title: Sleep Disruption is Associated with Increased Ventricular Ectopy and Cardiac Arrest in Hospitalized Adults.
abstract: OBJECTIVE
  To determine whether sleep disruption increases ventricular ectopy and the risk of cardiac arrest in hospitalized patients.
  
  
  METHODS
  Hospital emergency codes (HEC) trigger multiple hospital-wide overhead announcements. In 2014 an electronic "code white" program was instituted to protect staff from violent patients. This resulted in an increase in nocturnal HEC. Telemetry data was examined between September 14 and October 2, 2014. The frequency of nocturnal announcements was correlated with changes in frequency of premature ventricular complexes per hour (PVC/h). Cardiac arrest data were examined over a 3-y period. All HEC were assumed to have triggered announcements. The relationship between nocturnal HEC and the incidence of subsequent cardiac arrest was examined.
  
  
  RESULTS
  2,603 hours of telemetry were analyzed in 87 patients. During nights with two or fewer announcements, PVC/h decreased 33% and remained 30% lower the next day. On nights with four or more announcements, PVC/h increased 23% (P < 0.001) and further increased 85% the next day (P = 0.001). In 2014, following the introduction of the code white program, the frequency of all HEC increased from 1.1/day to 6.2/day (P < 0.05). The frequency of cardiac arrest/24 h rose from 0.46/day in 2012-2013 to 0.62/day in 2014 (P = 0.001). During daytime hours (06:00-22:00), from 2012 through 2014, the frequency of cardiac arrest following zero, one or at least two nocturnal HEC were 0.331 ± 0.03, 0.396 ± 0.04 and 0.471 ± 0.09 respectively (R(2) = 0.99, P = 0.03).
  
  
  CONCLUSIONS
  Sleep disruption is associated with increased ventricular ectopy and increased frequency of cardiac arrest.
authors.affiliation: Southlake Regional Health Center, Newmarket, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Steven Edward Stuart
authors.initials: SE
authors.lastname: Miner
authors.affiliation: Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Dev
authors.initials: D
authors.lastname: Pahal
authors.affiliation: Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Laurel
authors.initials: L
authors.lastname: Nichols
authors.affiliation: Southlake Regional Health Center, Newmarket, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Darwood
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.|Labatt Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Lynne Elizabeth
authors.initials: LE
authors.lastname: Nield
authors.affiliation: Southlake Regional Health Center, Newmarket, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zaev
authors.initials: Z
authors.lastname: Wulffhart
mesh_terms: D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D012892:Sleep Deprivation / Q000453:epidemiology*; D013686:Telemetry; D018879:Ventricular Premature Complexes / Q000453:epidemiology*
keywords: arrhythmias; cardiac; cardiac arrest; hospital emergency service; sleep; sleep deprivation