Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
JAMA Netw Open. 2022 Sep 1;5(9):e2232623. doi: 10.1001/jamanetworkopen.2022.32623.
Inadequate sleep negatively affects patients' physical health, mental well-being, and recovery. Nonpharmacologic interventions are recommended as first-choice treatment. However, studies evaluating the interventions are often of poor quality and show equivocal results.
To assess whether the implementation of nonpharmacologic interventions is associated with improved inpatient night sleep.
DESIGN, SETTING, AND PARTICIPANTS: In a nonrandomized controlled trial, patients were recruited on the acute medical unit and medical and surgical wards of a Dutch academic hospital. All adults who spent exactly 1 full night in the hospital were recruited between September 1, 2019, and May 31, 2020 (control group), received usual care. Patients recruited between September 1, 2020, and May 31, 2021, served as the intervention group. The intervention group received earplugs, an eye mask, and aromatherapy. Nurses received sleep-hygiene training, and in the acute medical unit, the morning medication and vital sign measurement rounds were postponed from the night shift to the day shift. All interventions were developed in collaboration with patients, nurses, and physicians.
Sleep was measured using actigraphy and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System sleep disturbance item bank. Other outcomes included patient-reported sleep disturbing factors and the use of sleep-enhancing tools.
A total of 374 patients were included (222 control, 152 intervention; median age, 65 [IQR, 52-74] years). Of these, 331 were included in the analysis (195 [59%] men). Most patients (138 [77%] control, 127 [84%] intervention) were in the acute medical unit. The total sleep time was 40 minutes longer in the intervention group (control: median, 6 hours and 5 minutes [IQR, 4 hours and 55 minutes to 7 hours and 4 minutes]; intervention: 6 hours and 45 minutes [IQR, 5 hours and 47 minutes to 7 hours and 39 minutes]; P < .001). This was mainly due to a 30-minute delay in final wake time (median clock-time: control, 6:30 am [IQR, 6:00 am to 7:22 am]; intervention, 7:00 am [IQR, 6:30-7:30 am]; P < .001). Sleep quality did not differ significantly between groups. For both groups, the main sleep-disturbing factors were noises, pain, toilet visits, and being awakened by hospital staff. Sleep masks (23 of 147 [16%]) and earplugs (17 of 147 [12%]) were used most. Nightly vital sign checks decreased significantly (control: 54%; intervention: 11%; P < .001).
The findings of this study suggest that sleep of hospitalized patients may be significantly improved with nonpharmacologic interventions. Postponement of morning vital sign checks and medication administration rounds from the night to the day shift may be a useful way to achieve this.
Netherlands Trial Registry Identifier: NL7995.
睡眠不足会对患者的身体健康、心理健康和康复产生负面影响。建议将非药物干预作为首选治疗方法。然而，评估这些干预措施的研究通常质量较差，结果也不一致。
评估非药物干预是否与改善住院夜间睡眠有关。
设计、地点和参与者：在一项非随机对照试验中，患者在荷兰一家学术医院的急性内科病房和内科及外科病房招募。2019 年 9 月 1 日至 2020 年 5 月 31 日期间（对照组），在医院过夜的所有成年人都被招募，接受常规护理。2020 年 9 月 1 日至 2021 年 5 月 31 日期间招募的患者作为干预组。干预组接受耳塞、眼罩和芳香疗法。护士接受了睡眠卫生培训，在急性内科病房，早上的药物和生命体征测量轮次从夜班推迟到白班。所有干预措施都是与患者、护士和医生合作开发的。
使用活动记录仪和荷兰-佛兰德斯患者报告的结果测量信息系统睡眠障碍项目库来测量睡眠。其他结果包括患者报告的睡眠干扰因素和使用助眠工具。
共有 374 名患者入组（对照组 222 名，干预组 152 名；中位年龄 65 [IQR，52-74] 岁）。其中 331 名患者纳入分析（195 [59%] 名男性）。大多数患者（对照组 138 [77%]，干预组 127 [84%]）在急性内科病房。干预组的总睡眠时间延长了 40 分钟（对照组：中位数为 6 小时 5 分钟 [IQR，4 小时 55 分钟至 7 小时 4 分钟]；干预组：6 小时 45 分钟 [IQR，5 小时 47 分钟至 7 小时 39 分钟]；P <.001）。这主要是由于最终醒来时间推迟了 30 分钟（对照组的中位时钟时间为 6:30 am [IQR，6:00 am 至 7:22 am]；干预组为 7:00 am [IQR，6:30-7:30 am]；P <.001）。两组的睡眠质量无显著差异。对于两组患者，主要的睡眠干扰因素是噪音、疼痛、上厕所和被医护人员唤醒。睡眠眼罩（147 人中的 23 人 [16%]）和耳塞（147 人中的 17 人 [12%]）使用最多。夜间生命体征检查显著减少（对照组：54%；干预组：11%；P <.001）。
本研究结果表明，非药物干预可能显著改善住院患者的睡眠。将晨间生命体征检查和药物治疗轮次从夜间推迟到白天可能是实现这一目标的一种有效方法。
荷兰试验注册处标识符：NL7995。
