement sleep state than intravenous propofol, potentially providing more restorative sleep and lessening delirium. Protocols to improve intensive care unit sleep and neurophysiological studies evaluating the effect of these on sleep and sleep architecture are here reviewed.

Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients

Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.

The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study

Background

Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being.

Objective

We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift.

Methods

Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights’ sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post–overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls.

Results

In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights’ sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI –0.90 to –0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI –0.81 to –0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores.

Conclusions

Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions’ effect on other populations of shift workers’ post–night shift alertness, users’ long-term physical and mental health, and patient outcomes.

Sleep improvement intervention and its effect on patients' sleep on the ward

AIM AND OBJECTIVE

The aim of the study was to investigate how the sleep improvement interventions developed for the wards were associated with patients' sleep. The objective was to promote patients' sleep.

BACKGROUND

The quality of sleep is vital for patients' health and recovery from illness. However, patients generally sleep poorly during hospitalisation. Sleep-disturbing factors are connected to the hospital environment, patients' physical illness, emotional state and the activities of the staff. Many sleep-disturbing factors can be influenced by appropriate nursing interventions.

DESIGN

A two-group intervention study including the development of nursing interventions aimed at supporting patients' sleep. One group received a sleep promotion intervention and the other received standard care. Both groups evaluated their sleep in the morning.

METHODS

A survey of participants' sleep evaluations was collected with the five-item Richards-Campbell Sleep Questionnaire. The data were analysed statistically. The STROBE checklist was used to report the study.

RESULTS

From the participants' perspective, sleep was better in the intervention group, even though statistically significantly only among men. The pain intensity correlated with sleep quality. The number of patients in the room or whether participants had had an operation had no effect on their sleep evaluations.

CONCLUSIONS

Interventions targeted at supporting and promoting the sleep quality of hospital inpatients may be effective. They should be developed in collaboration with patients and nurses. Several nursing interventions can be proposed to promote better sleep among patients; however, more research is needed to confirm the results. Sleep promotion should include both standardised protocols and individualised sleep support.

RELEVANCE TO CLINICAL PRACTICE

Investing in nursing interventions to promote patients' sleep is important. Patients' individual sleep-related needs should be part of their care plan. Training programmes that support nurses' knowledge and skills of patients' sleep promotion should be part of nursing education in healthcare organisations.

Effect of the use of earplugs and eye masks on the quality of sleep after major abdominal surgery: a randomised controlled trial

Significant sleep disturbance can occur following major abdominal surgery. We aimed to evaluate the effectiveness of earplugs and eye masks in improving sleep quality and patient satisfaction, reducing nursing demands and in the incidence of delirium in patients after major abdominal surgery. We conducted a randomised controlled trial in 100 patients undergoing major abdominal surgery. We randomly allocated participants to sleep with or without earplugs and eye masks on postoperative days 1-3. The primary outcome measure was sleep quality as measured by the Richards-Campbell Sleep Questionnaire. Secondary outcomes were patient satisfaction, frequency of nursing demand and incidence of delirium measured by the Neelon and Champagne Confusion Scale. Median (IQR [range]) sleep scores were 64 (38-74 [0-100] and 60 (44-82 [18-100]) for the control and intervention groups, respectively (p = 0.310). Age and Pittsburgh Sleep Quality Index scores were found to be significant factors affecting sleep quality. There were no differences in patient satisfaction, reduction in frequency of nursing demands or incidence of delirium on postoperative days 1-3 after major abdominal surgery. The compliance rate in the intervention group was 60-65%. This study has demonstrated that the use of earplugs and eye masks did not contribute to improvements in sleep quality. Of note, sleep quality was moderate, with higher age and worse baseline sleep quality contributing to worse sleep scores. More studies are needed to investigate interventions to improve sleep quality after major abdominal surgery.

The Impact of Nonpharmacological Interventions on Sleep Quality Among Older Adult Patients in the Intensive Care Unit

Sleep is a basic human need that is required for good health and overall well-being. Adequate sleep is critical for cognitive functioning, memory consolidation, and emotional regulation by rejuvenating the body. Sleep may not be of significant concern unless it becomes lacking or disturbed as it alters the immune function, neurological processes, and intellectual and decision making of individuals. Hospitalized older adults are particularly vulnerable for the negative impact of poor sleep due to reduced physiological reserve and comorbidities. The purpose of this review is to appraise current evidence on nonpharmacological sleep interventions to promote better sleep quality and overall health outcomes among the general adult and older patients in the intensive care unit compared with no intervention at all. The findings of this integrative review will be useful in designing and implementing interdisciplinary plans of care that promote the use of nonpharmacological sleep protocols within the hospital setting.

The Efficacy of Eye Masks and Earplugs Interventions for Sleep Promotion in Critically Ill Patients: A Systematic Review and Meta-Analysis

Using physical devices such as eye masks and earplugs to improve to the quality of sleep in intensive care units (ICUs) is a very important issue. This study was conducted to assess the efficacy of eye masks and earplugs for sleep promotion in critically ill adult patients in the ICU based on various sleep quality assessment tools. PubMed, Scopus, Web of Science, and ProQuest were systematically retrieved until May 2021. Both randomized and non-randomized experimental and quasi-experimental studies were included if they evaluated the efficacy of eye masks and earplugs interventions on sleep outcomes in critically ill patients. The methodological quality was assessed by the Joanna Briggs Institute (JBI) critical appraisal tool. For the main outcome (sleep quality), a mean difference (MD) and confidence intervals (CIs) of 95% were determined. A total of 2,687 participants from 35 studies met the inclusion criteria. Twenty one studies were included in meta-analysis and 14 studies were included in the qualitative analysis. According to the results based on sleep quality assessment tools; overall scores of Pittsburgh Sleep Quality Index (PSQI) and Richards-Campbell Sleep Questionnaire (RCSQ), eye mask and/or earplug interventions have a positive effect on sleep quality. Based on Verran-Snyder-Halpern Sleep Scale (VSHSS), sleep disturbance was significantly lower in the intervention groups. In terms of polysomnography, the use of eye masks and/or earplugs resulted in a significant increase in total sleep time, sleep efficiency, rapid eye movement (REM) time, significant reduction of awaking, and sleep arousals index. The results of the present study suggest that the use of earplugs or eye masks, separately or combined affects sleep improvement in critically ill patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145830, PROSPERO: CRD42020145830.

Sleep Promotion among Critically Ill Patients: Earplugs/Eye Mask versus Ocean Sound-A Randomized Controlled Trial Study

BACKGROUND

Poor sleep quality is common in the intensive care unit (ICU), where several factors including environmental factors contribute to sleep deprivation.

OBJECTIVE

This study aims to assess and compare the effectiveness of earplugs and eye mask versus ocean sound on sleep quality among ICU patients.

DESIGN

A true experimental crossover design was used. Setting. Medical ICU of the Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana, India. Participants. Sixty-eight patients admitted in the medical ICU were randomly allocated by lottery methods into group 1 and group 2.

METHODS

Nocturnal nine-hour (10 : 00 pm to 7 : 00 am) for a four-night period were measured. Earplugs and eye mask versus ocean sound were crossed over between two groups. Subjective sleep quality of four nights was assessed using a structured sleep quality scale. Scores for each question range from 0 to 3, with a higher score indicating poor sleep quality.

RESULTS

Repeated measures ANOVA showed that there was a significant change in the sleep quality score (p=0.001), which showed that sleep quality score was improved after the administration of earplugs and eye mask and ocean sound. Fisher's LSD post hoc comparison showed a significant difference (p=0.001).

CONCLUSION

Earplugs and eye mask were better than ocean sound in improving sleep quality. Earplugs, eye mask, and ocean sound are safe and cost effective, which could be used as an adjuvant to pharmacological interventions to improve sleep quality among ICU patients. However, further research in this area needs to be conducted. This trial is registered with NCT03215212.

Sleep problems worsen health-related quality of life and participation during the first 12 months of stroke rehabilitation

OBJECTIVE

Evaluate the impact of self-reported sleep problems on post-stroke recovery.

DESIGN

Cross-sectional secondary analysis of longitudinal data from the Locomotor Experience Applied Post-Stroke (LEAPS) rehabilitation and recovery study (phase-III single-blind randomized controlled clinical trial). Group medians were compared for three sleep problem groups across three time points.

SETTING

Outpatient and in-home physical therapy.

SUBJECTS

Adults during the first year following stroke (n = 408, 380, 360 at 2, 6, 12 months, respectively).

INTERVENTIONS

The original study compared effects of locomotor training with body weight support in the year post-stroke. This analysis evaluated function in three sleep/functional-impact groups: no sleep problems, sleep problems with no-to-minimal-impact and sleep problems with moderate-to-quite-a-bit of impact.

MAIN MEASURES

Participants' responses regarding if they had "a sleep problem, such as insomnia" and, if so, what the impact was on their function. Stroke Impact Scale subscales for strength, hand function, mobility, ADLs, memory, communication, emotion, participation, and percent recovery.

RESULTS

About 25% of people with stroke reported sleep difficulty, 10% perceived sleep problems negatively impact function. Groups self-reporting worse sleep performed worse in all functional subscales (except self-perceived percent recovery) during the first year post-stroke.

CONCLUSION

Self-reported poor sleep adversely effects post-stroke functional recovery.

Sleep quality among orthopaedic patients in Denmark - A nationwide cross-sectional study

BACKGROUND

Hospitalised patients sleep less and have a lower quality of sleep compared to patients who recover in their own home. Low sleep quality is associated with complications such as increased pain sensation, delirium and reduced rehabilitation capacity.

PURPOSE

To investigate patients' self-reported sleep quality and factors related to sleep quality during admission to a department of Orthopaedic Surgery.

METHODS

The Richard-Campbell Sleep Questionnaire was used to assess patients' sleep quality, measured using a VAS 0-100 scale, (a higher score indicating good sleep quality). The moderated Pittsburgh Sleep Quality Index assessed the most severe and frequent barriers to high sleep quality.

RESULTS

A total of 533 patients undergoing orthopaedic surgery participated. There was an overall mean sleep quality score of 54. The most common and severe factors impacting sleep quality were; waking during the night, difficulties falling asleep, waking early, waking for toileting or pain. The intensity of the pain was found to be proportional to the quality of sleep.

CONCLUSION

Patients reported their overall quality of sleep to be moderately good due to difficulties falling asleep, waking up during the night or early morning and having pain. The results call for better pain management and non-pharmacological nursing interventions to optimise sleep quality.