Hospitalized kids sleep less, wake more than they do at home


By Lisa Rapaport

(Reuters Health) - Children who are hospitalized have a shorter sleep duration and more nighttime awakenings than they do at home, and a new study suggests that sounds exceeding 80 dB and lights greater than 150 lux increase the risk of sleep disturbance.

Researchers examined data on 69 children aged 1 to 18 years who were admitted to a general pediatric unit or pediatric intensive care unit at a teaching hospital in Toronto from October 2007 to July 2008. Children wore actigraphs for one to three consecutive days and nights, had sound and light meters at the bedside, and provided information on usual sleep habits at home as well as sleep diary details in the hospital.

Overall, the mean number of minutes children slept from 7:30 p.m. to 7:29 a.m. in the hospital was less than parent-estimated usual mean sleep time at home for children aged 1 to 3 years (444 vs 647 minutes), 4 to 7 years (475 vs 656 minutes), 8 to 12 years (436 vs 562 minutes), and 13 to 18 years (384 vs 505 minutes).

"I think it is important for clinicians to understand children aren't just missing out on a bit of sleep - they are missing out on hours of sleep at night, and their napping during the day is not making up for that lost time," said lead study author Robyn Stremler, an associate professor at the University of Toronto and an adjunct scientist at The Hospital for Sick Children.

"Furthermore, they are waking up so frequently that they are unlikely to get into the deeper, restful stages of sleep," Stremler said by email.

Across all age groups, the mean number of nighttime awakenings ranged from as low as 12 among children 13 to 18 years old to as high as 18 for children 4 to 7 years old, researchers report in JAMA Network Open.

Children were significantly more likely to awaken when they were exposed to sounds greater than 80 dB (hazard ratio 1.35), light brighter than 150 lux (HR 1.17), medications promoting sleep (HR 1.04), or nurses in their room most of the night (HR 1.08).

Children were significantly less likely to awaken when they were on the general pediatric unit (HR 0.81), admitted for planned surgery (HR 0.95), given medications to promote wakefulness (HR 0.96), or sharing a room with another patient (HR 0.78).

Limitations of the study include the single-center design as well as the limited time in the hospital for many participants, the study team notes.

Poor sleep in hospitalized children is also often multifactorial, said Dr. Ashley Sutton, an associate professor of pediatrics at the University of North Carolina School of Medicine in Chapel Hill.

"Hospitalized children can be in pain, battling illness symptoms like fever or vomiting and are definitely out of their routine, all of which contribute to later sleep onset, earlier awakening in the morning and increased likelihood of waking up overnight," Dr. Sutton, who wasn't involved in the study, said by email. "That being said, the hospital environment clearly exacerbates a baseline likelihood for poor sleep in children due to necessary monitoring alarms, IV pumps that beep, noise from other patients and staff, and need for light for nursing checks of fluids and medications."

SOURCE: JAMA Network Open, online April 1, 2021.

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