Sleep Interrupted: Nocturnal Care Disturbances

Purpose:  The importance of sleep in the hospital environment is often overshadowed by other competing needs.  Care requirements during hours generally reserved for sleep result in nocturnal disruptions that impact sleep quality.  Patients receiving high dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) typically require an extended hospitalization.  This intensive cancer treatment places patients at risk for frequent sleep interruptions due to nocturnal care requirements.  The types and frequency of night-time care requirements in HSCT patients have not been documented making it difficult to determine which interactions are modifiable.  The purpose of this study is to (1) examine the types and frequency of HSCT patient/healthcare provider interactions occurring between 9:00 pm and 7:00 am; and, (2) determine the frequency of sleep disturbance recognition by healthcare providers in hospitalized stem cell transplant patients.

Methods:  This retrospective study examined hourly nocturnal care interactions over a four-night period using the electronic medical record. The data was extracted from hospitalized HSCT patients (n = 40) during the acute post recovery period.  Data for each HSCT patient was retrieved on days four through eight when patients were experiencing the toxic effects of the intensive cancer therapy. 

Results:  A total of 1643 nocturnal care interactions occurred over 160 nights (range, 20 – 58 interactions per patient over four nights).  Interactions were clustered between the hours of 12:00 – 1:00 am and 4:00 – 5:00 am, accounting for 26% and 25% of interactions, respectively. The majority involved medication administration (39.9%) followed by vital sign assessment (20.9%), obtaining blood samples (11%), intravenous catheter maintenance (9.9%), and patient assessments independent of other listed activities (6.2%).  Registered nurses recorded patient-reported sleep disturbances for 29 subjects (72.5%) while physicians recorded sleep problems for only 11 subjects (22.5%).  

Conclusion:  This study suggests that HSCT patients experience frequent sleep interruptions due to nocturnal care requirements.  Half of the interactions occurred between two specific time periods.  The other half occurred throughout the night leaving patients with little time for uninterrupted sleep.  This study provides information to begin developing care processes that minimize interactions at night and maximize the time-intervals without interruptions.