1057 Objectively and Subjectively Measured Sleep Quality in an Acute-Care Hospital Setting: A Pilot Study

Abstract

Abstract Poor sleep is common in hospitalized patients, but is not often measured objectively. We gathered subjective and objective sleep data among older adults in an acute-care hospital to determine the feasibility of conducting an intervention study to improve sleep among those hospitalized. The study setting was an 81-bed community hospital, in rural Tracy, California (January 2016 to November 2017). Inclusion criteria were age ≥60 years and expected duration of stay ≥1 night. Exclusion criteria were severe cognitive impairment, language barrier, or examiner determination of inability to perform study components. Sleep data was collected with 24-hour wrist actigraphy and interviews about pre-hospitalization sleep [Pittsburgh Sleep Quality Index (PSQI)]. Descriptive data was gathered by questionnaire and electronic medical records. Of 2315 patients screened, 112 were enrolled. Many met the exclusions for cognitive impairment (16%) or language barrier (15%) and 21% refused. The participants were 69 ± 7 years old, 54% female, and 77% white. The median length of stay was 3 days, 11% were discharged to a skilled nursing facility, and 70% had an impairment of instrumental activities of daily living. Self-reported pre-hospitalization sleep disturbance was high: 77% had poor sleep quality (PSQI>5). Actigraphy was well tolerated, with data collection for all nights for 89% of participants. During the interval patients reported trying to sleep at night while admitted, objectively measured sleep fragmentation was high (mean sleep efficiency 68% ± 15%) with average actigraphic total sleep time of 5.6 ± 1.9 hrs. When asked about sleep interruption, the most common reasons were for measurement of vital signs (23%), staff interruption (22%), and blood draws (21%). Poor subjective sleep prior to hospitalization was high, with high levels of sleep fragmentation and low levels of sleep while admitted. Variability of objective sleep measures was high. Improving modifiable factors in the hospital setting could lead to better sleep quality. The study was funded by the Sutter Tracy Community Hospital Foundation. Thanks to student volunteers from University of California, Davis and hospital staff.