Hilde M Wesselius1, Eva S van den Ende1, Jelmer Alsma2, Jan C Ter Maaten3, Stephanie C E Schuit2, Patricia M Stassen4,5, Oscar J de Vries6, Karin H A H Kaasjager7, Harm R Haak4,5,8, Frederiek F van Doormaal9, Jacobien J Hoogerwerf10, Caroline B Terwee11, Peter M van de Ven11, Frank H Bosch12, Eus J W van Someren13,14,15, Prabath W B Nanayakkara1. 1. Section of Acute Medicine, Department of Internal Medicine, and Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands. 2. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands. 3. Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands. 4. Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands. 5. Care and Public Health Research Institute School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht University, Maastricht, the Netherlands. 6. Department of Internal Medicine, , Amsterdam, the Netherlands. 7. Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands. 8. Department of Internal Medicine, Máxima Medical Center, Veldhoven, the Netherlands. 9. Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands. 10. Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands. 11. Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands. 12. Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands. 13. Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands. 14. Department of Psychiatry/GGZ InGeest, VU University Medical Center, Amsterdam, the Netherlands. 15. Department of Integrative Neurophysiology, Amsterdam Neuroscience, VU University, Amsterdam, the Netherlands.
Abstract
Importance: Although inadequate sleep has a proven negative association with health care outcomes, to date, no large-scale studies have examined sleep in general hospital wards. Objectives: To assess the subjective quantity and quality of sleep and to identify the hospital-related factors associated with sleep disturbances in hospitalized patients. Design: For this nationwide, single-day, multicenter, cross-sectional, observational study, which took place on February 22, 2017, all hospitals in the Netherlands were encouraged by word of mouth and conventional and social media to participate in this study. A total of 39 hospitals participated. Included patients were at least 18 years of age, were able to give informed consent, and had spent at least 1 night in a regular-care hospital ward. Exposures: Hospitalization in a regular-care ward. Main Outcomes and Measures: Quantity and quality of last night's sleep in the hospital compared with habitual sleep at home the month before hospitalization. The Consensus Sleep Diary and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank were used. Complementary questions assessed sleep-disturbing factors. Results: A total of 2005 patients were included (median age, 68 years; interquartile range, 57-77 years; 994 of 1935 [51.4%] were male [70 patients did not identify their sex]). Compared with habitual sleep at home, the total sleep time in the hospital was 83 minutes (95% CI, 75-92 minutes; P < .001) shorter. The mean number of nocturnal awakenings was 2.0 (95% CI, 1.9-2.1) times at home vs 3.3 (95% CI, 3.2-3.5) times during hospitalization (P < .001). Patients woke up 44 minutes (95% CI, 44-45 minutes; P < .001) earlier than their habitual wake-up time at home. A total of 1344 patients (70.4%) reported having been awakened by external causes, which in 718 (35.8%) concerned hospital staff. All aspects of sleep quality measured using PROMIS questions were rated worse during hospitalization than at home. The most reported sleep-disturbing factors were noise of other patients, medical devices, pain, and toilet visits. Conclusions and Relevance: This study demonstrated that the duration and quality of sleep in hospitalized patients were significantly affected and revealed many potentially modifiable hospital-related factors negatively associated with sleep. Raising awareness about the importance of adequate sleep in the vulnerable hospital population and introducing interventions to target sleep-disturbing factors may improve healing.
Importance: Although inadequate sleep has a proven negative association with health care outcomes, to date, no large-scale studies have examined sleep in general hospital wards. Objectives: To assess the subjective quantity and quality of sleep and to identify the hospital-related factors associated with sleep disturbances in hospitalized patients. Design: For this nationwide, single-day, multicenter, cross-sectional, observational study, which took place on February 22, 2017, all hospitals in the Netherlands were encouraged by word of mouth and conventional and social media to participate in this study. A total of 39 hospitals participated. Included patients were at least 18 years of age, were able to give informed consent, and had spent at least 1 night in a regular-care hospital ward. Exposures: Hospitalization in a regular-care ward. Main Outcomes and Measures: Quantity and quality of last night's sleep in the hospital compared with habitual sleep at home the month before hospitalization. The Consensus Sleep Diary and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance item bank were used. Complementary questions assessed sleep-disturbing factors. Results: A total of 2005 patients were included (median age, 68 years; interquartile range, 57-77 years; 994 of 1935 [51.4%] were male [70 patients did not identify their sex]). Compared with habitual sleep at home, the total sleep time in the hospital was 83 minutes (95% CI, 75-92 minutes; P < .001) shorter. The mean number of nocturnal awakenings was 2.0 (95% CI, 1.9-2.1) times at home vs 3.3 (95% CI, 3.2-3.5) times during hospitalization (P < .001). Patients woke up 44 minutes (95% CI, 44-45 minutes; P < .001) earlier than their habitual wake-up time at home. A total of 1344 patients (70.4%) reported having been awakened by external causes, which in 718 (35.8%) concerned hospital staff. All aspects of sleep quality measured using PROMIS questions were rated worse during hospitalization than at home. The most reported sleep-disturbing factors were noise of other patients, medical devices, pain, and toilet visits. Conclusions and Relevance: This study demonstrated that the duration and quality of sleep in hospitalized patients were significantly affected and revealed many potentially modifiable hospital-related factors negatively associated with sleep. Raising awareness about the importance of adequate sleep in the vulnerable hospital population and introducing interventions to target sleep-disturbing factors may improve healing.
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