The research, in which Hospital Universitario Marqués de Valdecilla (HUMV) participated through the Nursing Research Group of the Marqués de Valdecilla Research Institute (IDIVAL), shows that poor sleep quality increases during hospitalization and identifies potentially modifiable factors
Good sleep is a fundamental part of recovery, but the hospital environment can significantly disrupt patients’ rest. A national multicenter study in which Hospital Universitario Marqués de Valdecilla participated has analyzed how sleep quality changes during hospitalization and which factors related to the hospital environment and nighttime care may contribute to its deterioration.
The study, entitled The Influence of Hospitalization and Nursing Interventions on Inpatients’ Sleep Quality: A Multicenter Observational Study, was conducted with 383 adult patients admitted to medical and surgical units in 12 Spanish public hospitals. The results show that the proportion of patients with poor sleep quality increased from 71% at admission to 85.9% during hospitalization.
Cantabria’s participation was coordinated through Hospital Universitario Marqués de Valdecilla, with nursing professionals from the Critical Care Cardiology, Cardiology and Cardiovascular Surgery units. Valdecilla’s representation in the article corresponds to Isabel Pérez-Loza, a staff nurse in the Critical Care Cardiology Unit, a member of the Nursing Research Group at IDIVAL and holder of a Venia Docendi from the University of Cantabria (UC), who served as the center’s principal investigator and coordinated the participation of the different units.
Analyzing what happens to sleep during hospitalization
The research stems from the CHRONOHOSPI project, “Circadian health in patients admitted to intensive care and hospitalization units,” funded by the Carlos III Health Institute in the 2018 call, with European ERDF funding, through projects PI18/00732, PI18/00743 and PI18CIII/0012.
CHRONOHOSPI is also part of a broader research line focused on the sleep of hospitalized patients and connected with SueñOn, an initiative driven by nursing professionals to raise awareness among healthcare professionals, managers and patients about the importance of protecting rest during hospitalization.
“We wanted to understand how patients actually sleep when they are in hospital and which factors related to hospitalization and the care they receive at night may be interfering with their rest,” explains Isabel Pérez-Loza.
To this end, patients’ sleep quality was assessed using the Pittsburgh Sleep Quality Index, both at admission and at discharge, while data were collected on nighttime nursing interventions, room characteristics, perceived disturbances and other sociodemographic and clinical variables.
Sleep quality deteriorates during hospitalization
One of the main findings of the study is that a very high proportion of patients already had poor sleep quality before admission, but this situation worsened during hospitalization.
Specifically, 71% of patients had poor sleep quality at admission, while during hospitalization this proportion rose to 85.9%.
The study also found an association between a greater number of days with nighttime interventions and poorer sleep quality. Among the interventions recorded, 78.9% of patients received medication at night, 54% underwent vital sign checks and 36.3% had blood samples taken.
In addition, certain factors related to the hospital environment were also associated with poorer sleep quality, including disturbances caused by roommates, the bed or bedding.
Nighttime blood sampling was specifically associated with a deterioration in sleep quality among women, while interventions related to anxiety management were associated with poorer sleep quality among men.
Identifying which factors can be modified
For the researchers, one of the most relevant aspects of the findings is that some of the factors identified may be amenable to modification.
“We cannot prevent someone from being ill or needing care, but we can consider whether certain nighttime activities can be organized differently, reduce unnecessary interruptions or better adapt the environment to promote rest,” Pérez-Loza points out.
In this regard, the findings highlight the need to incorporate sleep as another element of the quality of hospital care. Possible strategies include reviewing the organization of certain nighttime activities, grouping interventions whenever possible, reducing non-essential interruptions, improving environmental comfort and training professionals in care practices that promote rest.
“It is not simply about doing fewer things at night, but about organizing care more effectively, identifying which interventions are actually necessary during nighttime hours and looking for alternatives that make it possible to balance clinical safety and rest,” the researcher explains.
The article also highlights the usefulness of developing protocols aimed at protecting sleep, introducing environmental modifications and using monitoring technologies that allow certain checks to be carried out in a less disruptive way.
Research also conducted during the pandemic
Data collection took place between January 2020 and February 2022, meaning that a significant part of the fieldwork coincided with the COVID-19 pandemic.
This circumstance represented an additional challenge for a study that already required the coordination of research teams and nursing professionals from 12 hospitals. Access restrictions, changes in the organization of hospital units, patient isolation and the high clinical workload may have influenced both the development of the study and the well-being and sleep of patients.
Despite these difficulties, collaboration between the different centers made it possible to complete a multicenter study providing data on an aspect of hospital care that, according to the authors, has traditionally received limited attention.
From knowledge to clinical practice
The publication now opens a new stage aimed at translating these findings into clinical practice through the development and evaluation of interventions designed to reduce avoidable sleep disturbances.
In this context, initiatives such as SueñOn play an important role in raising awareness among professionals and institutions and promoting strategies to protect the rest of hospitalized patients.
“Sleep is not a luxury or a secondary issue in the hospital: it is also part of care,” concludes Isabel Pérez-Loza.
The study thus highlights the importance of incorporating rest as another dimension of patient care and moving towards care models that make it possible to maintain clinical safety while protecting, as far as possible, the sleep of hospitalized patients.
Photo: Part of the research team
