Objective:

To characterize sleep in neurologic in-patients using objective and subjective measures.

Background:

In-patient sleep is not prioritized in the hospital setting, despite sleep-friendly interventions improving outcomes like readmission rates and patient-reported mental health. Furthermore, poor sleep during one's hospital stay can lead to poor clinical outcomes like adverse cardiometabolic effects and delirium.

Design/Methods:

We enrolled consecutive adult patients admitted to the inpatient neurology ward service at the Hospital of the University of Pennsylvania. We excluded patients with clinical instability, as determined by the covering physician, and those who could not provide consent. We used actigraphy devices to measure total duration of overnight sleep (10pm-7am) and total interruptions per recorded sleep period. Subjective experiences were measured using the Richard Campbell Sleep Questionnaire (RCSQ), and additional survey questions about sleep experience.

Results:

We recorded 158 nights of sleep in 61 patients. Hours of sleep per night were mean 6.5, median 7.1, range 1.3-9.0. Patients slept <6 hours in 48/158 nights (37%), and 29/61 patients (48%) had at least one night with <6 hours sleep. The median number of awakenings per night was 2, with a range of 0 to 8 awakenings. Reducing interruptions due to hospital staff was frequently mentioned as an area of improvement (n = 49, 30%). Across all nights, the median RCSQ score was 73 (IQR 53.8-85.3), and there was a significant correlation between sleep duration and RCSQ scores (r = .22, p = 0.01).

Conclusions:

Impaired sleep was common in our in-patient neurology ward. Our study paradigm can be used to measure impacts of future interventions aimed at improving in-patient sleep, such as by engaging hospital staff and providing alternatives to limit overnight interruptions.