Characterizing pediatric inpatient sleep duration and disruptions

Abstract

Objective: To contextualize inpatient sleep duration and disruptions in a general pediatric hospital ward by comparing in-hospital and at-home sleep durations to recommended guidelines and to objectively measure nighttime room entries.

Methods: Caregivers of patients four weeks - 18 years of age reported patient sleep duration and disruptions in anonymous surveys. Average at-home and in-hospital sleep durations were compared to National Sleep Foundation recommendations. Objective nighttime traffic was evaluated as the average number of room entries between 11:00pm and 7:00am using GOJO brand hand-hygiene room entry data.

Results: Among 246 patients, patients slept less in the hospital than at home with newborn and infant cohorts experiencing 7- and 4-h sleep deficits respectively (Newborn: 787 ± 318 min at home vs. 354 ± 211 min in hospital, p < 0.001; Infants: 703 ± 203 min at home vs. 412 ± 152 min in hospital, p < 0.01). Newborn children also experienced >2 h sleep deficits at home when compared to NSF recommendations (Newborns: 787 ± 318 min at home vs. 930 min recommended, p < 0.05). Objective nighttime traffic measures revealed that hospitalized children experienced 7.3 room entries/night (7.3 ± 0.25 entries). Nighttime traffic was significantly correlated with caregiver-reported nighttime awakenings (Spearman Rank Correlation Coefficient: 0.83, p < 0.001).

Conclusion: Hospitalization is a missed opportunity to improve sleep both in the hospital and at home.

Keywords: Hospital; Pediatrics; Sleep.

Figure 1:. Comparing at home and in-hospital sleep duration to recommended pediatric patient guidelines for nighttime sleep

Sleep duration was reported by caregivers using the Karolinska Sleep Log within a Pediatric Sleep Assessment. Recommended sleep duration values for children are averages of age-specific ranges published by the National Sleep Foundation (NSF).

Figure 2:. Monthly average of objectively measured nighttime room entries and number of caregiver-reported of nighttime awakenings in the hospital

Data from activity counters within hand-hygiene heat sensors inside of each patient room in the general pediatric ward were obtained to objectively measure nighttime room entries. Caregiver reports regarding number of nighttime awakenings were drawn from responses to the Karolinska Sleep Log. Monthly variation in the average number of objectively measured nighttime room entries varied in a similar manner as monthly changes in the average number of caregiver-reported nighttime awakenings within the hospital (Spearman Rank Correlation Coefficient: 0.58, p=.04).