Patient and Parent Sleep in a Children's Hospital
Patient and Parent Sleep in a Children's Hospital
The final sample included 72 children and adolescents (50% female, 68% Caucasian) ages 8 to 21 years (mean = 13.1 years, SD = 3.1) and 58 parents who roomed in with their child the previous night (89% female, 78% Caucasian; mean age = 41.9, SD 7.1; 48% high school/some college, 50% college degree or higher). Fortynine percent of youth were in the hospital due to a chronic illness that required treatment (such as asthma, cancer, cystic fibrosis, sickle cell disease), and 21% were in the hospital for surgery. Other reasons for hospitalization included medical tests, infections, flu, stomach pain/virus, and blood transfusion. This was the first hospitalization for 36% of the youth, with the median length of hospitalization of 3 days (range 1 to 150 days). Thirteen children (18%) reported taking a medication to help them sleep the previous night during hospitalization (including diphenhydramine, benzodiazepines, zolpidem, and morphine) compared to 2 children (3%) who took a medication to help them sleep at home.
Sleep variables at home and during the previous night in hospital can be found in Table 1. Compared to typical weekday sleep at home, children (8 to 12 years of age) reported a later bedtime, later wake time, more night wakings, and shorter TST in the hospital. It is notable that children reported sleeping almost one hour less in hospital. Adolescents (13 to 21 years of age) reported a later wake time, more night wakings, and longer TST in the hospital compared to at home. As opposed to children, it is notable that adolescents slept 55 minutes more in hospital. Parents reported a slightly later wake time and significantly more night wakings during the previous night in hospital.
Three types of sleep disruptors were examined: noises, worries/discomfort, and hospital specific variables (pain, vital sign checks). "Alarms beeping on medical equipment" was rated as bothering 42% of children, 33% of adolescents, and 66% of parents "somewhat" or "a lot." This was followed by "doors opening, closing, slamming" (21% children, 22% adolescents, 29% parents), and "people talking outside your room" (18% children, 19% adolescents, 23% parents). For patients with a roommate (43%), "roommate making noise (snoring, moaning)" was disruptive for 20% of children, 23% of adolescents, and 35% of parents.
The most common worries/discomfort that were rated as bothering participants "somewhat" or "a lot" were being homesick (36% children, 19% adolescents) or worrying about other family members (42% parents), worries about why the child is in the hospital (24% children, 25% adolescents, 59% parents), worries about missing school/work (30% children, 22% adolescents, 20% parents), and an uncomfortable bed (15% children, 22% adolescents, and 58% parents).
Finally, participants were asked about specific sleep disruptors (such as pain, vital sign checks, noises in the room) that may have bothered them specifically while trying to fall asleep at bedtime or during the night, or that caused early sleep termination in the morning. No specific time periods were given for bedtime and wake time, but rather, participants were asked about disruptors that bothered them when trying to fall asleep and upon waking in the morning. For children, vital sign checks and pain were most frequently identified as bothersome at bedtime (vitals 39%, pain 36%), during the night (vitals 46%, pain 28%), and in the morning (vitals 39%, pain 23%). For adolescents, vital sign checks and pain were also the most frequently identified disruptors at bedtime (vitals 57%, pain 51%) and during the night (vitals 60%, pain 40%). In the morning, adolescents were bothered by vital sign checks (55%) and noise in the room (45%). For parents, vital sign checks for the child and the child's pain were again the most frequently endorsed as bothering sleep at bedtime (vitals 41%, pain 41%) and during the night (vitals 45%, pain 37%). In the morning, parent sleep was most commonly bothered by vital sign checks for the child (46%) and noises in the room (35%).
Because sleep disruptions at these specific time periods would likely be associated with sleep continuity variables, t-tests were used to compare sleep onset latency at bedtime, night waking frequency during the night, and morning wake time between participants who endorsed specific sleep disruptions and participants who did not endorse these sleep disruptions. As outlined in Table 2, children who reported pain at bedtime had a significantly longer sleep onset latency. Moderate to large effect sizes were found for adolescents during the night, with more night wakings reported by adolescents whose sleep was bothered by pain, vital sign checks, or noise in the room. In addition, adolescents whose sleep was bothered by vital sign checks in the morning had an earlier wake time (large effect size). Parents whose sleep was bothered by noise in the room reported a significantly longer sleep onset latency and significantly more night wakings (large effect sizes).
One way ANCOVA (controlling for age) was used to examine sleep differences between groups for reason for hospitalization and first night effects (see Table 3). Significant differences for bedtime during hospitalization were found, with youth who had surgery reporting an earlier bedtime than the other two groups. Although not significant, youth who had surgery also reported an earlier wake time (29 to 48 minutes). First-night patients had a later bedtime (55 minutes), earlier wake time (47 minutes), and significantly shorter total sleep time (85 minutes).
Results
Sample Demographics
The final sample included 72 children and adolescents (50% female, 68% Caucasian) ages 8 to 21 years (mean = 13.1 years, SD = 3.1) and 58 parents who roomed in with their child the previous night (89% female, 78% Caucasian; mean age = 41.9, SD 7.1; 48% high school/some college, 50% college degree or higher). Fortynine percent of youth were in the hospital due to a chronic illness that required treatment (such as asthma, cancer, cystic fibrosis, sickle cell disease), and 21% were in the hospital for surgery. Other reasons for hospitalization included medical tests, infections, flu, stomach pain/virus, and blood transfusion. This was the first hospitalization for 36% of the youth, with the median length of hospitalization of 3 days (range 1 to 150 days). Thirteen children (18%) reported taking a medication to help them sleep the previous night during hospitalization (including diphenhydramine, benzodiazepines, zolpidem, and morphine) compared to 2 children (3%) who took a medication to help them sleep at home.
Sleep at Home and in Hospital
Sleep variables at home and during the previous night in hospital can be found in Table 1. Compared to typical weekday sleep at home, children (8 to 12 years of age) reported a later bedtime, later wake time, more night wakings, and shorter TST in the hospital. It is notable that children reported sleeping almost one hour less in hospital. Adolescents (13 to 21 years of age) reported a later wake time, more night wakings, and longer TST in the hospital compared to at home. As opposed to children, it is notable that adolescents slept 55 minutes more in hospital. Parents reported a slightly later wake time and significantly more night wakings during the previous night in hospital.
Sleep Disruptions in Hospital
Three types of sleep disruptors were examined: noises, worries/discomfort, and hospital specific variables (pain, vital sign checks). "Alarms beeping on medical equipment" was rated as bothering 42% of children, 33% of adolescents, and 66% of parents "somewhat" or "a lot." This was followed by "doors opening, closing, slamming" (21% children, 22% adolescents, 29% parents), and "people talking outside your room" (18% children, 19% adolescents, 23% parents). For patients with a roommate (43%), "roommate making noise (snoring, moaning)" was disruptive for 20% of children, 23% of adolescents, and 35% of parents.
The most common worries/discomfort that were rated as bothering participants "somewhat" or "a lot" were being homesick (36% children, 19% adolescents) or worrying about other family members (42% parents), worries about why the child is in the hospital (24% children, 25% adolescents, 59% parents), worries about missing school/work (30% children, 22% adolescents, 20% parents), and an uncomfortable bed (15% children, 22% adolescents, and 58% parents).
Finally, participants were asked about specific sleep disruptors (such as pain, vital sign checks, noises in the room) that may have bothered them specifically while trying to fall asleep at bedtime or during the night, or that caused early sleep termination in the morning. No specific time periods were given for bedtime and wake time, but rather, participants were asked about disruptors that bothered them when trying to fall asleep and upon waking in the morning. For children, vital sign checks and pain were most frequently identified as bothersome at bedtime (vitals 39%, pain 36%), during the night (vitals 46%, pain 28%), and in the morning (vitals 39%, pain 23%). For adolescents, vital sign checks and pain were also the most frequently identified disruptors at bedtime (vitals 57%, pain 51%) and during the night (vitals 60%, pain 40%). In the morning, adolescents were bothered by vital sign checks (55%) and noise in the room (45%). For parents, vital sign checks for the child and the child's pain were again the most frequently endorsed as bothering sleep at bedtime (vitals 41%, pain 41%) and during the night (vitals 45%, pain 37%). In the morning, parent sleep was most commonly bothered by vital sign checks for the child (46%) and noises in the room (35%).
Because sleep disruptions at these specific time periods would likely be associated with sleep continuity variables, t-tests were used to compare sleep onset latency at bedtime, night waking frequency during the night, and morning wake time between participants who endorsed specific sleep disruptions and participants who did not endorse these sleep disruptions. As outlined in Table 2, children who reported pain at bedtime had a significantly longer sleep onset latency. Moderate to large effect sizes were found for adolescents during the night, with more night wakings reported by adolescents whose sleep was bothered by pain, vital sign checks, or noise in the room. In addition, adolescents whose sleep was bothered by vital sign checks in the morning had an earlier wake time (large effect size). Parents whose sleep was bothered by noise in the room reported a significantly longer sleep onset latency and significantly more night wakings (large effect sizes).
Additional Factors Related to Sleep in Hospital
One way ANCOVA (controlling for age) was used to examine sleep differences between groups for reason for hospitalization and first night effects (see Table 3). Significant differences for bedtime during hospitalization were found, with youth who had surgery reporting an earlier bedtime than the other two groups. Although not significant, youth who had surgery also reported an earlier wake time (29 to 48 minutes). First-night patients had a later bedtime (55 minutes), earlier wake time (47 minutes), and significantly shorter total sleep time (85 minutes).
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