Objective Sleep Duration and Quality in Hospitalized Older Adults: Associations with Blood Pressure and Mood

Arora, Vineet M.; Chang, Kevin L.; Fazal, Arshiya Z.; Staisiunas, Paul G.; Meltzer, David O.; Zee, Phyllis C.; Knutson, Kristen L.; Cauter, Eve Van

doi:10.1111/j.1532-5415.2011.03644.x

Cited by 47 publications

(43 citation statements)

References 10 publications

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“…Despite emerging evidence of the importance of sleep in maintaining adequate immune, cardiovascular, and cognitive function, there are limited data regarding the benefits of sleep during acute illness . In the absence of compelling data, promoting sleep in the hospital has been difficult.…”

Section: Discussionmentioning

confidence: 99%

Inpatient pharmacological sleep aid utilization is common at a tertiary medical center

Gillis

Poyant

DeGrado

et al. 2014

Journal of Hospital Medicine

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BACKGROUND Sleep is known to be poor in the hospital. Patients frequently request pharmacological sleep aids, despite the risk of altered mental status (delirium) and falls. Little is known about the scope of pharmacological sleep aid use in hospitalized patients. METHODS We performed a single center, retrospective review of all patients admitted to the general adult (age >18 years) medical and surgical units of a tertiary care center during a recent 2‐month period (January 2013–February 2013). Review of the electronic medication administration system was performed to assess for medications administered for sleep. RESULTS Of 642 unique admissions, 168 patients (26.2%) received a medication for sleep. Most (n = 115, 68.5%) had no known history of insomnia or regular prior sleep medication use. Patients most frequently were treated with trazodone (30.4%; median dose, 50 mg; range, 12.5–450 mg), lorazepam (24.4%; median, 0.5 mg; range, 0.25–2 mg), and zolpidem tartrate (17.9%; median, 10 mg; range, 2.5–10 mg). Of the medications given, 36.7% were given early (before 9 pm) or late (after midnight). Of patients not known to be previously taking a pharmacological sleep aid, 34.3% of them were discharged with a prescription for one. CONCLUSIONS Despite increasing evidence of risks such as delirium or falls, pharmacological sleep aid use in general wards remains common, even in elderly patients. Medication administration time is frequently suboptimal. Many previously sleep medication‐naïve patients leave the hospital with a sleep aid prescription. Further research is needed to understand the factors that contribute to the high rate of sleep medication use in hospitalized patients. Journal of Hospital Medicine 2014;9:652–657. © 2014 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Inpatient pharmacological sleep aid utilization is common at a tertiary medical center

Gillis

Poyant

DeGrado

et al. 2014

Journal of Hospital Medicine

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“…8,9 Because hospitalization has been characterized as a period of acute sleep loss due to environmental factors, inpatients with undiagnosed OSA may experience even more sleep disruptions than their healthier counterparts. 10 Despite these associations, in one study of inpatients, there was no documentation of sleep histories or any sleep-associated symptoms in their hospital charts. 11 In addition, there is a high frequency of sleep disordered breathing in hospitalized patients referred for polysomnography, especially in patients with underlying cardiopulmonary disease.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Risk of Sleep Apnea in Hospitalized Older Patients

Shear

Balachandran

Mokhlesi

et al. 2014

Journal of Clinical Sleep Medicine

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Background/Objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality. Design: Prospective cohort study. Setting: General medicine ward in academic medical center Participants: 424 hospitalized adult patients ≥ 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American). Main Measures: The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and effi ciency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI). Key Results: Two of every 5 inpatients ≥ 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ~ 5 h and mean sleep effi ciency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ~ 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These fi ndings remained signifi cant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ~ 5.5% less sleep effi ciency per night (-5.50 [-9.96 S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is a common sleep disorder that affects approximately 1 of every 4 adults in the United States.1,2 Unfortunately, up to 90% of people with OSA are undiagnosed.3 Without treatment, severe OSA is associated with increased risk of cardiovascular and cerebrovascular morbidity and mortality in both men and women.3-5 Early diagnosis and treatment of OSA have been recommended to improve patient health outcomes.Hospitalized patients are likely at high risk of OSA. One reason is that OSA is especially prevalent among patients with medical conditions that can result in hospitalization, such as congestive heart failure. [4][5][6][7] Hospitalized patients with OSA also have an increased risk of postoperative complications and exacerbations of chronic conditions. 8,9 Because hospitalization has been characterized as a period of acute sleep loss due to environmental factors, inpatients with undiagnosed OSA may experience even more sleep disruptions than their healthier counterparts.10 Despite these associations, in one study of inpatients, there was no documentation of sleep histories or any sleep-associated symptoms in their hospital charts.11 In addition, there is a high frequency of sleep disordered breathing in hospitalized patients referred for polysomnography, especially in patients with underlying cardiopulmonary disease. 12These fi ndings suggest that hospitalization may represent a missed opportunity to screen patients for sleep disorders. Risk of Sleep Apnea in Hospitalized Older Patients BRIEF SUMMARYCurrent Knowledge/Study Rationale: While the prevalence of OSA in the US is estimated at approximately 25%, it ...

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“…We are aware of only one Canadian study where family medicine and general medicine patients were grouped together [7]. Other studies have excluded patients transferred from an intensive care unit, those unable to ambulate, those with previously documented sleep disorders or those that are being discharged to a location other than independent community living [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Sleep Quality and Factors Influencing Self-Reported Sleep Duration and Quality in the General Internal Medicine Inpatient Population

et al. 2016

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BackgroundSleep quality in hospitalized Canadian General Internal Medicine patients is not well characterized. Our goals were to characterize hospital sleep quality in this population and identify potentially modifiable barriers to good sleep.MethodsGIM inpatients at a quaternary centre in Edmonton, Canada completed a survey, including the Verran-Snyder Halpern (VSH) questionnaire, to characterize the previous night’s sleep within 48 hours prior to discharge. A chart review was also completed to assess comorbidities, discharge diagnoses, and pharmaceutical sleep aid use.ResultsPatients reported significantly worse nighttime sleep duration in hospital compared with home (mean 5.5 versus 7.0 hours per night, p < 0.0001). Sleep quality was poor, as measured by the VSH disturbance (mean 371), effectiveness (190), and supplementation (115) subscales. Variables independently associated with poorer sleep duration in multivariable regression include prior diagnosis of sleep disorder and multi-patient occupancy rooms. Age, sex, admitting diagnosis, length of stay, frequency of vital checks, and use of sleep pharmaceuticals during the index hospitalization were not associated with sleep duration. The most frequently reported reasons for poor sleep included noise (59%), nursing interruptions (30%), uncomfortable beds (18%), bright lights (16%), unfamiliar surroundings (14%), and pain (9%).ConclusionsSleep quality for GIM inpatients is significantly worse in hospital than at home. There is a need to test non-pharmacologic interventions to address the most frequently identified factors causing poor sleep hygiene for GIM inpatients.

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Objective Sleep Duration and Quality in Hospitalized Older Adults: Associations with Blood Pressure and Mood

Cited by 47 publications

References 10 publications

Inpatient pharmacological sleep aid utilization is common at a tertiary medical center

Inpatient pharmacological sleep aid utilization is common at a tertiary medical center

Risk of Sleep Apnea in Hospitalized Older Patients

Sleep Quality and Factors Influencing Self-Reported Sleep Duration and Quality in the General Internal Medicine Inpatient Population

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