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Mansour W, Knauert MP. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Sleep Med Clin 2024; 19:607-623. [PMID: 39455181 DOI: 10.1016/j.jsmc.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2024]
Abstract
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.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa P Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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Koshy K, Gibney M, O'Driscoll DM, Ogeil RP, Young AC. Factors affecting sleep quality in hospitalised patients. Sleep Breath 2024:10.1007/s11325-024-03144-8. [PMID: 39243288 DOI: 10.1007/s11325-024-03144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/04/2024] [Accepted: 08/14/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Hospitalised patients are at increased risk of poor sleep quality which can negatively impact on recovery and quality of life. This study aimed to assess sleep quality in hospitalised patients and explore the factors associated with poor sleep. METHODS Prospective data were collected from 84 respiratory ward inpatients at time of discharge using a Likert scale questionnaire on contributing factors to sleep quality. Differences between groups reporting good and poor quality sleep were recorded. RESULTS Most participants (77%) described inpatient sleep quality to be worse or much worse compared to their home environment. Noise (39%), checking of vital signs (33%) and light (24%) were most frequently identified as factors disrupting sleep. Binary logistic regression analysis demonstrated that men (OR 2.8, CI 1.1-7.4, p = 0.037) and those in shared rooms (OR 3.9, CI 1.4-10.9, p = 0.009) were more likely to be affected by noise. Younger patients (OR 0.92, CI 0.88-0.96, p < 0.001) and those in shared rooms (OR 8.5 CI 1.9-37.9, p < 0.001) were more likely to be affected by light. CONCLUSION In conclusion, a high proportion of hospitalised respiratory patients on a medical ward reported poorer sleep quality compared to home due to operational interruptions and noise. Age, gender and room type further modified the sleep disruption. Future research should focus on whether strategies to reduce interruptions and noise will improve sleep quality and clinical outcomes.
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Affiliation(s)
- Kavya Koshy
- Department of Respiratory and Sleep Medicine, Box Hill Hospital, Box Hill, VIC, Australia.
| | - Matthew Gibney
- Department of Respiratory and Sleep Medicine, Box Hill Hospital, Box Hill, VIC, Australia
| | - Denise M O'Driscoll
- Department of Respiratory and Sleep Medicine, Box Hill Hospital, Box Hill, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Rowan P Ogeil
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Turning Point, Eastern Health, Melbourne, VIC, Australia
| | - Alan C Young
- Department of Respiratory and Sleep Medicine, Box Hill Hospital, Box Hill, VIC, Australia.
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.
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Rinehart MC, Ghorashi S, Heavner MS, Tata A, Bathula M, Kelly S, Yeung SYA, Landolf K, So JY, Goel N, Grover BE. Reprint of: An assessment of a sleep aid and sleep promotion practices in hospitalized medical patients. J Am Pharm Assoc (2003) 2024; 64:102182. [PMID: 39152979 DOI: 10.1016/j.japh.2024.102182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/14/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Half of patients admitted to medicine units report sleep disruption, which increases the risk of sleep deprivation. Non-pharmacological interventions are the first step to improving sleep. However, utilization of sleep aids continues to be prevalent. Limited data are available on sleep aid prescribing practices across transitions of care. OBJECTIVES The aim of this study was to describe the current practices for assessing sleep and prescribing pharmacologic agents to promote sleep in the adult medicine population. METHODS This study was designed as a single-center, retrospective, observational cohort study of all patients discharged by the general medicine teams over a 3-month period (September 2019- November 2019). Prior to admission, inpatient and discharge prescriptions for sleep aids were recorded, and documentation of sleep assessments and non-pharmacological interventions were evaluated. RESULTS Of 754 patients included, 211 (28%) were prescribed a sleep aid while inpatient. During hospitalization, 124 (16%) patients had at least one documented sleep assessment, and only 22 (3%) were ordered the institutional non-pharmacological sleep promotion order set. The most prescribed sleep aid in inpatients was melatonin (50%), as well as prior to admission (35%) and at discharge (25%). Overall, the relative reduction in sleep aid prescriptions between admission and discharge was 67%. CONCLUSION Inpatient sleep aid prescribing is common in medical patients. Despite this, sleep assessments and the standard of care of non-pharmacological interventions are rarely utilized. Future efforts should focus on implementation of strategies to make sleep assessments and non-pharmacological sleep promotion routine and consistent in the inpatient setting.
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Leclerc C, Gervais C, Hjeij D, Briand MM, Williamson D, Bernard F, Duclos C, Arbour C. Sleep Disruptions in Hospitalized Adults Sustaining a Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2024; 39:E201-E215. [PMID: 37767918 DOI: 10.1097/htr.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Adults sustaining a traumatic brain injury (TBI) are at risk of sleep disturbances during their recovery, including when such an injury requires hospitalization. However, the sleep-wake profile, and internal and external factors that may interfere with sleep initiation/maintenance in hospitalized TBI patients are poorly understood. This review aimed to: (1) identify/summarize the existing evidence regarding sleep and sleep measurements in TBI adults receiving around-the-clock care in a hospital or during inpatient rehabilitation, and (2) identify internal/external factors linked to poor sleep in this context. METHODS A scoping review was conducted in accordance with the PRISMA Scoping Review Extension guidelines. A search was conducted in MEDLINE, PsycINFO, CINAHL, and Web of Science databases. RESULTS Thirty relevant studies were identified. The most common sleep variables that were put forth in the studies to characterize sleep during hospitalization were nighttime sleep time (mean = 6.5 hours; range: 5.2-8.9 hours), wake after sleep onset (87.1 minutes; range: 30.4-180 minutes), and sleep efficiency (mean = 72.9%; range: 33%-96%) using mainly actigraphy, polysomnography, and questionnaires (eg, the sleep-wake disturbance item of the Delirium Rating Scale or the Pittsburgh Sleep Quality Index). Twenty-four studies (80%) suggested that hospitalized TBI patients do not get sufficient nighttime sleep, based on the general recommendations for adults (7-9 hours per night). Sleep disruptions during hospitalization were found to be associated to several internal factors including TBI severity, cognitive status, and analgesia intake. External and modifiable factors, such as noise, light, and patient care, were consistently associated with sleep disruptions in this context. CONCLUSION Although the literature on sleep disturbances in hospitalized TBI patients has been increasing in recent years, many gaps in knowledge remain, including phenotypes and risk factors. Identifying these factors could help clinicians better understand the multiple sources of TBI patients' sleep difficulties and intervene accordingly.
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Affiliation(s)
- Catherine Leclerc
- Author Affiliations: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada (Mss Leclerc and Hjeij, Mr Gervais, and Drs Williamson, Bernard, Duclos, and Arbour); Department of Psychology, Université de Montréal, Montréal, Québec, Canada (Ms Leclerc and Mr Gervais); Faculty of Medicine (Drs Briand and Bernard), Faculty of Pharmacy (Dr Williamson), and Faculty of Nursing (Dr Arbour), Université de Montréal, Montréal, Québec, Canada; Division of Trauma Research, Departments of Surgery and of Neurological Sciences, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada (Drs Briand, Bernard, Duclos, and Arbour); and Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada (Dr Duclos)
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Steverson T, Marsden J, Blake J. The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10) in post-acute patients with stroke. Clin Rehabil 2024; 38:944-954. [PMID: 38439657 PMCID: PMC11118775 DOI: 10.1177/02692155241236602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores. SETTING A post-acute stroke rehabilitation ward in the East of England. PARTICIPANTS A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia. MAIN MEASURES Alongside the CORE-10, the Patient Health Questionnaire - 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures. RESULTS To assess reliability, the internal consistency and test-retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test-retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach's alpha) for the CORE-10 was .80, and test-retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported. CONCLUSIONS This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.
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Affiliation(s)
| | | | - Joshua Blake
- University of East Anglia, UK
- Norfolk Community Health and Care NHS Trust, UK
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van der Perk CJ, Burger P, Maaskant J, Gemke RJBJ. Parents' Experiences and Perspectives of Their Child's Sleep Quality During Hospitalization. Clin Pediatr (Phila) 2024; 63:755-763. [PMID: 37496367 PMCID: PMC11103915 DOI: 10.1177/00099228231188223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements.
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Affiliation(s)
- Cor-Jan van der Perk
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pia Burger
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jolanda Maaskant
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud J. B. J. Gemke
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Jensen PS, Specht K, Mainz H. Orthopaedic patients' experiences of their sleep during hospitalisation and suggestions for improvements. Int J Orthop Trauma Nurs 2024; 53:101056. [PMID: 37863721 DOI: 10.1016/j.ijotn.2023.101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE To describe orthopaedic patients' perspectives on their sleep quality and their suggestions for improvement initiatives to achieve better sleep quality during hospitalisation. METHODS In a qualitative design, 265 (50%) of 533 patients from a questionnaire survey responded to two free-text questions. Data were analysed based on a phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory of narrative and interpretation. RESULTS Three themes emerged: 1) Sleeping environment and preferences tailored to the individual patient, 2) The link between orthopaedic surgery care and sleeping, and 3) Noise challenged a good night's sleep. Good sleep was related to nurses' professional behaviour and the physical environment, such as quality beds and sleeping aids. Single and shared rooms, room lighting, and fresh air all influenced sleep quality. Unfamiliar and uncomfortable sleeping positions posed a challenge for orthopaedic patients but aids such as pillows, and duvets could provide more comfort at night. Offset circadian rhythms could affect sleep quality, as could nausea and vomiting. Pain and lack of pain relief were associated with poor sleep quality. Noise from both nurses and other patients affected sleep quality. Therefore, unnecessary care activities should be kept to a minimum, and a "night noise level" was suggested. CONCLUSION Patients' sleep disturbance following orthopaedic surgery needs to be addressed by both nurses and hospital management. Patients' involvement is essential to create a sleep environment tailored to individual needs and to provide strategies patients use at home for addressing sleeping problems.
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Affiliation(s)
- Pia Søe Jensen
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; Department of People and Technology, Health Promotion Research Center, Roskilde University, Denmark
| | - Kirsten Specht
- Center for COPD, City of Copenhagen, Denmark; Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Hanne Mainz
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Danish Orthopaedic Nursing Knowledge and Science Centre (VIDOKS), Denmark
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Rinehart MC, Ghorashi S, Heavner MS, Tata A, Bathula M, Kelly S, Yeung SYA, Landolf K, So JY, Goel N, Grover BE. An assessment of a sleep aid and sleep promotion practices in hospitalized medical patients. J Am Pharm Assoc (2003) 2024; 64:102042. [PMID: 38382836 DOI: 10.1016/j.japh.2024.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Half of patients admitted to medicine units report sleep disruption, which increases the risk of sleep deprivation. Non-pharmacological interventions are the first step to improving sleep. However, utilization of sleep aids continues to be prevalent. Limited data are available on sleep aid prescribing practices across transitions of care. OBJECTIVES The aim of this study was to describe the current practices for assessing sleep and prescribing pharmacologic agents to promote sleep in the adult medicine population. METHODS This study was designed as a single-center, retrospective, observational cohort study of all patients discharged by the general medicine teams over a 3-month period (September 2019- November 2019). Prior to admission, inpatient and discharge prescriptions for sleep aids were recorded, and documentation of sleep assessments and non-pharmacological interventions were evaluated. RESULTS Of 754 patients included, 211 (28%) were prescribed a sleep aid while inpatient. During hospitalization, 124 (16%) patients had at least one documented sleep assessment, and only 22 (3%) were ordered the institutional non-pharmacological sleep promotion order set. The most prescribed sleep aid in inpatients was melatonin (50%), as well as prior to admission (35%) and at discharge (25%). Overall, the relative reduction in sleep aid prescriptions between admission and discharge was 67%. CONCLUSION Inpatient sleep aid prescribing is common in medical patients. Despite this, sleep assessments and the standard of care of non-pharmacological interventions are rarely utilized. Future efforts should focus on implementation of strategies to make sleep assessments and non-pharmacological sleep promotion routine and consistent in the inpatient setting.
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Kadura S, Poulakis A, Roberts DE, Arora VM, Darrow SN, Eisner L, Ibarra M, Lin J, Wang L, Pigeon WR. Sleeping with one cerebrum open: patient and staff perceptions of sleep quality and quantity on an inpatient neurology unit. J Clin Sleep Med 2024; 20:619-629. [PMID: 38063214 PMCID: PMC10985310 DOI: 10.5664/jcsm.10958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES This study sought to investigate perceptions of sleep disruptions among patients and staff in the inpatient neurology setting. The objectives were to explore the differences between these groups regarding factors that impact sleep, identify the most significant sleep disruptions, and examine the barriers and opportunities suggested to improve inpatient sleep. METHODS A survey-based observational study was conducted on a 25-bed inpatient neurology unit at an academic medical center. Staff and patients completed the Potential Hospital Sleep Disruptions and Noises Questionnaire, and focus groups were held to gather qualitative data. Patient-reported sleep measures were collected for additional assessment. Responses were dichotomized for comparison. Regression models were used to assess associations between disruptors and patient-reported sleep measures. Qualitative thematic analyses were performed. RESULTS Forty-nine inpatient staff and 247 patients completed sleep surveys. Top primary patient diagnoses included stroke, epilepsy, autoimmune diseases, and psychogenic nonepileptic attacks. Medical interventions, environmental factors, patient-related factors, and unit workflows emerged as key themes related to sleep disruptions. Patient-reported sleep efficiency was significantly reduced when pain, anxiety, stress, temperature, and medication administration disrupted sleep. Staff perspectives highlighted medical interventions as most disruptive to sleep, while patients did not find them as disruptive as expected. CONCLUSIONS Differing perspectives on sleep disruption exist between staff and patients in the inpatient neurology setting. Medical interventions may be overstated in staff perceptions and inpatient sleep research, as pain, anxiety, and stress had the most significant impact on patient-reported sleep efficiency. CITATION Kadura S, Poulakis A, Roberts DE, et al. Sleeping with one cerebrum open: patient and staff perceptions of sleep quality and quantity on an inpatient neurology unit. J Clin Sleep Med. 2024;20(4):619-629.
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Affiliation(s)
- Sullafa Kadura
- Department of Medicine, Pulmonary Diseases and Critical Care, University of Rochester Medical Center, Rochester, New York
| | - Alexander Poulakis
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Debra E. Roberts
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Vineet M. Arora
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Stephanie N. Darrow
- Department of Operations Excellence, University of Rochester Medical Center, Rochester, New York
| | - Lauren Eisner
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Michael Ibarra
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Lin
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Lu Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Wilfred R. Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Mohamed B, Yarlagadda K, Self Z, Simon A, Rigueiro F, Sohooli M, Eisenschenk S, Doré S. Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options. Transl Stroke Res 2024; 15:239-332. [PMID: 36922470 DOI: 10.1007/s12975-023-01123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 03/18/2023]
Abstract
Sleep-disordered breathing (SDB) can be a sequela of stroke caused by vascular injury to vital respiratory centers, cerebral edema, and increased intracranial pressure of space-occupying lesions. Likewise, obstructive sleep apnea (OSA) contributes to increased stroke risk through local mechanisms such as impaired ischemic cerebrovascular response and systemic effects such as promoting atherosclerosis, hypercoagulability, cardiac arrhythmias, vascular-endothelial dysfunction, and metabolic syndrome. The impact of OSA on stroke outcomes has been established, yet it receives less attention in national guidelines on stroke management than hyperglycemia and blood pressure dysregulation. Furthermore, whether untreated OSA worsens stroke outcomes is not well-described in the literature. This scoping review provides an updated investigation of the correlation between OSA and stroke, including inter-relational pathophysiology. This review also highlights the importance of OSA treatment and its role in stroke outcomes. Knowledge of pathophysiology, the inter-relationship between these common disorders, and the impact of OSA therapy on outcomes affect the clinical management of patients with acute ischemic stroke. In addition, understanding the relationship between stroke outcomes and pre-existing OSA will allow clinicians to predict outcomes while treating acute stroke.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Keerthi Yarlagadda
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Zachary Self
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Alexandra Simon
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Frank Rigueiro
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Maryam Sohooli
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Sylvain Doré
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Departments of Neurology, Psychiatry, Pharmaceutics, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
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Fernández-Puerta L, Prados G, Quiñoz-Gallardo MD, Vellido-González D, González-Guerrero ML, Rivas-Campos A, Jiménez-Mejías E. Hospital Environmental Disruptors and Caregiver Sleep During Hospitalization. CLIN NURSE SPEC 2023; 37:272-280. [PMID: 37870513 DOI: 10.1097/nur.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE Caregivers must cope with a poor sleep environment when caring for someone admitted to the hospital. The aim was to study the environmental factors associated with a sleep disruption pattern in caregivers during hospitalization and to test their association with caregivers' insomnia symptoms. DESIGN This was a cross-sectional study. METHODS One hundred twenty-three caregivers completed the study. The effect of environmental stimuli on sleep disruption was measured on a scale from 1 to 10 (1 = no disruption, 10 = significant disruption). Type of room (single vs shared), insomnia symptoms, anxiety and depression, and patients' dependence (Barthel Index) were assessed as well. Caregiver and patient characteristics as well as identified hospital disruptors were compared with Student t test, χ2 test, and Fisher exact test according to the caregivers' type of room. A linear regression model using main caregiver and patient sociodemographic variables, questionnaires, and the sum of all hospital disruptors determined the factors associated with caregivers' insomnia symptoms. RESULTS Of the caregivers and their care recipients, 51.2% shared a room with 1 to 2 other patients. Higher self-reported levels of sleep disruption due to environmental stimuli were found in shared rooms when compared with single rooms (eg, nursing care, noise, and light) (P < .05). Hospital sleep disruptors (adjusted regression coefficient, 0.15; 95% confidence interval, 0.06-0.24) and caregiver anxiety (adjusted regression coefficient, 0.57; 95% confidence interval, 0.33-0.81) were predictors for insomnia (P < .01). However, caregivers' type of room was not associated with insomnia severity symptoms (P > .05). CONCLUSIONS Interventions are urgent to implement, such as relieving caregivers from patient needs during the night, providing them with single rooms, and conducting multiple nursing tasks in 1 visit to minimize night hospital noise.
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Affiliation(s)
- Laura Fernández-Puerta
- Author Affiliations: Department of Nursing, School of Health Sciences, University of Granada (Ms Fernández-Puerta and Dr Prados); Virgen de las Nieves University Hospital, Granada (Ms Quiñoz-Gallardo, Vellido-González, González-Guerrero, and Mr Rivas-Campos); and Department of Preventive Medicine and Public Health, University of Granada (Dr Jiménez-Mejías), Spain
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Schafthuizen L, Ista E, van der Heijden M, van Heel L, Maben J, van Rosmalen J, van Eijck CHJ, van Dijk M. Hospitalized Patients' Sleep Quality Compared Between Multioccupancy Rooms and Single-Patient Rooms. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:119-133. [PMID: 37143320 PMCID: PMC10328146 DOI: 10.1177/19375867231168895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To evaluate patients' sleep quality in a former hospital with two-and four-bedded rooms compared to a new hospital that incorporated evidence-based design features, including exclusively single-patient rooms (SPRs). BACKGROUND Hospitalized patients often report poor sleep quality due to both patient-related factors and hospital environmental factors. It is unclear if staying in an SPR in a hospital designed as a healing environment is associated with better sleep quality. METHODS In a before-after study, sleep quality, duration, and efficiency over 72 hr were measured with a sleep diary, GENEActiv accelerometer, and the Richards-Campbell Sleep Questionnaire (RCSQ) with scores ranging from 0 to 100, with higher scores reflecting better sleep. Participants were either staying alone in the former hospital with two-and four-bedded rooms (Group 1), sharing a room with one to three fellow patients (Group 2), or staying alone in a newly designed hospital with 100% SPRs (Group 3). RESULTS We included 17 patients in Group 1, 32 patients in Group 2, and 56 patients in Group 3. Univariable linear mixed model analysis, controlling for night number, revealed that the RCSQ total score was lowest in Group 2 compared to the other two groups. In the multivariable analysis, the RCSQ score was also the lowest in Group 2, with a significant effect from covariate "use of night medication." CONCLUSION Self-reported sleep quality of hospitalized patients in a hospital with 100% SPRs designed as a healing environment was slightly better than that of patients staying in multioccupancy rooms with fellow patients.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marianne van der Heijden
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Liesbeth van Heel
- Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Casper H. J. van Eijck
- Department of Surgery, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Mohedat H, Somayaji D. Promoting sleep in hospitals: An integrative review of nurses' attitudes, knowledge and practices. J Adv Nurs 2023. [PMID: 37151091 DOI: 10.1111/jan.15694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023]
Abstract
AIMS To explore nurses' knowledge, attitudes and practices related to improving hospitalized patients' sleep. DESIGN Integrative review. DATA SOURCES We searched CINAHL, PubMed and PsycInfo electronically including a manual search of references listed within the relevant studies. Original, peer-reviewed studies published in English between 2000 and 2022 evaluating nurses' sleep knowledge, attitudes, or practices to improve inpatients' sleep were reviewed. REVIEW METHODS This review was guided by Whittemore and Knafl method and followed PRISMA guidelines to search the literature. Fifteen articles reporting nurses' sleep knowledge, attitudes or practices to improve inpatients' sleep were included. The quality appraisal was done using the Mixed Methods Appraisal Tool version 2018. RESULTS Inadequate training of nurses regarding sleep hygiene and insufficiency in sleep-promoting practices were apparent. Most studies reported that nurses hold positive attitudes about sleep. The acuity of patients' health conditions affected their perception of sleep priorities. Lack of organizational sleep policies/protocols and coworkers' attitudes negatively impacted nurses' motivation to implement sleep hygiene interventions. Interventions reported in the studies were reducing noise and nursing interventions at night, using a clock for time orientation, earplugs, reducing light, keeping patients awake during the daytime, maintaining comfortable room temperature and managing patients' stress. These practices were hindered by poor knowledge, negative attitudes, patients' acuity and lack of sleep assessment tools. CONCLUSION It is essential to support nursing practice to improve patients' sleep in hospitals through interventions that target nurses' knowledge, attitudes and confidence towards implementing sleep hygiene interventions to improve patients' sleep and, consequently, their health outcomes during hospitalization. IMPACT This integrative review explored nurses' knowledge, attitudes and practices to improve patients' sleep during hospitalization. It revealed that expanding nurses' sleep knowledge and empowering them to implement sleep promotion practices are needed. Nursing educators and leaders need to be involved. NO PATIENT OR PUBLIC CONTRIBUTION This paper is an integrative review and does not include patient or public contribution.
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Affiliation(s)
- Heba Mohedat
- School of Nursing, University at Buffalo, New York, Buffalo, USA
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Darryl Somayaji
- School of Nursing, University at Buffalo, New York, Buffalo, USA
- Roswell Park Comprehensive Cancer Center, New York, Buffalo, USA
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14
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Levy M, Connors C, Ravivarapu KT, Chin CP, Tomer N, Larenas F, Stock J, Palese M. Evaluating the safety of same-day discharge following pediatric pyeloplasty and ureteral reimplantation; A NSQIP analysis 2012-2020. J Pediatr Urol 2023:S1477-5131(23)00141-9. [PMID: 37147143 DOI: 10.1016/j.jpurol.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Same-day discharge (SDD) is a safe option for several adult urologic surgeries, benefiting patients and hospitals. By decreasing length of stay while maintaining patient safety, SDD is in-line with recent goals to provide high value care while minimizing costs. Literature on SDD in the pediatric population, however, is scarce, and no study has identified the efficacy of SDD for pediatric pyeloplasty (PP) and ureteral reimplantation (UR). OBJECTIVE The aim of this study was to identify trends in the usage of SDD as well as its efficacy and safety based on surgical outcomes for pediatric PP and UR. STUDY DESIGN The 2012-2020 files of the American College of Surgeon's National Surgical Quality Improvement Project pediatric database were queried for PP and UR. Patients were stratified as SDD or standard-length discharge (SLD). Trends in SDD usage, differences in baseline characteristics, surgical approach, and surgical outcomes including 30-day readmission, complication, and reoperation rates were analyzed between SDD and SLD groups. RESULTS 8213 PP (SDD: 202 [2.46%]) and 10,866 UR (469 [4.32%]) were included in analysis. There were no significant changes in SDD rates between 2012 and 2020, averaging 2.39% (PP), and 4.39% (UR). For both procedures, SDD was associated with higher rates of open versus minimally invasive (MIS) surgical approach and with shorter operative and anesthesia durations. For PP, there were no differences in readmission, complication, or reoperation rates in the SDD group. For UR, there was a 1.69% increase in CD I/II complications in those receiving SDD, correlating to 1.96-fold higher odds of CD I/II in all SDD patients compared to SLD patients. DISCUSSION These results suggest that while the rate of SDD has not increased in recent years, the current screening methods for SDD have been generally effective in maintaining the safety of SDD for pediatric procedures. Though SDD for UR did show a very small increase in minor complications, this may be due to less strict screening protocols, and may be alleviated via MIS surgical approach. While this is the first paper to investigate SDD for pediatric urology procedures, these results are similar to those found for adult procedures. This study is limited by the lack of clinical data reported in the database. CONCLUSION SDD is a generally safe option for pediatric PP and UR, and further research should identify proper screening protocols to continue to allow for safe SDD.
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Affiliation(s)
- Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Christopher Connors
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Krishna T Ravivarapu
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Francisca Larenas
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Jeffrey Stock
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
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Letsinger E, Sickley R, Saum L. Melatonin Versus Trazodone for the Treatment of New Onset Insomnia in Hospitalized Adult Patients. Hosp Pharm 2023; 58:165-170. [PMID: 36890954 PMCID: PMC9986572 DOI: 10.1177/00185787221123213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: New-onset insomnia and other sleep disturbances occur more frequently in the inpatient setting due to a variety of physical and psychological factors. Studies have found that non-pharmacologic interventions can be effective in treating insomnia in the inpatient setting, particularly in the ICU, to prevent adverse outcomes, but further research is needed to identify optimal pharmacologic interventions. Objective: To compare treatment outcomes of patients initiated on melatonin and trazodone to treat new-onset insomnia in non-ICU hospitalized patients based on the need for an additional sleep aid therapy during hospitalization and to compare the rate of adverse events of each agent. Methods: A retrospective chart review was conducted for adult patients admitted to a non-ICU general medicine or surgical floor at a community teaching hospital between July 1, 2020 and June 30, 2021. Patients were included if they were initiated on scheduled melatonin or trazodone for the treatment of new onset insomnia during their hospitalization. Patients were excluded if they had a previous diagnosis of insomnia, were prescribed 2 sleep aids simultaneously, or if their admission medication reconciliation included pharmacologic treatment for insomnia. Clinical data collected included non-pharmacologic interventions, sleep aid dose, number of doses of sleep aid administered, and total number of nights an additional sleep aid was needed. The primary outcome was the percentage of patients needing additional therapy defined as, administering an additional sleep aid between 2100-0600 or utilizing more than 1 sleep aid agent during hospitalization compared between melatonin and trazodone. Secondary outcomes of this study included the rate of adverse events such as difficulty awakening, daytime sleepiness, serotonin syndrome, falls, and development of in hospital delirium. Results: Of 158 included patients, 132 received melatonin and 26 received trazodone. Male sex (53.8% [melatonin] vs. 53.8% [trazodone]; P = 1), hospital length of stay (7.7 vs 7.7 days; P = .68), and administration of drugs that could cause insomnia (34.1% vs 23.1%vs; P = .27) were similar between sleep aids. Percentage of patients needing an additional sleep aid during hospitalization (19.7% vs 34.6%; P = .09), and patients prescribed a sleep aid at discharge (39.4% vs 46.2%; P = .52) were similar between sleep aids, respectively. Rates of adverse events were similar between sleep aids. Conclusions: There was no significant difference between the 2 agents in terms of the primary outcome, even though a higher rate of patients treated with trazodone for new-onset insomnia during hospitalization required an additional sleep aid compared to those treated with melatonin. No difference in adverse events was observed.
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Affiliation(s)
| | - Rachel Sickley
- Butler University College of Pharmacy
and Health Sciences, Chicago, IL, USA
| | - Lindsay Saum
- Ascension St. Vincent Indianapolis,
Indianapolis, IN, USA
- Butler University College of Pharmacy
and Health Sciences, Chicago, IL, USA
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16
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Fernández-Puerta L, Prados G, Quiñoz-Gallardo MD, Vellido-González D, González-Guerrero ML, Rivas-Campos A, Jiménez-Mejías E. Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients. Healthcare (Basel) 2023; 11:healthcare11060852. [PMID: 36981509 PMCID: PMC10048481 DOI: 10.3390/healthcare11060852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night’s rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients’ hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients’ neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients’ neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.
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Affiliation(s)
- Laura Fernández-Puerta
- Department of Nursing, School of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Germán Prados
- Department of Nursing, School of Health Sciences, University of Granada, 18071 Granada, Spain
- Correspondence: ; Tel.: +34-958248048
| | | | | | | | | | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
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17
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Kadura S, Siala T, Arora VM. Perspective: leveraging the electronic health record to improve sleep in the hospital. J Clin Sleep Med 2023; 19:421-423. [PMID: 36448329 PMCID: PMC9892746 DOI: 10.5664/jcsm.10360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/05/2022] [Accepted: 10/16/2022] [Indexed: 12/05/2022]
Abstract
Inpatient sleep loss can worsen health outcomes, including delirium and falls. Sleep disruptions in the hospital often originate from provider-patient interactions ordered electronically through computerized provider order entry. These orders contain clinical decision support systems with default schedules. These defaults are often around-the-clock, may not align with patients' needs, and cause iatrogenic sleep loss. Optimizing clinical decision support in the electronic health record can decrease unnecessary sleep disruptions and influence sleep-friendly decision-making. CITATION Kadura S, Siala T, Arora VM. Perspective: Leveraging the electronic health record to improve sleep in the hospital. J Clin Sleep Med. 2023;19(2):421-423.
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Affiliation(s)
- Sullafa Kadura
- University of Rochester Medical Center, Rochester, New York
| | - Tarek Siala
- University of Rochester Medical Center, Rochester, New York
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18
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Meng R, Kato T, Mastrotheodoros S, Dong L, Fong DYT, Wang F, Cao M, Liu X, Yao C, Cao J, Yu Y, Luo Y, Yu C, Gozal D. Adaptation and validation of the Chinese version of the Sleep Quality Questionnaire. Qual Life Res 2023; 32:569-582. [PMID: 36125602 DOI: 10.1007/s11136-022-03241-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVES Sleep quality is essential to health. The current study aimed to adapt and validate the Sleep Quality Questionnaire (SQQ) into Chinese language. METHODS The Chinese version of the SQQ (SQQ-C) was created following the guidelines for cross-cultural adaptation. Compliant with the COSMIN methodology, baseline data (N = 13,325) examined three validity domains and internal consistency, including content validity using the content validity index (CVI) and the cognitive debriefing and focus group (relevance, comprehensiveness and comprehensibility), construct validity using structural validity and cross‑sectional measurement invariance, and criterion validity using concurrent/convergent validity. Follow-up data (N = 3410) gathered within a mean of 168 (167-207) h interval were used to additionally assess longitudinal measurement invariance and test-retest reliability using intraclass correlation coefficient (ICC). RESULTS Scale-level CVI/Average was equal to 0.922; Item-level CVIs ranged from 0.889 to 1.000 (excellent), except for item 2 (0.556-fair). A panel of local experts and local participants during cognitive debriefing and focus group stated that it had sufficient relevance and comprehensibility but a slight deficiency in comprehensiveness. Confirmatory factor analysis indicated a stable two-factor structure encompassing Daytime Sleepiness Subscale and Sleep Difficulty Subscale from baseline to follow-up data. The SQQ-C-9 (without item 2) outperformed the SQQ-C-10 (full form). The SQQ-C-9 provided evidence of measurement invariance (strict) across subgroups (cohorts, gender, and age) and across time. The SQQ-C was negatively correlated with the Chinese Nonrestorative Sleep Scale and the Chinese Sleep Condition Indicator. Cronbach's alpha (α), McDonald's Omega (ω), and ICC, respectively, ranged from 0.712 to 0.838, 0.723 to 0.840, and 0.738 to 0.764 for total scale and each subscale. CONCLUSION The SQQ-C exhibits adequate psychometric properties and a stable two-factor structure, and should enable valuable assessments of sleep quality in clinical and research settings.
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Affiliation(s)
- Runtang Meng
- School of Public Health, Hangzhou Normal University, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311121, Zhejiang, China. .,School of Public Health, Wuhan University, Wuhan, Hubei, China.
| | - Tsukasa Kato
- Department of Social Psychology, Toyo University, Tokyo, Japan
| | - Stefanos Mastrotheodoros
- Department of Psychology, University of Crete, Rethymno, Crete, Greece.,Department of Youth and Family, Utrecht University, Utrecht, the Netherlands
| | - Lu Dong
- Department of Behavioral & Policy Sciences, RAND Corporation, Santa Monica, CA, USA
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Fang Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Menglu Cao
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Xinliang Liu
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Chenmin Yao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education (KLOBM), School & Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Jinhong Cao
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Yong Yu
- School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yi Luo
- School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Chuanhua Yu
- School of Public Health, Wuhan University, Wuhan, Hubei, China.,Global Health Institute, Wuhan University, Wuhan, Hubei, China
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
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19
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Vandenberghe A, Lefranc M, Furlan A. An Overview of the Circadian Clock in the Frame of Chronotherapy: From Bench to Bedside. Pharmaceutics 2022; 14:pharmaceutics14071424. [PMID: 35890319 PMCID: PMC9317821 DOI: 10.3390/pharmaceutics14071424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Most living organisms in both the plant and animal kingdoms have evolved processes to stay in tune with the alternation of day and night, and to optimize their physiology as a function of light supply. In mammals, a circadian clock relying on feedback loops between key transcription factors will thus control the temporally regulated pattern of expression of most genes. Modern ways of life have highly altered the synchronization of human activities with their circadian clocks. This review discusses the links between an altered circadian clock and the rise of pathologies. We then sum up the proofs of concept advocating for the integration of circadian clock considerations in chronotherapy for health care, medicine, and pharmacotherapy. Finally, we discuss the current challenges that circadian biology must face and the tools to address them.
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Affiliation(s)
- Alan Vandenberghe
- Univ. Lille, CNRS, UMR 8523-PhLAM-Physique des Lasers Atomes et Molécules, F-59000 Lille, France;
| | - Marc Lefranc
- Univ. Lille, CNRS, UMR 8523-PhLAM-Physique des Lasers Atomes et Molécules, F-59000 Lille, France;
- Correspondence: (M.L.); (A.F.)
| | - Alessandro Furlan
- Univ. Lille, CNRS, UMR 8523-PhLAM-Physique des Lasers Atomes et Molécules, F-59000 Lille, France;
- Tumorigenesis and Resistance to Treatment Unit, Centre Oscar Lambret, F-59000 Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France
- Correspondence: (M.L.); (A.F.)
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20
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Mansour W, Knauert M. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Clin Chest Med 2022; 43:287-303. [PMID: 35659026 PMCID: PMC9177053 DOI: 10.1016/j.ccm.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Wissam Mansour
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, 1821 Hillandale Road, Suite 25A, Durham, NC 27705, USA
| | - Melissa Knauert
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.
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21
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Fidler AL, Voorhees S, Zhou ES, Stacciarini JM, Fedele DA. A systematic review and proposed conceptual model of sleep disturbances during pediatric hospitalizations. Sleep 2022; 45:zsac038. [PMID: 35554575 DOI: 10.1093/sleep/zsac038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/19/2022] [Indexed: 09/21/2023] Open
Abstract
STUDY OBJECTIVES The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children. METHODS A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1 and 18 years old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims. RESULTS Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g. noise, staff interruptions), most interventions targeted the child level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components. CONCLUSIONS Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as the main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.
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Affiliation(s)
- Andrea L Fidler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sara Voorhees
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | | | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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22
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Greysen SR, Waddell KJ, Patel MS. Exploring Wearables to Focus on the “Sweet Spot” of Physical Activity and Sleep After Hospitalization: Secondary Analysis. JMIR Mhealth Uhealth 2022; 10:e30089. [PMID: 35476034 PMCID: PMC9096634 DOI: 10.2196/30089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/15/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Inadequate sleep and physical activity are common during and after hospitalization, but their impact on patient-reported functional outcomes after discharge is poorly understood. Wearable devices that measure sleep and activity can provide patient-generated data to explore ideal levels of sleep and activity to promote recovery after hospital discharge.
Objective
This study aimed to examine the relationship between daily sleep and physical activity with 6 patient-reported functional outcomes (symptom burden, sleep quality, physical health, life space mobility, activities of daily living, and instrumental activities of daily living) at 13 weeks after hospital discharge.
Methods
This secondary analysis sought to examine the relationship between daily sleep, physical activity, and patient-reported outcomes at 13 weeks after hospital discharge. We utilized wearable sleep and activity trackers (Withings Activité wristwatch) to collect data on sleep and activity. We performed descriptive analysis of device-recorded sleep (minutes/night) with patient-reported sleep and device-recorded activity (steps/day) for the entire sample with full data to explore trends. Based on these trends, we performed additional analyses for a subgroup of patients who slept 7-9 hours/night on average. Differences in patient-reported functional outcomes at 13 weeks following hospital discharge were examined using a multivariate linear regression model for this subgroup.
Results
For the full sample of 120 participants, we observed a “T-shaped” distribution between device-reported physical activity (steps/day) and sleep (patient-reported quality or device-recorded minutes/night) with lowest physical activity among those who slept <7 or >9 hours/night. We also performed a subgroup analysis (n=60) of participants that averaged the recommended 7-9 hours of sleep/night over the 13-week study period. Our key finding was that participants who had both adequate sleep (7-9 hours/night) and activity (>5000 steps/day) had better functional outcomes at 13 weeks after hospital discharge. Participants with adequate sleep but less activity (<5000 steps/day) had significantly worse symptom burden (z-score 0.93, 95% CI 0.3 to 1.5; P=.02), community mobility (z-score –0.77, 95% CI –1.3 to –0.15; P=.02), and perceived physical health (z-score –0.73, 95% CI –1.3 to –0.13; P=.003), compared with those who were more physically active (≥5000 steps/day).
Conclusions
Participants within the “sweet spot” that balances recommended sleep (7-9 hours/night) and physical activity (>5000 steps/day) reported better functional outcomes after 13 weeks compared with participants outside the “sweet spot.” Wearable sleep and activity trackers may provide opportunities to hone postdischarge monitoring and target a “sweet spot” of recommended levels for both sleep and activity needed for optimal recovery.
Trial Registration
ClinicalTrials.gov NCT03321279; https://clinicaltrials.gov/ct2/show/NCT03321279
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Affiliation(s)
- S Ryan Greysen
- Section of Hospital Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Philadelphia Corporal Michael Crescenz Veterans Medical Center, Philadelphia, PA, United States
| | - Kimberly J Waddell
- Philadelphia Corporal Michael Crescenz Veterans Medical Center, Philadelphia, PA, United States
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23
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Neculicioiu VS, Colosi IA, Costache C, Sevastre-Berghian A, Clichici S. Time to Sleep?-A Review of the Impact of the COVID-19 Pandemic on Sleep and Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3497. [PMID: 35329184 PMCID: PMC8954484 DOI: 10.3390/ijerph19063497] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Sleep is intrinsically tied to mental and overall health. Short sleep duration accompanies the modern lifestyle, possibly reaching epidemic proportions. The pandemic and subsequent lockdowns determined a fundamental shift in the modern lifestyle and had profound effects on sleep and mental health. This paper aims to provide an overview of the relationship between sleep, mental health and COVID-19. Contrasting outcomes on sleep health have been highlighted by most reports during the pandemic in the general population. Consequently, while longer sleep durations have been reported, this change was accompanied by decreases in sleep quality and altered sleep timing. Furthermore, an increased impact of sleep deficiencies and mental health burden was generally reported in health care workers as compared with the adult general population. Although not among the most frequent symptoms during the acute or persistent phase, an increased prevalence of sleep deficiencies has been reported in patients with acute and long COVID. The importance of sleep in immune regulation is well known. Consequently, sleep deficiencies may influence multiple aspects of COVID-19, such as the risk, severity, and prognosis of the infection and even vaccine response.
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Affiliation(s)
- Vlad Sever Neculicioiu
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
| | - Ioana Alina Colosi
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
| | - Carmen Costache
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.A.C.); (C.C.)
| | - Alexandra Sevastre-Berghian
- Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.S.-B.); (S.C.)
| | - Simona Clichici
- Department of Physiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (A.S.-B.); (S.C.)
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Crous EC, North N. Sleep promotion for hospitalised children: Developing an evidence-based guideline for nurses. Curationis 2021; 44:e1-e10. [PMID: 34636624 PMCID: PMC8603136 DOI: 10.4102/curationis.v44i1.2219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/16/2021] [Accepted: 08/15/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Adequate sleep in hospitalised children is important for a variety of physiological and psychological processes associated with growth, development, and recovery from illness and injury. Hospitalisation often prioritises clinical care activities at the expense of age-appropriate sleep. Nurses and the wider healthcare team contribute to this paradox. However, through conscious practice and partnering with mothers, nurses are able to enact change and promote sleep. OBJECTIVES To adopt, adapt or contextualise existing guidelines to develop an evidence-based practice guideline to promote sleep-friendly ward environments and routines facilitated by nurses, and in partnership with mothers. METHOD A six-step methodology for guideline adaptation was followed, as recommended by the South African Guidelines Excellence project: (1) existing guidelines and protocols were identified and (2) appraised using the AGREE II instrument; (3) an evidence base was developed; (4) recommendations were modified, (5) assigned levels of evidence and grades of recommendation; and (6) end user guidance was developed. Expert consultation was sought throughout. RESULTS Existing relevant guidance comprised 61 adult-centric recommendations. Modification of the evidence base led to six composited recommendations that facilitate sleep in hospitalised children: (1) prioritising patient safety; (2) collaborating with the mother or caregiver to promote sleep; (3) coordinating ward routine and (4) environment to improve sleep; (5) work with clinical and non-clinical staff; and (6) performing basic sleep assessments. Practice recommendations were aligned to the South African regulatory framework for nursing. CONCLUSION Hospitalisation is a time of physiological and psychological dysregulation for children, which is amplified by poor sleep in a hospital. Nurses have the opportunity to promote sleep during hospitalisation by implementing this African-centric guideline in partnership with mothers.
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Affiliation(s)
- Elijeshca C Crous
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Khoddam H, Maddah SA, Rezvani Khorshidi S, Zaman Kamkar M, Modanloo M. The effects of earplugs and eye masks on sleep quality of patients admitted to coronary care units: A randomised clinical trial. J Sleep Res 2021; 31:e13473. [PMID: 34514653 DOI: 10.1111/jsr.13473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
Sleep is an essential need for patients admitted to coronary care units. The present clinical trial aimed to determine the effect of using eye masks and earplugs on the sleep quality of patients with coronary heart disease (CHD). A total of 68 eligible patients with CHD were randomly allocated into four groups of 17 (control, eye masks, earplugs, and eye masks with earplugs). All three interventions were performed during the night from 10:00 p.m. to 7:00 a.m. the next day. The outcomes were the quality of sleep, measured by the Verran and Snyder-Halpern (VSH) Sleep Scale, and the urinary levels of nocturnal melatonin and cortisol, measured by urine samples taken during the night (from 10:00 p.m. to 7:00 a.m.). The study outcomes were measured on the third and fourth days. Sleep disturbance was statistically significantly lower in patients with earplugs (visual analogue scale mean difference [MD]: 74.31 mm, SE: 11.34, p = 0.001). Sleep effectiveness was statistically significantly higher in patients with eye mask (MD: 36.88 mm, SE: 8.75, p = 0.001). The need for sleep supplementation was statistically significantly lower in patients with eye masks (MD: 39.79 mm, SE: 7.23, p = 0.001). There was a significant difference in melatonin levels between eye masks and the control group (p = 0.03). For urinary cortisol levels, there were significant differences between eye masks and the control group (p = 0.007), earplugs and the control group (p = 0.001), and eye masks with earplugs and the control group (p = 0.006). The mean scores for comfort, effectiveness, and ease of use were highest for the group that used eye masks (2.88, 2.94, and 3.18, respectively). As a result, all three interventions improved the sleep quality of patients. However, the interventions had different effects on the three dimensions of the VSH Sleep Scale, as well as the urinary levels of cortisol and melatonin.
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Affiliation(s)
- Homeira Khoddam
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Seyedmahrokh A Maddah
- Department of Anesthesiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sommayeh Rezvani Khorshidi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Zaman Kamkar
- Department of Psychiatry, Golestan Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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Ury E. Supporting older people with dementia to sleep well while in hospital. Nurs Older People 2021; 33:14-19. [PMID: 34231346 DOI: 10.7748/nop.2021.e1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/09/2022]
Abstract
Optimal sleep is essential for health, well-being and recovery from illness but can be challenging to achieve in the acute hospital setting. Older people with dementia may find it particularly challenging to sleep well in the unfamiliar and disruptive environment of a hospital ward. Suboptimal sleep may potentially accelerate the progression of dementia. Conversely, optimal sleep may slow disease progression. Nursing staff who care for older people with dementia in hospital therefore need to find ways of supporting them to sleep well. This article explores the causes and consequences of suboptimal sleep in hospitalised older people with dementia and discusses evidence-based interventions that nursing staff can use to support these patients to sleep well, including person-centred sleep care, changes to sleep hygiene, environmental adaptations and changes to medicine regimens.
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Affiliation(s)
- Ela Ury
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
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Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer. Curr Treat Options Oncol 2021; 22:81. [PMID: 34213651 DOI: 10.1007/s11864-021-00872-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Sleep and circadian rhythm disturbance are among the most commonly experienced symptoms in patients with cancer. These disturbances occur throughout the spectrum of cancer care from diagnosis, treatment, and long into survivorship. The pathogenesis of these symptoms and disturbances is based on common inflammatory pathways related to cancer and its' treatments. The evaluation of sleep and circadian disorders requires an understanding of how these symptoms cluster with other cancer-related symptoms and potentiate each other. A thorough evaluation of these symptoms and disorders utilizing validated diagnostic tools, directed review of clinical information, and diagnostic testing is recommended. Treatment of sleep and circadian disturbance in cancer patients should be based on the findings of a detailed evaluation, including specific treatment of primary sleep and circadian disorders, and utilize integrative and personalised management of cancer-related symptoms through multiple pharmacologic and non-pharmacologic modalities. Recognition, evaluation, and treatment of sleep and circadian rhythm disturbance in cancer may lead to improved symptom management, quality of life, and outcomes.
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Affiliation(s)
- Diwakar D Balachandran
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA.
| | - Michelle A Miller
- Division of Health Sciences (Mental Health & Wellbeing), University of Warwick, Warwick Medical School, Gibbet Hill, Coventry, UK
| | - Saadia A Faiz
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street. Unit 1462, Houston, TX, 77030-4009, USA
| | - Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pasquale F Innominato
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
- Cancer Chronotherapy Team, Warwick Medical School, Coventry, UK
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28
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Ritmala-Castren M, Salanterä S, Holm A, Heino M, Lundgrén-Laine H, Koivunen M. Sleep improvement intervention and its effect on patients' sleep on the ward. J Clin Nurs 2021; 31:275-282. [PMID: 34114280 DOI: 10.1111/jocn.15906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Marita Ritmala-Castren
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Nursing Administration, Helsinki, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | | | - Heljä Lundgrén-Laine
- Department of Nursing Science, University of Turku, Turku, Finland.,Central Finland Hospital Nova, Central Finland Health Care District, Jyvaskyla, Finland
| | - Marita Koivunen
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
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