Background Patients supported with home parenteral nutrition (HPN) often report poor sleep; however, limited research has been conducted to objectively measure sleep patterns of HPN‐dependent patients. Methods We aimed to characterize the sleep patterns of patients receiving HPN through 7‐day actigraphy in a home‐based observational study. Sleep measures of clinical importance were derived from actigraphy, including sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset. Participants also completed validated sleep surveys. Results Twenty participants completed all study procedures (mean [SD]: age = 51.6 [13.9] years, body mass index = 21.4 [4.6], and 80% female). The population median (IQR) for sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset was 6.9 (1.1) h, 83.3% (7.8%), 11.8 (7.1) min, and 57.2 (39.9) min, respectively, and 55%, 60%, 35%, and 100% of participants did not meet the recommendations for these measures from the National Sleep Foundation. Sixty‐five percent of participants reported napping at least once during the 7‐day period. Based on the Insomnia Severity Index, 70% of participants were classified as having subthreshold or more severe insomnia. Based on the Pittsburgh Sleep Quality Index, 85% were classified as having significant sleep disturbance. Conclusion Most HPN‐dependent patients likely have disrupted sleep largely driven by difficulty maintaining sleep. The extent to which HPN contributed to poor sleep cannot be elucidated from this observational study. Addressing known factors that contribute to sleep disruption and considering sleep interventions may improve the overall quality of life of patients receiving HPN.
Background: The emerging field of chrononutrition investigates the effects of the timing of nutritional intake on human physiology and disease pathology. It remains largely unknown when patients receiving home nutrition support routinely administer home parenteral nutrition (HPN) and/or home enteral nutrition (HEN). Methods: The present descriptive study included data collected from a patientoriented survey designed to assess the timing of infusions and sleep habits of patients receiving HPN and HEN in the United States. Results: A total of 100 patients were included. Patients had a mean age of 44.1 years and 81% were female. Among 73 patients supported with HPN and 27 patients supported with HEN, 86% and 44% reported overnight infusions, respectively. The median start and end times of overnight infusions were 2100 (interquartile range [IQR] = 1900-2200) and 0800 (IQR = 0700-1000), respectively, for HPN and 2000 (IQR = 1845-2137) and 0845 (IQR = 0723-1000), respectively, for HEN. Overnight infusions started 2.0 h (IQR = 1.1-3.0) and 2.0 h (IQR = 0.6-3.3) before bedtime for HPN and HEN, respectively, and stopped 12.9 min (IQR = −21.3 to 29.1) and 30.0 min (IQR = −17.1 to 79.3) after wake time for HPN and HEN, respectively. Sleep disruption because of nutrition support or urination was most common among patients receiving infusions overnight compared with those receiving infusions continuously or during the daytime. Conclusions: Our survey study focusing on a novel and medically relevant dimension of nutrition found that most HPN-dependent and HEN-dependent patients receive infusions overnight while asleep. Our findings suggest that overnight infusions coinciding with sleep may result in sleep and circadian disruption.
Introduction Whereas home parenteral nutrition (HPN), a form of nutrition administered through a central venous catheter for patients with intestinal failure, is necessary for survival, the current standard practice for HPN is to administer infusions for approximately 12-hour periods overnight, coinciding with nighttime sleep. Patients supported with HPN often report poor sleep, however limited research has been conducted to objectively measure sleep patterns of HPN-dependent patients. Methods We aimed to characterize the sleep patterns of patients on HPN through 7-day actigraphy in a remote, home-based observational study. Sleep measures of clinical importance were derived from actigraphy including sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset. Participants also completed validated sleep surveys electronically. Results 20 participants completed all study procedures [mean (standard deviation): age =51.6 (13.9), BMI =21.4 kg/m2 (4.6), 80% female]. The population median (interquartile range) for sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset was 6.9 (1.1) hours, 83.3 (7.8) %, 11.8 (7.1) minutes and 57.2 (39.9) minutes, respectively, and 55%, 60%, 35%, and 100% of participants did not meet the recommendations for these measures from the National Sleep Foundation. 65% of participants reported napping at least once during the 7-day period. Based on the Insomnia Severity Index, 70% of participants were classified as having sub-threshold or more severe insomnia. Based on the Pittsburgh sleep quality index, 85% were classified as having significant sleep disturbance. Conclusion Most HPN-dependent patients likely have disrupted sleep largely driven by difficulty maintaining sleep. The extent to which overnight HPN infusions contributed to poor sleep cannot be elucidated from this observational study. Addressing known factors that contribute to poor sleep and encouraging sleep hygiene and sleep interventions are imperative to improve the overall quality of life of patients requiring HPN. Support (If Any) Research reported in this publication was supported by the American Society for Parenteral and Enteral Nutrition (ASPEN) Rhoads Research Foundation.
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