Advertisement

Deep sleep and beeps II: Sleep quality improvement project in general surgery patients

Published:October 27, 2022DOI:https://doi.org/10.1016/j.surg.2022.09.013

      Abstract

      Background

      Poor sleep leads to poor health outcomes. Phase I of our sleep quality improvement project showed severe sleep disturbance in the ward setting. We implemented a novel PostOp Pack to improve sleep quality.

      Methods

      Patients underwent elective, general surgery procedures. Fitbit trackers measured total sleep time. Patients completed the inpatient Richards-Campbell Sleep Questionnaire, which combines 5 domains into a cumulative score (0–100). Patients completed the outpatient Pittsburgh Sleep Quality Index preoperatively and postoperatively. Patients received the PostOp Pack, which included physical items and a sleep-protective order set to reduce nighttime awakenings. Patients from phase I served as the historical control. The primary outcome was the percentage of patients with Richards-Campbell Sleep Questionnaire total sleep score ≥50. The secondary outcomes included the mean Richards-Campbell Sleep Questionnaire domain scores and Fitbit total sleep time.

      Results

      A total of 49 patients were compared with 64 historical controls. The percentage of patients with a total sleep score ≥50 was significantly higher in patients receiving a PostOp Pack versus historical control (69% vs. 44%, difference 26%, 95% confidence interval 6.1-45%, P = .01). The mean Richards-Campbell Sleep Questionnaire Total Sleep Score was significantly higher in patients with a PostOp Pack (62 vs 49, mean difference 13, 95% confidence interval 6–21, P ≤ .01). The PostOp Pack Richards-Campbell Sleep Questionnaire domain scores were significantly higher in various areas: Sleep Latency (68 vs 49, P ≤ .01), Awakenings (56 vs 40, P = .01), Sleep Quality (61 vs 49, P = .02), and Noise Disturbance (70 vs 59, P = .04). Of all patients, 92% would use PostOp Pack again in a future hospitalization. No patients had a failure to rescue event with PostOp Pack. The mean total sleep time was significantly improved with PostOp Pack on night 1 (6.4 vs 4.7 hours, P = .03).

      Conclusion

      The PostOp Pack improves inpatient sleep quality and is safe.

      Graphical abstract

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cohen S.
        • Doyle W.J.
        • Alper C.M.
        • Janicki-Deverts D.
        • Turner R.B.
        Sleep habits and susceptibility to the common cold.
        Arch Intern Med. 2009; 169: 62-67
        • Patel S.R.
        • Malhotra A.
        • Gao X.
        • Hu F.B.
        • Neuman M.I.
        • Fawzi W.
        A prospective study of sleep duration and pneumonia risk in women.
        Sleep. 2012; 35: 97-101
        • Hoevenaar-Blom M.
        • Spijkerman A.
        • Kromhout D.
        • van den Berg J.
        • Verschuren W.M.M.
        Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence.
        Sleep. 2011; 34: 1487-1492
        • Jiddou M.
        • Pica M.
        • Boura J.
        • Franklin B.A.
        Incidence of myocardial infarction with shifts to and from daylight savings time.
        Am J Cardiol. 2013; 111: 631-635
        • Jacobson S.
        • Dwyer P.
        • Machan J.
        • Carskadon M.A.
        Quantitative analysis of rest-activity patterns in elderly postoperative patients with delirium: support for a theory of pathologic wakefulness.
        J Clin Sleep Med. 2008; 4: 137-142
        • Weinhouse G.
        • Schwab R.
        • Watson P.
        • et al.
        Bench-to-bedside review: delirium in ICU patients-importance of sleep deprivation.
        Crit Care. 2009; 13: 234
        • Centers for Disease Control and Prevention (CDC)
        Effect of short sleep duration on daily activities—United States, 2005–2008.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 239-242
        • Mormont M.
        • Waterhouse J.
        • Bleuzen P.
        • et al.
        Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status.
        Clin Cancer Res. 2000; 6: 3038-3045
        • Chouchou F.
        • Khoury S.
        • Chauny J.
        • Denis R.
        • Lavigne G.J.
        Postoperative sleep disruptions: a potential catalyst of acute pain?.
        Sleep Med Rev. 2014; 18: 273-282
        • Kavey N.B.
        • Altshuler K.Z.
        Sleep in herniorrhaphy patients.
        Am J Surg. 1979; 138: 682-687
        • Allen R.W.
        • Burney C.P.
        • Davis A.
        • Henkin J.
        • Kelly J.
        • Judd B.G.
        • Ivatury S.J.
        Deep sleep and beeps: sleep quality improvement project in general surgery patients.
        J Am Coll Surg. 2021; 232: 882-888
        • Rosenberg-Adamsen S.
        • Kehlet H.
        • Dodds C.
        • Rosenberg J.
        Postoperative sleep disturbances: mechanisms and clinical implications.
        Br J Anaesth. 1996; 76: 552-559
        • Frisk U.
        • Nordström G.
        Patients’ sleep in an intensive care unit—patients’ and nurses’ perception.
        Intensive Crit Care Nurs. 2003; 19: 342-349
        • Kamdar B.
        • Shah P.A.
        • King L.M.
        • et al.
        Patient-nurse interrater reliability and agreement of the Richards-Campbell sleep questionnaire.
        Am J Crit Care. 2012; 21: 261-269
        • Nicolás A.
        • Aizpotarte E.
        • Iruarrizaga A.
        • Vázquez M.
        • Margall A.
        • Asiain C.
        Perception of night-time sleep by surgical patients in an intensive care unit.
        Nurs Crit Care. 2008; 13: 25-33
        • Richards K.C.
        • ’O’Sullivan P.S.
        • Phillips R.L.
        Measurement of sleep in critically ill patients.
        J Nurs Meas. 2000; 8: 131-144
        • Williamson J.
        The effects of ocean sounds on sleep after coronary artery bypass graft surgery.
        Am J Crit Care. 1992; 1: 91-97
        • Centers for Disease Control and Prevention (CDC)
        Effect of short sleep duration on daily activities—United States, 2005–2008.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 239-242
        • Buysse D.
        • Reynolds 3rd, C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193-213
        • Kushida C.A.
        • Chang A.
        • Gadkary C.
        • Guilleminault C.
        • Carrillo O.
        • Dement W.C.
        Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients.
        Sleep Med. 2001; 2: 389-396
        • de Zambotti M.
        • Baker F.C.
        • Willoughby A.R.
        • et al.
        Measures of sleep and cardiac functioning during sleep using a multi-sensory commercially-available wristband in adolescents.
        Physiol Behav. 2016; 158: 143-149
        • Dickinson D.L.
        • Cazier J.
        • Cech T.
        A practical validation study of a commercial accelerometer using good and poor sleepers.
        Health Psychol Open. 2016; 32055102916679012
        • Lee J.
        • Finkelstein J.
        Consumer sleep tracking devices: a critical review.
        Stud Health Technol Inform. 2015; 210: 458-460
      1. Purta R, Mattingly S, Song L, et al. Experiences measuring sleep and physical activity patterns across a large college cohort with fitbits. Paper presented at: ISWC ’16: Proceedings of the 2016 ACM International Symposium on Wearable Computers; September 8. 2016; Heidelberg, Germany.

        • Zavrel E.
        • Krieger A.
        1091 clinical evaluation of a wristband activity tracker’s sleep feature.
        Sleep. 2018; 41: A405-A406
        • Baron K.G.
        • Duffecy J.
        • Berendsen M.A.
        • Mason I.C.
        • Lattie E.G.
        • Manalo N.C.
        Feeling validated yet? A scoping review of the use of consumer-targeted wearable and mobile technology to measure and improve sleep.
        Sleep Med Rev. 2018; 40: 151-159
      2. Feehan L, Geldman J, Sayre, E, et al. Accuracy of Fitbit devices: systematic review and narrative syntheses of quantitative data. JMIR mHealth uHealth. 2108;6:e10527.

        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009 Apr; 42: 377-381
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • et al.
        The REDCap consortium: building an international community of software partners.
        J Biomed Inform. 2019; 95103208
      3. R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/. Accessed December 12, 2021.

      4. Rstudio Team (2021). Rstudio: Integrated Development Environment for R. Rstudio, PBC, Boston, MA. http://www.rstudio.com/. Accessed December 12, 2021.

        • Wickham H.
        • Averisk M.
        • Bryan J.
        • et al.
        Welcome to the tidyverse.
        J Open Source Software. 2019; 4: 1686
        • Sjoberg D.D.
        • Whiting K.
        • Curry M.
        • Lavery J.A.
        • Larmarange J.
        Reproducible summary tables with the gtsummary package.
        The R Journal. 2021; 13: 570-580
        • Zhou J.
        • Liu D.
        • Li X.
        • Ma J.
        • Zhang J.
        • Fang J.
        Pink noise: effect on complexity synchronization of brain activity and sleep consolidation.
        J Theor Biol. 2012; 306: 68-72
        • Kahn D.M.
        • Cook T.E.
        • Carlisle C.C.
        • Nelson D.L.
        • Kramer N.R.
        • Millman R.P.
        Identification and modification of environmental noise in an ICU setting.
        Chest. 1998; 114: 535-540
        • Dieleman J.L.
        • Squires E.
        • Bui A.L.
        • et al.
        Factors associated with increases in US health care spending, 1996-2013.
        JAMA. 2017; 318: 1668-1678
        • Kluender R.
        • Mahoney N.
        • Wong F.
        • Yin W.
        Medical debt in the US, 2009–2020.
        JAMA. 2021; 326: 250-256
        • Porter E.D.
        • Kelly J.L.
        • Fay K.A.
        • et al.
        Reducing unnecessary chest x-ray films after thoracic surgery: a quality improvement initiative.
        Ann Thorac Surg. 2021; 111: 1012-1018
        • Cadamuro J Ibarz M.
        • Cornes Met al
        Managing inappropriate utilization of laboratory resources.
        Diagnosis (Berl). 2019; 6: 5-13
        • Frye E.B.
        • Hubbell F.A.
        • Akin B.V.
        • Rucker L.
        Usefulness of routine admission complete blood cell counts on a general medical service.
        J Gen Intern Med. 1987; 2: 373-376
        • Koch C.G.
        • Li L.
        • Sun Z.
        • et al.
        Hospital-acquired anemia: prevalence, outcomes, and healthcare implications.
        J Hosp Med. 2013; 8: 506-512
        • de Wijkerslooth E.M.L.
        • Bakas J.M.
        • van Rosmalen J.
        • van den Boom A.L.
        • Wijnhoven B.P.L.
        Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis.
        Int J Colorectal Dis. 2021; 36: 1297-1309
        • Leepalao M.C.
        • Arredondo D.
        • Speights F.
        • Duncan T.D.
        Same-day discharge on laparoscopic Roux-en-Y gastric bypass patients: an outcomes review.
        Surg Endosc. 2020; 34: 3614-3617
        • McKenna N.P.
        • Bews K.A.
        • Shariq O.A.
        • et al.
        Is same-day and next-day discharge after laparoscopic colectomy reasonable in select patients?.
        Dis Colon Rectum. 2020; 63: 1427-1435
        • Kohyama J.
        Which is more important for health: sleep quantity or sleep quality.
        ? Children (Basel). 2021; 8: 542
        • Faerman A.
        • Kaplan K.A.
        • Zeitzer J.M.
        Subjective sleep quality is poorly associated with actigraphy and heart rate measures in community-dwelling older men.
        Sleep Med. 2020; 73: 154-161
        • Ramlee F.
        • Sanborn A.N.
        • Tang N.K.Y.
        What sways people’s judgment of sleep quality? A quantitative choice-making study with good and poor sleepers.
        Sleep. 2017; 40: zsx091