Managing Circadian Disruption due to Hospitalization: A Pilot Randomized Controlled Trial of the CircadianCare Inpatient Management System

Abstract

The objective of the present study was to test the effects of an inpatient management system (CircadianCare) aimed at limiting the negative impact of hospitalization on sleep by enhancing circadian rhythmicity. Fifty inpatients were randomized to either CircadianCare ( n = 25; 18 males, 62.4 ± 1.9 years) or standard of care ( n = 25; 14 males, 64.5 ± 2.3 years). On admission, all underwent a full sleep-wake evaluation; they then completed daily sleep diaries and wore an actigraph for the whole length of hospitalization. On days 1 (T0), 7 (T1), and 14 (T2, if still hospitalized), salivary melatonin for dim light melatonin onset (DLMO) and 24-h skin temperature were recorded. In addition, environmental noise, temperature, and illuminance were monitored. Patients in the CircadianCare arm followed 1 of 3 schedules for light/dark, meal, and physical activity timings, based on their diurnal preference/habits. They wore short-wavelength-enriched light-emitting glasses for 45 min after awakening and short-wavelength light filter shades from 18:00 h until sleep onset. While the first, primary registered outcome (reduced sleep-onset latency on actigraphy or diary) was not met, based on sleep diaries, there was a trend (0.05 < p < 0.1) toward an advance in bedtime for CircadianCare compared to standard of care patients between T0 and T1. Similarly, DLMO time significantly advanced in the small group of patients for whom it could be computed on both occasions, with untreated ones starting from earlier baseline values. Patients sleeping near the window had significantly higher sleep efficiency, regardless of treatment arm. As noise fluctuation increased, so did the number of night awakenings, regardless of treatment arm. In conclusion, the CircadianCare management system showed positive results in terms of advancing sleep timing and the circadian rhythm of melatonin. Furthermore, our study identified a combination of environmental noise and lighting indices, which could be easily modulated to prevent hospitalization-related insomnia.

Evaluation of Sleep in Pregnant Inpatients Compared With Outpatients

“…Other interventions during hospitalization, such as syncing daily activities with circadian rhythms, have been studied outside of pregnancy with success. 30 Additional studies analyzing different interventions are warranted, such as providing universal eye masks and earplugs, minimizing overnight monitoring, and coordinating check-ins to reduce disturbances. Our results also highlight the importance of assessing sleep hygiene during inpatient rounds and taking an individualized approach to solutions beyond the use of routine pharmacologic sleep aids.…”

Editorial: Rising stars in chronobiology 2022

“…Conversely, the use of diverse models in the field of chronobiology will enable comparative analysis and formulation of broad principles governing circadian rhythm and its adaptive nature. Finally, the impact of chronobiology on biomedical sciences is hard to ignore, especially after 2017 when pioneering chronobiologists Michael Young, Michael Rosbash, and Jeffrey Hall, were awarded the Nobel Prize in Physiology and Medicine “for their discoveries of molecular mechanisms controlling the circadian rhythm.” In addition to established links between circadian disruption and many human diseases (reviewed in Manoogian and Panda, 2017 ; Masri and Sassone-Corsi, 2018 ; Acosta-Rodriguez et al, 2021 ; Lopez-Otin and Kroemer, 2021 ), chronobiologists and clinicians are increasing recognizing the potential of incorporating circadian medicine into healthcare and medical treatments ( Ruben et al, 2019 ; Rasmussen et al, 2022 ; Kramer, 2023 ; Sole and Martino, 2023 ; Mangini et al, 2024 ; Zhu et al, 2024 ).…”