title: Awakenings? Patient and Hospital Staff Perceptions of Nighttime Disruptions and Their Effect on Patient Sleep.
abstract: OBJECTIVE
  Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with objective sleep loss can help target improvement initiatives.
  
  
  METHODS
  Patients and hospital staff completed the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Cutoff points were defined based on means, and responses were dichotomized. Perceived percent disrupted for each item was calculated, and responses were compared across groups using chi-square tests. Objective sleep time of patients was measured using wrist actigraphy. The association between patient-reported disruptions and objective sleep time was assessed using a multivariable linear regression model controlling for subject random effects.
  
  
  RESULTS
  Twenty-eight physicians (78%), 37 nurses (88%), and 166 of their patients completed the PHSDNQ. Patients, physicians, and nurses agreed that pain, vital signs and tests were the top three disrupters to patient sleep. Significant differences among the groups' perceptions existed for alarms [24% (patients) vs. 46% (physicians) vs. 27% (nurses), p < 0.040], room temperature (15% vs. 0% vs. 5%, p < 0.031) and anxiety (18% vs. 21% vs. 38%, p < 0.031). Using survey and actigraphy data from 645 nights and 379 patients, the presence of pain was the only disruption associated with lower objective sleep duration (minutes) [-38.1 (95% confidence interval -63.2, -12.9) p < 0.003].
  
  
  CONCLUSIONS
  Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.
authors.affiliation: University of Chicago Pritzker School of Medicine, Chicago, IL.
authors.forename: Mila N
authors.initials: MN
authors.lastname: Grossman
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Anderson
authors.affiliation: CareMore Health Plan.
authors.forename: Aelaf
authors.initials: A
authors.lastname: Worku
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: William
authors.initials: W
authors.lastname: Marsack
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Nimit
authors.initials: N
authors.lastname: Desai
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Ambrosio
authors.initials: A
authors.lastname: Tuvilleja
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ramos
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Francisco
authors.affiliation: The University of Chicago Medicine, Chicago, IL.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Lafond
authors.affiliation: Section of Pulmonary and Critical Care, Columbia St. Mary's Hospital, Milwaukee, WI.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Balachandran
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Farnan
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
mesh_terms: D056044:Actigraphy; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology; D010564:Personnel, Hospital / Q000523:psychology*; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: disruptions; noise; pain; quality improvement; sleep