Noise and light levels during hospitalizations can disrupt sleep and circadian health, resulting in worse health outcomes. This study describes patterns of noise and light in an inpatient room of children undergoing stem cell transplants. Objective meters tracked noise and light levels every minute for 6 months. Median overnight sound was 55dB (equivalent to conversational speech), which exceeded recommendations. There were 3.4 loud noises (>80dB) per night on average. Children spent 62% of the 24-hour cycle in non-optimal lighting, with daytime light dimmer than recommended 98% of the time. These data suggest improvements for hospital environment in pediatric cancer patients.
Introduction Pediatric patients undergoing stem cell transplant (SCT) often experience extended hospitalizations. Inappropriate lighting during admissions is known to disrupt sleep and circadian health, which can result in worse health outcomes. This study aimed to describe patterns of light across 24-hour periods in two inpatient rooms of children undergoing SCT. Methods Wall-mounted light meters (Extech SDL400) continuously tracked noise and light levels at one-minute intervals in two patient rooms over six months. We determined the percent of time that patients were exposed to non-optimal light levels (< 448 lux during the daytime, >18 lux in the evening, >2 lux at night); thresholds were based on converting recent consensus-based melanopic equivalent daylight illuminance guidelines to vertically measured illuminance thresholds. We assessed the frequency that light exceeded thresholds associated with night wakings (>150 lux). Wilcoxon rank-sum tests compared light levels between the two rooms. Room A had a single northwest-facing window overlooking a narrow courtyard. Room B had an unobstructed window facing north. Results On average, hospitalized pediatric SCT patients spent 50% of their time in inappropriate light conditions. They were exposed to light spikes >150 lux on 2% of nights, with overnight light peaking at 513 lux. When comparing average daytime and nighttime light levels between the two rooms, Room A was significantly dimmer than Room B, p <.001. In the dimmer room, light levels never reached the recommended threshold during the daytime, and the light was too bright for 19% of the evening and 17% of the nighttime. In the brighter room, light levels were too dim during 97% of the daytime and too bright during 59% of the evening and 30% of the nighttime. Conclusion During the day, pediatric SCT patients are rarely exposed to light bright enough to preserve a healthy circadian rhythm. Hospitals have an opportunity to significantly improve the sleep and circadian health for children already at elevated risk for health morbidities during transplant. Support (if any) This research was generously supported by grant funding from Pedals for Pediatrics (PI: Zhou) and an institutional research training grant (T32DK063929).
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