Vineet Arora, MD, MAAP, on Sleep and Physical Activity Among Older Adults Discharged From the Hospital

Does sleep loss continue after patients are discharged from the hospital? A new study1 published in SLEEP found that it may.

The study was led by Vineet M. Arora, MD, MAPP, who is professor of medicine, assistant dean for Scholarship and Discovery, and associate chief medical officer-Clinical Learning Environment at the Pritzker School of Medicine at the University of Chicago in Chicago, Illinois.

To conduct their study, Dr Arora and colleagues reviewed data from wrist accelerometers collected from 54 patients for 404 nights and 384 days. The data analyzed included sleep duration and efficiency as well as physical activity.

Overall, the research team found that nighttime sleep duration and efficiency, as well as daytime sleep duration, were similar in the hospital and after discharge. However, daytime physical activity was greater after discharge and increased more rapidly during hospitalization than after discharge.

Neurology Consultant caught up with Dr Arora to gain more insight into these findings and how they might translate to clinical practice.

NEURO CON: What approach(es) was used to ensure patients slept well in the hospital?

Vineet Arora: We have completed a study called SIESTA (Sleep for Inpatients: Empowering Staff to Act)2 that uses both interprofessional coaching of doctors and nurses along with “nudges” to order sleep-friendly vital signs and medications for hospitalized patients. Using this approach, we have seen a major decline in sleep disruptions among inpatients and improved patient experience scores.

The default in many hospitals is to do vital signs every 4 hours and not consider batching care, so this is something we try hard to focus on with staff—that they can be empowered to make these changes without any harm to patients. More recently, we have worked hard to improve laboratory test draw times from 4 AM to 6 AM to provide some uninterrupted sleep for patients.

NEURO CON: How did hospital physicians and staff support physical activity goals among in-patients?

VA: We do have ongoing work here, led by physical therapists and nurses, to get patients mobile so that they do not suffer from immobility. That project has been successful in reducing falls.

NEURO CON: Your results showed that sleep duration was not affected in the hospital or after discharge, and that physical activity increased after discharge. Did demographics such as age or gender play a role in these results? That is to say, were there any disparities?

VA: Age and gender are both important to control for since, in our prior work, we have shown that activity is much lower among older adults, which is to be expected. Likewise, gender can be an important part of sleep, since men have a higher risk of underlying sleep disorders than women. Because we were not specifically looking at this as a primary question, we chose to simply ensure that our results did not change when we factored in age and gender, and they did not. So, our results looking at changes in sleep and activity from hospital to home are consistent across age and gender.

NEURO CON: Your study also found that sleep disturbances may persist once discharged from the hospital. How may these results impact clinical practice and how patients are managed in a hospital setting?

VA: I think that many physicians naturally assume that returning a hospitalized patient to their home setting will mean they get better sleep. We often say, “You’ll sleep better at home,” for example. However, our data shows that is not true, especially as you are recovering at home and becoming more mobile. This means that it is important to consider whether sleep loss in the hospital is continuing beyond the hospital and contributing to what has been described as “post-hospital syndrome.” More is needed to help patients sleep better at home as they recover. We are now doing longer-term follow-up on patients to understand whether their sleep patterns normalize 3 months after hospitalization.

References:

1. Kessler R, Knutson KL, Mokhlesi B, Anderson SL, Shah M, Meltzer DO, Arora VM. Sleep and activity patterns in older patients discharged from the hospital. Sleep. 2019;42(11):zsz153. https://doi.org/10.1093/sleep/zsz153.
2. Arora VM, Machado N, Anderson SL, et al. Effectiveness of SIESTA on objective and subjective metrics of nighttime hospital sleep disruptors. J Hosp Med. 2019;14(1):38-41. https://doi.org/10.12788/jhm.3091.