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A Multicomponent Intervention for Prevention and Treatment of Sleep Disturbances in a Psychiatric Intensive Care Unit (SUEÑA-SM)

29 septembre 2022 mis à jour par: Constanza Caneo, Pontificia Universidad Catolica de Chile

A Multicomponent Intervention for Prevention and Treatment of Sleep Disturbances in a Psychiatric Intensive Care Unit: A Before-After, Randomized, Controlled Trial

Hospitalized adult patients suffer from sleep deprivation, which has been associated with multiple negative consequences, both in short and in the long term. Many factors have been attributed to poor sleep quality, including excessive noise, inappropriate lighting, interactions with the healthcare team, administration of drugs, patients' symptoms, among others. There is scarce evidence reporting multicomponent interventions aimed at ensuring and improving sleep quality in hospitalized patients. The following before-after, randomized controlled trial will evaluate and determine the feasibility, acceptability and effectivity of a multicomponent intervention in improving sleep quality and reducing the consequences of poor sleep in a psychiatric intensive care unit (PICU). The intervention is comprised of changes in health personnel habits, improvements in the PICU environment, patient's psychoeducation and continuous sleep and activity monitoring through a validated wearable device.

Aperçu de l'étude

Type d'étude

Interventionnel

Inscription (Anticipé)

120

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

  • Nom: Constanza Caneo Robles, MD
  • Numéro de téléphone: +56 9 4290 9250
  • E-mail: cmcaneo@uc.cl

Sauvegarde des contacts de l'étude

  • Nom: Juan C Rodríguez, MD
  • Numéro de téléphone: +56 9 4448 9732
  • E-mail: jcrtjcrt@gmail.com

Lieux d'étude

    • Región Metropolitana
      • Santiago de Chile, Región Metropolitana, Chili, 7550000
        • Recrutement
        • Clínica San Carlos de Apoquindo UC
        • Sous-enquêteur:
          • Pedro Letelier Camus, MD
        • Sous-enquêteur:
          • Simón Medina, MD
        • Sous-enquêteur:
          • Matías Paredes Gálvez, BE

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans et plus (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • Hospitalized in the last 72 hours.
  • Capacity to consent
  • Approval by treating physician

Exclusion Criteria:

  • Active psychosis
  • Active eating disorder
  • Delirium
  • Major cognitive disorder

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: La prévention
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation séquentielle
  • Masquage: Seul

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Aucune intervention: Pre-intervention, control group
A basal measurement of primary and secondary outcomes of the target population, prior to the implementation the intervention. Estimated duration 3 months, n = 30.
Expérimental: Post-intervention, SUEÑA half bundle, active group 1

Post-intervention, environmental and behavioral modifications in patient care interventions.

Implementation of components 1 through 4 of SUEÑA intervention in the entire PICU unit. All participants will be exposed to the intervention. Estimated duration: 3 months, n = 30.

The nursery staff will be instructed to promote sleep hygiene. Nurse technicians will: inform patients of the efforts to ensure a healthy sleep environment, verify the minimization of light and noise after 23:00 PM, favour natural light after 07:00 AM, and foment patient's activities and participation in group therapy. Nurses will: reduce sleep interruptions to a minimum, to only perform actions (i.e. blood testing, clinical controls, medicine administration) deemed strictly necessary between 23:00 PM and 07:00 AM. A list of commonly used medications with their pharmacodynamic and pharmacokinetic properties tailored by a pharmaceutical chemist will be provided, to ensure optimal medication administration while protecting the guaranteed sleep hours, to be coordinated with the treating physician.
Every night, nursery staff will include anxiety and pain screenings as part of vital signs assessments, using visual analog scales for each one. If any screening is altered, clinical actions will be performed to alleviate symptomatology if deemed necessary, using clinical judgement.
The use of hypnotics will be standardized to be administered no later than at 22:00 PM; in the case of melatonin, its administration will be suggested at sundown, at 20:00 PM. Caffeinated drinks will be prohibited after 15:00 PM.
Sleep masks and ear plugs will be available to all patients if they wish to use them. The nursery team will reinforce its use between 23:00 PM and 07:00 AM.
Expérimental: Post-intervention, randomization for SUEÑA half bundle plus, active group 2

Randomization for full SUEÑA bundle: environmental and behavioral modifications in patient care interventions plus sleep informed treatment.

Participants will be randomized to receive SUEÑA components 1 through 5 Estimated duration: 6 months, n = 30

The nursery staff will be instructed to promote sleep hygiene. Nurse technicians will: inform patients of the efforts to ensure a healthy sleep environment, verify the minimization of light and noise after 23:00 PM, favour natural light after 07:00 AM, and foment patient's activities and participation in group therapy. Nurses will: reduce sleep interruptions to a minimum, to only perform actions (i.e. blood testing, clinical controls, medicine administration) deemed strictly necessary between 23:00 PM and 07:00 AM. A list of commonly used medications with their pharmacodynamic and pharmacokinetic properties tailored by a pharmaceutical chemist will be provided, to ensure optimal medication administration while protecting the guaranteed sleep hours, to be coordinated with the treating physician.
Every night, nursery staff will include anxiety and pain screenings as part of vital signs assessments, using visual analog scales for each one. If any screening is altered, clinical actions will be performed to alleviate symptomatology if deemed necessary, using clinical judgement.
The use of hypnotics will be standardized to be administered no later than at 22:00 PM; in the case of melatonin, its administration will be suggested at sundown, at 20:00 PM. Caffeinated drinks will be prohibited after 15:00 PM.
Sleep masks and ear plugs will be available to all patients if they wish to use them. The nursery team will reinforce its use between 23:00 PM and 07:00 AM.
Two individualized, nurse-led psychoeducation PowerPoint presentations on sleep hygiene will be presented to patients, supported by educational material aimed at the patient and their families.
Expérimental: Post-intervention, randomization for SUEÑA full bundle, active group 3

Randomization for full SUEÑA bundle: environmental and behavioral modifications in patient care interventions plus sleep informed treatment and personalized psychoeducation.

. Participants will be randomized to receive SUEÑA components 1 through 6. Estimated duration: 6 months, n = 30

The nursery staff will be instructed to promote sleep hygiene. Nurse technicians will: inform patients of the efforts to ensure a healthy sleep environment, verify the minimization of light and noise after 23:00 PM, favour natural light after 07:00 AM, and foment patient's activities and participation in group therapy. Nurses will: reduce sleep interruptions to a minimum, to only perform actions (i.e. blood testing, clinical controls, medicine administration) deemed strictly necessary between 23:00 PM and 07:00 AM. A list of commonly used medications with their pharmacodynamic and pharmacokinetic properties tailored by a pharmaceutical chemist will be provided, to ensure optimal medication administration while protecting the guaranteed sleep hours, to be coordinated with the treating physician.
Every night, nursery staff will include anxiety and pain screenings as part of vital signs assessments, using visual analog scales for each one. If any screening is altered, clinical actions will be performed to alleviate symptomatology if deemed necessary, using clinical judgement.
The use of hypnotics will be standardized to be administered no later than at 22:00 PM; in the case of melatonin, its administration will be suggested at sundown, at 20:00 PM. Caffeinated drinks will be prohibited after 15:00 PM.
Sleep masks and ear plugs will be available to all patients if they wish to use them. The nursery team will reinforce its use between 23:00 PM and 07:00 AM.
Two individualized, nurse-led psychoeducation PowerPoint presentations on sleep hygiene will be presented to patients, supported by educational material aimed at the patient and their families.
Objective and subjective reports of sleep quality will be handed to attending psychiatrist, using data gathered with wearable devices (Fitbit Charge 4) and self-report questionnaires regarding perceived sleepiness and overall sleep. The psychiatrist in charge uses said information in the routine case management

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Change in Total Sleep Time
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in hours and minutes, using objective data obtained via Fitbit Charge 4 devices, and subjective data obtained directly from the patient using the Sleep Diary, a consensus tool for the self report of different standardized sleep variables.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Change in Mean Number and Total Duration of Nocturnal Awakenings
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in integer numbers for mean number and minutes for duration, using subjective data obtained directly from the patient using the Sleep Diary, and objective data obtained via Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Mean Number and Total Duration of Naps During the Day
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in integer numbers for mean number and minutes for duration, using subjective data obtained directly from the patient using the Sleep Diary, and objective data obtained via Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Average Time of Falling Sleep and Awakening
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in time of day in 24-hour notation, using subjective data obtained directly from the patient using the Sleep Diary, and objective data obtained via Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Sleep Architecture
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in minutes of total duration for each sleep phase (awake, light sleep, deep sleep and REM) and as a relative value of the total sleep time, using objective data measured by Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Sleep Onset Latency Mean Duration
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in minutes of total time spent awake from the time of going to bed with the intention of falling asleep to the time of the first registered sleep phase, using subjective data from the Sleep Diary and objective data measured by Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in REM Onset Latency Mean Duration
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in minutes of total time spent awake from the time of going to bed with the intention of falling asleep to the time of the first registered REM phase, using subjective data from the Sleep Diary and objective data measured by Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Wake After Sleep Onset Mean Duration
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in minutes of total time spent awake from the time of the first registered sleep phase to the time of the last registered awakening, using objective data measured by Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Sleep Efficiency
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in percentage of total time spent sleeping at night, calculated as total sleep time divided by total time spent in bed, using subjective data from the Sleep Diary and objective data measured by Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Mean Heart Rate
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in integer numbers, using objective data measured by Fitbit Charge 4 devices, considering the heart rate during the day and while in bed.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Mean Number of Steps
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in integer numbers, using objective data measured by Fitbit Charge 4 devices.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Mean Level of Sound
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in decibels, using objective data registered by a decibel meter placed in the participant's rooms.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Change in Mean Level of Light
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in lux, using objective data registered by a lux meter placed in the participant's rooms.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Changes in Sleep Quality Perception
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured using the Richard Campbell Sleep Questionnaire (RCSQ), which considers 5 domains in Likert scales, and registers a mean score of all domains.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Changes in Daytime Sleepiness
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured using the Epworth Sleepiness Scale (ESS), which considers 8 hypothetical situations and scores the likelihood of falling asleep from 0 to 3, and registers a total aggregated score (with a maximum total score of 24).
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Changes in Subjective Perception of Sleep-Disturbing Factors
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured using complementary questions regarding the presence/absence of factors (either environmental, symptomatological, or other) and their identification using predefined options: excessive light, excessive noise, interactions with health personnel, pain, anxiety, or others. In case of selecting "others", a text field will be available for its description.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Changes in Pharmacological Indications and Need of SOS Medication
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Registered using extensive charts of common use medications during hospitalization, obtaining data registered in the participant's daily medical chart.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Changes in Systolic and Diastolic Blood Pressure
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Measured in millimetres of mercury (mmHg), using morning data registered in the participant's daily medical chart.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge.
Level of Pain
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
Measured with a Visual Analog Scale for Pain (scores ranging from 0 - 10 points), using data registered at 20:00 PM, in the participant's daily medical chart.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
Level of Anxiety
Délai: From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
Measured with a Visual Analog Scale for Anxiety (scores ranging from 0 - 10 points), using data registered at 20:00 PM, in the participant's daily medical chart.
From enrollment, during the first 72 hours of hospitalization, for up to 14 days or discharge. To be measured from the second branch onward, after the environmental interventions implementation.
Change in Mean Length of Stay
Délai: From day 1 of hospitalization until discharge
Measured in days, using data from the participant's medical record.
From day 1 of hospitalization until discharge
Change in 30-day Readmission Rate
Délai: 30 days after the participant's discharge.
Measured as a proportion, using data from the participant's medical record and telephonic follow-up.
30 days after the participant's discharge.
Change in Participant Satisfaction Regarding Sleep During Hospitalization
Délai: 7 days after the participant's discharge.
Measurement of the subjective experience of the participant, using telephone surveys.
7 days after the participant's discharge.
Participant Satisfaction Regarding the Intervention
Délai: 7 days after the participant's discharge.
Measurement of the subjective experience of participants, using telephone surveys.
7 days after the participant's discharge.
Health Personnel Satisfaction and Agreeability Regarding the Intervention
Délai: Every 3 months through study completion, an average of 1.5 years
Measurement of the subjective experience of treating physicians and nursery team, using web-based surveys.
Every 3 months through study completion, an average of 1.5 years

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Collaborateurs

Les enquêteurs

  • Directeur d'études: Constanza Caneo Robles, MD, Pontifica Universidad Catolica De Chile
  • Directeur d'études: Juan C Rodríguez, MD, Pontifica Universidad Catolica De Chile
  • Chaise d'étude: María Rodríguez Fernández, PhD, Pontifica Universidad Catolica De Chile
  • Chaise d'étude: Marcela Babul, MD, Pontifica Universidad Catolica De Chile

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

22 juin 2021

Achèvement primaire (Anticipé)

1 décembre 2022

Achèvement de l'étude (Anticipé)

1 août 2023

Dates d'inscription aux études

Première soumission

22 juillet 2021

Première soumission répondant aux critères de contrôle qualité

31 juillet 2021

Première publication (Réel)

6 août 2021

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

30 septembre 2022

Dernière mise à jour soumise répondant aux critères de contrôle qualité

29 septembre 2022

Dernière vérification

1 septembre 2022

Plus d'information

Termes liés à cette étude

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

Oui

Description du régime IPD

We are available to be contacted by researchers aiming to conduct secondary analyses based on our study, after providing a study protocol based on international guidelines, in order to ensure adequate use of our data.

Délai de partage IPD

January 2024

Critères d'accès au partage IPD

contact to responsable researcher C Caneo

Type d'informations de prise en charge du partage d'IPD

  • Protocole d'étude
  • Plan d'analyse statistique (PAS)
  • Formulaire de consentement éclairé (ICF)
  • Rapport d'étude clinique (CSR)

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Non

Étudie un produit d'appareil réglementé par la FDA américaine

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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