0820 Challenges to Pediatric Patients Sleeping Well in the Hospital: Environmental and Practice Considerations

Pediatric oncology and bone marrow transplant (BMT) patients frequently experience poor sleep during their extended hospital stays due to various sleep disruptors. This study aimed to identify specific factors affecting the sleep of our hospitalized patients.

Hospitalized BMT / oncology patients aged ≥5 years old (n=25) and their parents completed a survey designed for this study, which involved describing the extent to which factors identified in prior studies / extant literature were barriers or facilitators to patient sleep. Over 5 consecutive days / nights, we measured the light that patients were exposed to and how frequently staff entered patient rooms during the night. Light intensity (lux) was collected via Condor ActTrust actigraphs installed at eye-level by the patient’s bed. Room entries were tracked via paper / pencil logs affixed to the door.

Participants (median age of 11.2 years) most frequently endorsed barriers related to vital sign checks, room entries, loud sounds, bright lights, medical procedures, and pain. Top sleep facilitators included reducing light in the room, pain / sleep medications, and having family nearby. Average light exposure varied over the course of the day: morning (median = 2.34 lux, range = 0.09-22.17), daytime (median = 15.55 lux, range = 3.49-125.63), evening (median = 10.48 lux, range = 2.64-64.82), and overnight (median = 1.03 lux, range = 0.28-9.44). Staff-recorded room entries averaged 5 per night, with one patient experiencing 18 room entries in a single night.

Participants endorsed numerous barriers to getting good quality sleep while hospitalized. Based on both patient / family-report as well as objective measurements, it is evident that staff room entries and bright lights at night are not conducive to sleep. Light levels in patient rooms were routinely too dim during the day to optimally support circadian rhythm entrainment. Given that sleep plays a crucial role in health maintenance and recovery, hospitals should strive to reduce staff-related sleep disturbances where possible and optimize lighting in patient rooms. These efforts would create a more “sleep friendly” environment for both patients and their resident family members.

AF is supported by an institutional training grant (National Institutes of Health T32DK063929).