Interventions needed to improve sleep quality in Asian wards

A study in Singapore pushes for the development of interventions to promote good sleep hygiene among Asian patients in the general wards by acknowledging the importance of overall sleep quality and identifying the harmful effects of inadequate rest during hospitalization.

“Inpatient sleep quality is influenced by multiple factors including medical conditions, use of medication, and the ward environment,” said the researchers, led by Siti Nadiah Binte Arman from the Alice Lee Centre for Nursing Studies, National University of Singapore.

“Without adequate rest, detrimental effects on patients’ physical and psychological performances may persist, inhibiting recovery and increasing length of stay,” they added.

Arman and colleagues conducted this observational study in the medical wards of an acute care hospital in Singapore from July to December 2018 to examine the sleep quality of adult inpatients and its associations with sociodemographic, clinical, and environmental factors.

Patients completed the Pittsburgh Sleep Quality Index (PSQI) and the Richards-Campbell Sleep Questionnaire (RCSQ) to establish baseline sleeping habits and to evaluate perception of sleep quality during hospitalization, respectively.

The researchers also measured noise levels using the SL-4023SD sound level meter and recorded environmental factors that affected sleep.

Fifty-two patients met the inclusion criteria and reported a mean RCSQ score of 5.83. Their mean Global PSQI score was 6.06, which suggested poor baseline sleep. [Proc Singap Healthc 2022;doi:10.1177/20101058221111664]

The highest mean noise level reached an average reading of 80 dB, which was double the recommended noise levels set by the World Health Organization. On the other hand, demographic and clinical factors, as well as bed locations, did not affect subjective sleep quality of patients. However, those exposed to night lamps reported a decrease in sleep quality (p=0.04).

“Improvements are necessary to help overcome the clinical and environmental factors that are associated with patients’ poor sleep quality during hospitalization,” the researchers said.

Patients with chronic illnesses were reported to experience sleep disturbances, to which it was thought that these frequent awakenings at night could be associated with nocturia. However, participants in this study suffered from acute short-term treatable conditions and were less prone to having persistent nocturnal awakenings ascribed to such conditions. [Prim Health Care Res Dev 2018;19:610-615]

Poor sleep appeared to be more prevalent among older patients, who are more susceptible to age-related sleep changes. [J Critical Care 2014;29:859-863]

In the present study, more than half of the patients were aged <65 years (59.6 percent), indicating fewer physiological changes and, in turn, lower risks of acquiring a less fragmented sleep-wake cycle.

“Results in this study revealed that participants obtained an ‘average’ overall sleep quality during hospitalization, inconsistent with the literature where inpatients experienced inadequate sleep attributed to extrinsic environmental disturbances,” the researchers noted. [Iran J Nurs Midwifery Res 2012;17:414-420]

“The differences in ward settings and relatively small sample size of participants in our study may have influenced the varying sleep quality outcomes,” they added.

In addition, there was a nonsignificant difference in patients’ self-reported sleep quality across different gender and age groups, which could be attributed to the high stress levels in Singapore.

In a recent survey, results showed that most individuals working in Singapore spend longer hours at work relative to their Hong Kong counterparts, causing stress levels among 52 percent of male and female workers in Singapore. [https://www.businesstimes.com.sg/governmenteconomy/spore-workplace-stress-on-the-rise-survey]

“It is widely known that work stressors and poor sleep quality are dependent of each other,” the researchers said. [Nat Sci Sleep 2017;9:151-161]