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OBJECTIVES To assess objectively measured daytime physical activity and sleep duration and efficiency in hospitalized older adults and explore associations with demographic characteristics and disease severity. DESIGN Prospective cohort study. SETTING University of Chicago Medical Center general medicine wards. PARTICIPANTS Community-dwelling inpatients aged 50 and older (N = 120) MEASUREMENTS Physical activity and sleep were measured using wrist accelerometers. Information on Charlson Comorbidity Index and length of stay was collected from charts. Random-effects linear regression analysis was used to examine the association between in-hospital sleep and physical activity. RESULTS From March 2010 to May 2013, 120 participants wore wrist actigraphy monitors for at least 2 nights and 1 intervening day. Median activity level over the waking period was 77 counts/min (interquartile range 51–121 counts/min), an activity level that approximately corresponds to sitting while watching television (65 counts/min). Mean sleep duration the night before the activity interval was 289 ± 157 minutes, and mean sleep efficiency the night before the activity interval was 65.2 ± 26.9%. Mean activity counts/min were lowest for the oldest participants (oldest quartile 62, 95% confidence interval (CI) = 50–75; youngest quartile 121, 95% CI = 98–145, trend test P < .001) and those with highest Charlson Comorbidity Index (highest tertile 71, 95% CI = 60–83; lowest tertile 125, 95% CI = 104–147, trend test P = .01). Controlling for severity of illness and demographic characteristics, activity declined by 3 counts/min (95% CI = −5.65 to −0.43, P = .02) for each additional hour of inpatient sleep. CONCLUSION Older, sicker adults are less physically active during hospitalization. In contrast to studies in the community, inpatients who slept more were not more active. This may highlight that need for sleep is greater in the hospital than in the community.

Background Esophagogastric junction outflow obstruction (EGJOO) has a variable disease course. Currently, barium swallow (BaS) and manometric parameters are used to characterize clinically significant EGJOO. The esophagogastric junction distensibility index (EGJ-DI) measured via functional lumen imaging probe (FLIP) can provide complementary information. Our aim was to assess symptom response in patients with EGJOO and an abnormal EGJ-DI after botulinum toxin (BT) treatment. Methods A prospective cohort study of adults with idiopathic EGJOO was performed from September 2019 to March 2021. Patients with dysphagia underwent upper endoscopy with FLIP. If the EGJ-DI was abnormally low, BT was injected. Data examined included demographics, medical history, endoscopic and FLIP findings, BaS, manometry, and Eckardt score (ES). ES improvement was assessed via paired samples t-test. Pearson’s chi-square tests were used to assess for associations. Results Of the 20 patients, 75% had an abnormal EGJ-DI and underwent BT injections. Mean ES for patients with abnormal EGJ-DIs significantly improved from baseline to 1, 3, and 6 month follow-up (P-values: 0.01, 0.05, and 0.02, respectively). There was a significant association between an abnormal EGJ-DI with delayed bolus transit and presence of rapid drink challenge panesophageal pressurization on manometry: P = 0.03 and P = 0.03. Conclusion This prospective study revealed that an abnormal EGJ-DI can guide BT as assessed via symptomatic response. Additionally, abnormal EGJ-DI measurements were significantly associated with other parameters used previously to determine clinically relevant EGJOO. Larger follow-up studies are warranted to further elucidate guidance for therapy in EGJOO.

Background/Objectives To examine the associations between perceived control over sleep, noise levels, sleep duration and noise complaints in a cohort of hospitalized adults. Design Prospective cohort study. Setting General medicine ward in an academic medical center. Participants 118 hospitalized patients age 50 years and over (mean age 65 years, 57% female, 67% African American). Measurements Sleep duration was measured via wrist actigraphy and noise levels in patient rooms were measured via sound monitors. Validated questionnaires used to assess sleep characteristics at baseline and sleep quality for each night. Perceived control over sleep was measured at baseline using the Sleep Self-Efficacy (SSE) scale (range 9–45). Results Mean SSE score was 32.1 (SD = 9.4) and median score was 34 (IQR = 24–41). Average sleep duration for patients in the hospital was 333 minutes (5.5 hours). Forty-two percent of patients complained of noise disrupting their sleep. Linear regression clustered by subject showed that above median SSE was associated with longer sleep duration (+55 minutes 95%CI[14, 97], p=0.010). This association remained significant after controlling for objective noise levels and patient demographics (+50 minutes 95%CI [11, 90], p=0.014). In logistic regression controlling for noise level and patient demographics, those patients with high SSE were 51% less likely to complain of noise disruptions (OR=0.49 95%CI[0.25, 0.96], p=0.039). Conclusion Higher perceived control over sleep is associated with longer sleep duration, better sleep quality, and fewer reports of noise disruptions. In addition to noise control, interventions to boost perceived control may improve in-hospital sleep.