Prioritizing Rest in Hospital Settings: Poor Sleep Increases Costs, Complications, and Mortality

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Minimizing sleep disruption for hospitalized patients is more important than initially thought.
Minimizing sleep disruption for hospitalized patients is more important than initially thought.

Minimizing sleep disruption for hospitalized patients is more important than initially thought, according to a research letter published in JAMA Internal Medicine.1

Matthew E. Growdon, MD, MPH, and Sharon K. Inouye, MD, MPH, both of Harvard Medical School in Boston, Massachusetts, reviewed the results of a Dutch study,2 also published in JAMA Internal Medicine, that suggested that patients sleep significantly less in hospital settings. Sleep was negatively affected by noise from other patients and hospital equipment, nocturnal awakenings to go to the toilet, and being awakened by hospital staff so that vital signs can be taken or other hospital procedures performed. The research method was based on surveys and sleep diary data, but limited by missing data. Nearly one-third of the initial 2005 patients had to be excluded from the study because of missing or incompatible sleep diary data. Data from 1427 patients were included in the analysis.

Despite the limitations of the initial study, Drs Growdon and Inouye contend that the results serve as an important impetus for physicians, nurses, hospital administrators, and others involved in the care of hospitalized patients to optimize sleep in the hospital setting. They note that sleep is becoming an area of focus, particularly in the intensive care unit. Disrupted sleep has been associated with an increased risk for delirium, increased hospital and intensive care unit lengths of stay, greater postoperative complications, and increased mortality.

The Hospital Elder Life Program is a multicomponent program that includes a nonpharmacologic sleep protocol. This protocol is associated with reduced delirium and falls and reduced length of stay, hospital and 1-year healthcare costs, institutionalization, and readmissions. The protocol includes warm drinks, relaxing music, massage, and noise reduction in hospital wards.

The authors argue that only with widespread shifts in current practice and implementation of interventions such as the Hospital Elder Life Program sleep protocol, can hospitals become more conducive to the essential human need for sleep.

References

  1. Growdon ME, Inouye SK. Minimizing sleep disruption for hospitalized patients. A wake-up call [published online July 16, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.2679.
  2. Wesselius HM, Van den Ende ES, Alsma J, et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients [published online July 16, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.2669.

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