Hillman David R, Carlucci Melissa, Charchaflieh Jean G, Cloward Tom V, Gali Bhargavi, Gay Peter C, Lyons M Melanie, McNeill Margaret M, Singh Mandeep, Yilmaz Meltem, Auckley Dennis H
From the West Australian Sleep Disorders Research Institute, Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia.
Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
Anesth Analg. 2023 Apr 1;136(4):814-824. doi: 10.1213/ANE.0000000000006395. Epub 2023 Feb 6.
This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it.
本文探讨了住院患者的睡眠问题，麻醉与睡眠医学协会认为，这一问题值得卫生当局给予比目前更广泛的关注。充足的睡眠是健康和幸福的基础，睡眠时间、质量或时间安排不足会产生明显的不利影响。这些影响包括心血管功能障碍、通气功能受损、认知障碍、疼痛感知增加、精神运动障碍（包括跌倒风险增加）、心理障碍（包括焦虑和抑郁）、代谢功能障碍（包括胰岛素抵抗增加和分解代谢倾向）以及免疫功能障碍和促炎作用（增加感染风险和疼痛产生）。所有这些变化都会对健康状况产生负面影响，不利于疾病康复和手术恢复。住院会以多种方式对睡眠造成挑战。这些挑战包括环境因素，如噪音、强光以及夜间因观察、干预和转运而醒来；生理因素，如疼痛、呼吸困难、肠道或泌尿系统功能障碍，或治疗设备引起的不适；心理因素，如压力和焦虑；与护理相关的因素，包括药物或停药；以及可能未被识别或未得到充分管理的既往睡眠障碍。其中许多挑战似乎很容易解决。关键在于更加重视睡眠，确保在医院内外都能认识并满足患者的睡眠需求。这需要对工作人员进行教育，制定协议以提高满足睡眠需求的可能性，并改善医院设计以减轻环境干扰。医院和医疗服务提供者有责任尽可能提供适当的康复前提条件。越来越多的证据表明，这些前提条件包括充足的患者睡眠时间和质量。麻醉与睡眠医学协会呼吁医院领导和工作人员在处理这个问题上进行系统性变革。所需措施包括将优化患者睡眠纳入围手术期和一般患者护理指南的目标中。这些措施应辅以进一步研究住院对睡眠的影响、睡眠不足对住院后健康结果的影响，以及对改善睡眠的干预措施进行评估。
