Sleep-Enhancing Education Intervention Effect on Patient-Reported Outcomes in Hospitalized Adults Open Access

HYPOTHESIS: We hypothesized that a sleep tool education intervention would significantly improve patient-reported sleep quality, physical function, and fatigue.

BACKGROUND: Hospital noise negatively affects patient sleep quality and is associated with increased fatigue. Here we present data for an easy-to-implement, low-cost clinical intervention to improve hospitalized patient sleep quality.

DESIGN: This was an experimental study design with single sample and pre–post testing.

PARTICIPANTS: Adults ages 18–75 yr who were on a non–intensive care unit and medically stable were approached. Bed-ridden patients or those with hearing aids or communicable diseases were not recruited.

Fifty-two patients were included, 23 women and 29 men (mean [M] age = 57.5 yr, standard deviation [SD] = 9.9). All patients provided informed consent. Patients completed surveys on Days 1 (baseline) and 3. At baseline, patients were educated by a research assistant on the benefits of sleep and provided with three sleep-enhancing tools: eye mask, ear plugs, and white noise machine.

METHOD: Patients completed self-reported PROMIS short-form surveys. Four domains were included: (1) sleep disturbance, a measure of sleep quality; (2) wake disturbance, the measure of impairment due to poor sleep; (3) fatigue; (4) physical function, ability to carry out physical activities (e.g., activities of daily living). Short forms consist of 8–10 items with 5-point Likert scale. Raw scores are standardized to 100-point scoring scale, with higher scores indicating improved outcome.

ANALYSIS: Paired t tests for a single sample were performed to assess for significant change from baseline to Day 3. Tests were two tailed, with p < .05 considered significant and analyzed with SPSS Version 22.

RESULTS: Patients had significant improvements in fatigue (t = 5.5, p < .001), sleep disturbance (t = 3.9, p < .001), and wake disturbance (t = 3.8, p < .001), with a mean 5.3 (SD = 6.9), 5.1 (SD = 9.4), and 3.1 (SD = 5.8) point improvement, respectively, on a 100-point scale. Perceived physical function improved (M = 1.1, SD = 4.73) but did not reach significance (p = .106).

DISCUSSION: The intervention significantly improved patient perceptions of sleep quality and significantly decreased perceptions of sleep-related impairment and fatigue. Such positive improvements with a small sample size indicate that future research on this topic should seek to assess improvements in occupational therapy (OT)–specific outcomes.

IMPACT STATEMENT: Simple sleep tool education from a research assistant significantly improved fatigue and sleep quality in hospitalized adults; one could argue that expanding hospital-based OT’s roles to include sleep education could significantly improve both patient-reported and OT-specific outcomes.