Section of Hospital Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Philadelphia Corporal Michael Crescenz Veterans Medical Center, Philadelphia, PA, United States.
JMIR Mhealth Uhealth. 2022 Apr 27;10(4):e30089. doi: 10.2196/30089.
Inadequate sleep and physical activity are common during and after hospitalization, but their impact on patient-reported functional outcomes after discharge is poorly understood. Wearable devices that measure sleep and activity can provide patient-generated data to explore ideal levels of sleep and activity to promote recovery after hospital discharge.
This study aimed to examine the relationship between daily sleep and physical activity with 6 patient-reported functional outcomes (symptom burden, sleep quality, physical health, life space mobility, activities of daily living, and instrumental activities of daily living) at 13 weeks after hospital discharge.
This secondary analysis sought to examine the relationship between daily sleep, physical activity, and patient-reported outcomes at 13 weeks after hospital discharge. We utilized wearable sleep and activity trackers (Withings Activité wristwatch) to collect data on sleep and activity. We performed descriptive analysis of device-recorded sleep (minutes/night) with patient-reported sleep and device-recorded activity (steps/day) for the entire sample with full data to explore trends. Based on these trends, we performed additional analyses for a subgroup of patients who slept 7-9 hours/night on average. Differences in patient-reported functional outcomes at 13 weeks following hospital discharge were examined using a multivariate linear regression model for this subgroup.
For the full sample of 120 participants, we observed a "T-shaped" distribution between device-reported physical activity (steps/day) and sleep (patient-reported quality or device-recorded minutes/night) with lowest physical activity among those who slept <7 or >9 hours/night. We also performed a subgroup analysis (n=60) of participants that averaged the recommended 7-9 hours of sleep/night over the 13-week study period. Our key finding was that participants who had both adequate sleep (7-9 hours/night) and activity (>5000 steps/day) had better functional outcomes at 13 weeks after hospital discharge. Participants with adequate sleep but less activity (<5000 steps/day) had significantly worse symptom burden (z-score 0.93, 95% CI 0.3 to 1.5; P=.02), community mobility (z-score -0.77, 95% CI -1.3 to -0.15; P=.02), and perceived physical health (z-score -0.73, 95% CI -1.3 to -0.13; P=.003), compared with those who were more physically active (≥5000 steps/day).
Participants within the "sweet spot" that balances recommended sleep (7-9 hours/night) and physical activity (>5000 steps/day) reported better functional outcomes after 13 weeks compared with participants outside the "sweet spot." Wearable sleep and activity trackers may provide opportunities to hone postdischarge monitoring and target a "sweet spot" of recommended levels for both sleep and activity needed for optimal recovery.
ClinicalTrials.gov NCT03321279; https://clinicaltrials.gov/ct2/show/NCT03321279.
住院期间和出院后，睡眠不足和身体活动不足很常见，但人们对其出院后患者报告的功能结果的影响知之甚少。可穿戴设备可测量睡眠和活动，可提供患者生成的数据，以探索理想的睡眠和活动水平，促进出院后的康复。
本研究旨在探讨出院后 13 周内每日睡眠和身体活动与 6 项患者报告的功能结果（症状负担、睡眠质量、身体健康、生活空间移动性、日常生活活动和工具性日常生活活动）之间的关系。
本二次分析旨在探讨出院后 13 周内每日睡眠、身体活动与患者报告的结果之间的关系。我们使用可穿戴睡眠和活动追踪器（Withings Activité 腕带）来收集睡眠和活动数据。我们对整个样本中具有完整数据的设备记录的睡眠（分钟/夜）和患者报告的睡眠以及设备记录的活动（每日步数）进行描述性分析，以探索趋势。基于这些趋势，我们对平均每晚睡眠时间为 7-9 小时的亚组患者进行了额外分析。使用多元线性回归模型对出院后 13 周内的这一组患者进行了功能结果的差异分析。
对于 120 名参与者的全样本，我们观察到设备报告的身体活动（每日步数）和睡眠（患者报告的质量或设备记录的分钟/夜）之间存在“T 形”分布，每晚睡眠时间<7 或>9 小时的人活动量最低。我们还对平均每晚睡眠时间为 7-9 小时的 60 名参与者进行了亚组分析。我们的主要发现是，既具有充足睡眠（7-9 小时/夜）又具有较高活动量（>5000 步/天）的参与者在出院后 13 周的功能结果更好。与活动量较大（≥5000 步/天）的参与者相比，睡眠充足但活动量较少（<5000 步/天）的参与者的症状负担（Z 分数 0.93，95%CI 0.3 至 1.5；P=.02）、社区移动性（Z 分数 -0.77，95%CI -1.3 至 -0.15；P=.02）和感知身体健康（Z 分数 -0.73，95%CI -1.3 至 -0.13；P=.003）均明显更差。
与活动量较小（<5000 步/天）的参与者相比，处于“理想点”（即平衡推荐睡眠时间（7-9 小时/夜）和身体活动量（>5000 步/天）的参与者在出院后 13 周时报告的功能结果更好。可穿戴睡眠和活动追踪器可能为出院后的监测提供机会，并针对推荐的睡眠和活动水平的“理想点”进行目标设定，以促进最佳康复。
ClinicalTrials.gov NCT03321279；https://clinicaltrials.gov/ct2/show/NCT03321279。
