The effects of sleep improving interventions in medical hospital wards: the WEsleep study - A randomized clinical trial

Abstract

Objective: Hospitalized patients often experience disturbed sleep, affecting general health. While some randomized studies have assessed individual non-pharmacological interventions, none have evaluated approaches that combine multiple strategies to improve sleep. This study aimed to assess the effects of a multicomponent sleep-enhancing protocol in hospitalized medical patients.

Methods: The WEsleep cluster randomized controlled trial was conducted between July 2023 and March 2024 across six medical departments in a large Dutch academic hospital. Adult medical patients who were able to provide informed consent and were expected to stay at least two nights were eligible for inclusion. The multicomponent intervention included delaying early morning nursing rounds, training healthcare professionals, optimizing sleep-disturbing medication timing, offering earplugs and eye masks, and conducting evening sleep rounds. The primary outcome was sleep quality on the second night, assessed with the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcomes included sleep quantity, 30-day mortality, delirium incidence, and use of sleep-enhancing tools.

Results: Data from 291 patients were analyzed. The intervention group reported better sleep quality, with a median RCSQ score of 66.6 (IQR 44.3-78.9), compared to 55.7 (IQR 38.2-74.3) in the control group (p = 0.033). No significant differences were observed in sleep quantity, 30-day mortality or delirium incidence. Protocol adherence ranged from 42 % to 73 %.

Conclusions: This study provides a valuable roadmap for hospitals aiming to enhance patient care through improved sleep management. A multicomponent intervention can lead to significantly better sleep quality in medical wards, highlighting the potential of structured, non-pharmacological strategies in routine hospital care.

Keywords: Hospital sleep; Multicomponent intervention; Non-pharmacological sleep interventions; Patient care improvement; Randomized controlled trial; Sleep improvement.