Improving Sleep for Hospitalized Antepartum Patients: A Non-Randomized Controlled Pilot Study

Abstract

Study Objectives: To evaluate feasibility and efficacy of a hospital-based protocol for improving sleep in high-risk antepartum patients. Methods: Sleep measures were compared during 1 week of hospitalization before and after implementing a Sleep Improvement Protocol for Antepartum Patients (SIP-AP). A non-randomized convenience sample of usual care controls was compared to a subsequent intervention sample after the protocol was implemented. Women were eligible if they spoke English, were medically stable, pregnant for at least 20 weeks, and hospitalized at least 24 hours; 25 pregnant women had sufficient data for analyses (11 controls, 14 intervention). Sleep was assessed in 3 ways: the Pittsburgh Sleep Quality Index was completed after obtaining consent to estimate sleep quality prior to hospital admission; sleep diary completed each hospital day; and General Sleep Disturbance Scale completed at 7 days or prior to hospital discharge. Symptoms that could affect sleep were assessed with the Memorial Symptom Assessment Scale. Results: Both groups recorded similar sleep duration (7 hours) but the intervention group had fewer symptoms and significantly (P = .015) lower sleep disturbance scores (53.1 ± 14.5) than controls (71.9 ± 18.8). Participant feedback about the intervention was positive, although adherence to components of the intervention protocol was variable. Conclusions: This pilot study provides evidence of the feasibility and preliminary efficacy of the SIP-AP intervention for reducing symptoms and improving sleep of antepartum patients during hospitalization. Further detailed evaluation of specific components of this protocol is warranted, and other types of hospitalized patients may benefit from unit-based modifications to this SIP-AP protocol. Keywords: antepartum, inpatient, intervention, pregnancy, sleep hygiene Citation: Lee KA, Gay CL. Improving sleep for hospitalized antepartum patients: a non-randomized controlled pilot study.

Interventions for sleep problems during pregnancy: A systematic review

“…Of the included studies, six were RCT [43][44][45][46][47][48], testing the efficacy of the following different interventions: use of lavender cream, pharmacotherapy, CBT-I, relaxation exercise, use of lactuca seeds and sleep hygiene. Ten were non-randomized trials testing the efficacy of acupuncture [49]; mindful yoga [50]; music listening relaxation [51] and general relaxation [52,53]; cognitive behavioral therapy interventions [54,55]; mindfulness [56]; massage therapy [57] and tai-chi [58]. The sample size of all included studies ranged from a minimum of 13 to a maximum of 215 participants.…”

“…Of the included studies, six included healthy women with no complaints [46,50,52,53,55,57], seven included healthy women with self-reported sleep problems [43, 44, 47-49, 51, 54]; one study had participants with insomnia diagnosis [45], one reported data for obese women [56] and one included women with clinical depression [58]. Furthermore, the majority of the included studies (n=10) used only self-reported measures as outcomes; two studies [44,53] used only actigraphy and four studies [45,50,54,55] used both subjective/objective sleep parameters (diaries or actigraphy) and self-reported measures. Only four of the included studies carried out follow ups [43,44,48,53].…”

“…Three studies did not report mean gestational age [51,53,58] of the participants, and only one study [53] included follow-up analyses. Finally, the majority of the non-RCT studies had exiguous samples, indeed seven studies had a sample with less than 40 participants [49,50,[52][53][54][55]57].…”

Prolonged antepartum hospitalization: no time for rest

“…In a non-randomized controlled pilot study, Lee & Gay implemented a sleep improvement protocol for antepartum patients, which consisted of sleep hygiene strategies and cognitive behavioral therapies for dealing with stress and worry. (12) They report that such an intervention is both feasible and efficacious; while sleep duration was not different between the experimental and control group, overall sleep disturbances were significantly less after the implementation of the protocol. Our findings reinforce the need for such studies and provide additional support for unit modifications and environmental changes, such as timing of lab draws and physician rounding, to improve sleep hygiene specifically.…”

“…(8–10) Only two studies to date have examined patterns of sleep disturbances among hospitalized antepartum patients. (11, 12) Therefore, the purpose of our study was to examine sleep quality among hospitalized antepartum patients.…”