# Evaluating Sleep Challenges in Hospitalized Youth

## TL;DR

This study examines sleep quality and disruptions in hospitalized youth and finds that frequent vital sign checks and noise are major sleep disruptors.

## Contribution

The study identifies specific factors disrupting sleep in hospitalized youth and suggests reducing overnight vital sign monitoring to improve sleep.

## Key findings

- Most hospitalized youth reported normal sleep quality, but some experienced impaired sleep and daytime sleepiness.
- Alarms, vital signs, and noise were rated as the most disruptive to sleep.
- Increased frequency of vital sign monitoring was associated with higher daytime sleepiness.

## Abstract

Objective: To characterize sleep quality and sleep disruptions among youth hospitalized outside of the intensive care unit (ICU).

Patients and methods: Participants were eligible for the survey-based study if they were 8-17 years old, English-speaking, hospitalized for ≥3 days outside of the ICU, and developmentally able to understand surveys. Survey administration included a sleep diary, the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and a study-specific Inpatient Sleep Disruptors Questionnaire. The chart review provided additional clinical information. Descriptive and comparative statistics were performed to assess the association between overnight clinical monitoring and daytime sleepiness.

Results: Forty-five participants (mean age 13.4 years, 60% female), recruited between May and December 2022, were included in the study. Mean total sleep time (8.2 ± 1.7 hours) and ESS-CHAD score (8.6 ± 4.3) were normal with 79% reporting fair to good sleep the previous night. Participants rated alarms on equipment, vital signs, and noise as most disruptive to sleep. Participants with vital signs every four hours showed higher levels of daytime sleepiness compared with participants with vitals measured every shift (9.3 vs. 6.3; p=0.04).

Conclusions: Most participants reported normal sleep, although there was wide variability with a portion with impaired sleep quality and elevated daytime sleepiness. Alarms on equipment, vital signs, and noise were most disruptive, and increased vital sign frequency was also associated with increased daytime sleepiness. In clinically stable pediatric patients, a reduction in vital sign monitoring overnight may be an important change to improve patient sleep.