Sleep Patterns During Hospitalization Following Hematopoietic Stem Cell Transplantation

Abstract

Purpose/objectives: To characterize patient-reported and objective sleep assessments and provide a preliminary examination of the relationships among sleep, quality of life, and demographic or treatment factors.

Design: A secondary data analysis using a descriptive-correlational design.

Setting: University of Illinois Hospital and Health Sciences System.

Sample: 40 patients undergoing a hematopoietic stem cell transplantation (HCT) hospitalized for the conditioning regimen, stem cell infusion, and immediate recovery period.

Methods: Each patient wore a wrist actigraph continuously from the fourth day following HCT to the eighth day to objectively assess sleep patterns (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings). At the end of the five-day period, patients completed measures of sleep disturbance and quality of life.

Main research variables: Objective sleep (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings), subjective sleep (sleep disturbance), and quality of life.

Findings: The mean total nighttime sleep (objectively obtained) was 232 minutes (SD = 71 minutes), with 14 patients (35%) sleeping less than three consecutive hours during one or more study days. Age was negatively correlated with patient-reported sleep disturbance. Patient-reported sleep disturbance was significantly associated with length of hospital stay. No correlations were found between patient-reported and objective sleep assessments.

Conclusions: This study objectively documents inadequate and irregular sleep in hospitalized patients undergoing HCT. Sole reliance on patient-reported sleep assessments may not represent the full extent of the problem.

Implications for nursing: Attempts to streamline care during the night by not waking patients for routine care unless indicated by the patient's condition (as advocated by the American Academy of Nursing) and providing supportive care for symptoms (such as diarrhea) during the night may reduce the number of awakenings and possibly improve overall sleep quality.

Keywords: hematopoietic stem cell transplantation; hospitalization; sleep; sleep disturbances.

Figures

Figure 1. Example of Wrist Actigraphy Output

Note. Each line represents a 24-hour period. The time starts at 12 pm and ends at 12 pm, 24 hours later. The black lines indicate physical activity, with height of the lines corresponding to the occurrence and degree of physical activity. Major sleep bouts lasting at least three hours are highlighted in blue. In this figure, although the mean time in bed is 9 hours, 21 minutes, the mean total nighttime sleep is only 193 minutes (a 34% mean sleep efficiency) because of frequent awakenings.