Infusion timing and sleep habits of adults receiving home parenteral and enteral nutrition: A patient‐oriented survey study

Abstract

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.

Comparison between self‐reported and actigraphy‐derived sleep measures in patients receiving home parenteral nutrition: Secondary analysis of observational data

“…This was the first comparison of sleep measures ascertained using two different commonly used methods in patients receiving HPN, a patient population that often experiences disrupted sleep 10,11 . We found strong‐to‐moderate agreement between objective and subjective sleep across five sleep measures.…”

“…Patients receiving home parenteral nutrition (HPN) often experience disrupted sleep 10 . Sleep disruption is particularly common among those who cycle their HPN infusions at night because of nocturnal polyuria, alarms and noise from infusion pumps, and restricted sleep positions to prevent central line dislodgement 11 .…”

“…[6][7][8][9] Patients receiving home parenteral nutrition (HPN) often experience disrupted sleep. 10 Sleep disruption is particularly common among those who cycle their HPN infusions at night because of nocturnal polyuria, alarms and noise from infusion pumps, and restricted sleep positions to prevent central line dislodgement. 11 A recent home-based observational study found that most patients receiving HPN were not meeting recommendations for sleep quantity and quality.…”

Healthy Sleep Practices for Consumers of Home Total Parenteral Nutrition: A Mixed-Methods Community-Based Participatory Study

“…Consumers of HPN range from acute (few months) to lifelong (>30 y) users and include patients living with short bowel syndrome, Crohn’s disease, and gastrointestinal dysmotility [ 19 ]. Infusions of HPN generally last 10–16 h and are cycled overnight by >80% of consumers to facilitate mobility during the day [ 20 ]. Overnight infusions of HPN are widely recognized by patients and their clinicians to disrupt sleep [ 21 , 22 ].…”

Home parenteral nutrition, sleep patterns, and depressive symptoms: Secondary analysis of cross‐sectional data

“…6 Home parenteral nutrition (HPN) is a life-sustaining yet complex therapy for people with compromised gastrointestinal tracts who are unable to adequately digest and/or absorb nutrients. 7 To limit hepatic impairment and metabolic disturbances (eg, dysglycemia and hypertriglyceridemia), HPN regimens are typically provided in cycles of 10-16 h, often infused nocturnally, 8 or continuously over 24 h. 7,9 Those receiving HPN experience highly disrupted sleep, 10 particularly when infusions coincide with sleep intervals. 8 Moreover, adults receiving HPN may experience psychological distress (ie, anxiety and depression), 11 which results in a remarkably high use of antidepressants.…”