乌鸦传媒

Good sleep was hard to come by for Dutch hospital patients, but the study authors said many noises and disruptions could be reduced fairly easily.

One day across 39 Dutch hospitals, 2,005 patients said in a survey that they spent the night before in the general wards sleeping an average 83 fewer minutes than at home (P<0.001); that they had more nocturnal awakenings during sleep (3.3 vs 2.0, P<0.001); and that they woke up that morning 44 minutes earlier than usual (P<0.001), according to Prabath Nanayakkara, MD, PhD, of VU University Medical Center in Amsterdam, and colleagues found.

Furthermore, 70.4% of study participants reported being awakened by external causes -- and that hospital staff were part of the reason in over half of these cases, they reported in .

All aspects of sleep quality from the Consensus Sleep Diary and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank were rated worse during hospitalization than at home.

Sleep tended to be rated worse by younger patients and those admitted to a surgical unit.

The most commonly reported disturbances of sleep were noises from other patients, medical devices, pain, and going to the toilet.

"Most of the sleep-disturbing factors found in our study seem easy to address by incorporating simple changes in nightly hospital routines," Nanayakkara's group said. "A recent pilot study demonstrated an increase in total sleep time and subjective sleep quality after offering sleep hygiene education to nurses, introducing interventions to minimize light and noise disturbances, and reducing care-related disruptions and overnight fluids."

Interventions of interest, they suggested, include dimmed lights in corridors and patient rooms, silent footwear, remote alarms in staff rooms and in the pockets of the nurses, and distribution of earplugs and eye masks at admission.

"The possibility of introducing remote measurement of vital signs and nocturnal checkups via webcams should also be explored. In addition, changing the timing and minimizing nursing activities early in the morning; avoiding unnecessary standard procedures, such as routine vital signs measurements, continuous intravenous drips at night, and diuretics in the afternoon, could potentially improve sleep," the authors suggested.

"However, to our knowledge, most of these interventions have never been tested in general wards; therefore, prospective interventional studies are needed," they cautioned.

The "flash mob" nature of the study -- having all patients fill out questionnaires on Feb. 22, 2017 -- left the researchers with lots of missing data. They acknowledged that their dataset also potentially had recall bias because they relied on patients to estimate usual sleep at home.

Even with these limitations, the impetus is there for "a much-needed hospital-wide culture change to minimize sleep disruption in the hospital setting," according to Matthew Growdon, MD, MPH, and Sharon Inouye, MD, MPH, both of Harvard Medical School in Boston.

"Sleep deprivation in the hospital has been linked to important adverse outcomes, including alteration of homeostatic functions, such as glucose metabolism, cortisol regulation, and circadian rhythmicity; difficulty weaning from mechanical ventilation; defects in cellular immunity; and increased risk of long-term sleep disorders that play a role in depression, anxiety, and posttraumatic stress disorder ... When our patients relate their difficulty sleeping in the hospital, they are not reporting only a nuisance but also a direct contributor to adverse outcomes, even mortality," Growdon and Inouye wrote in an .

To improve hospital outcomes, Inouye developed the Hospital Elder Life Program (HELP), which has a sleep protocol -- consisting of warm drinks, massage, relaxation music, unit-wide noise reduction strategies, and effective schedule adjustments -- that has been linked with decreased use of hypnotics and better quality of sleep the more these interventions were adopted, the editorialists noted.

"HELP and related programs have shown that it is possible to be thoughtful about addressing hospital-related factors that disrupt sleep and, of importance, that these interventions improve health care outcomes and cost-effectiveness of care. With the aging of the world's population, these programs will become more essential, particularly in the prevention of delirium and adverse cognitive outcomes," according to the pair.

Comment