Abstract
BackgroundHospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its determinants including the use of drugs with sedating properties.MethodsThis single-centre prospective study involved an assessment of sleep quality for consenting patients admitted to the general medicine and family practice units of an acute care Canadian hospital. A validated Verran and Snyder-Halpern (VSH) Sleep Scale measuring sleep disturbance, sleep effectiveness, and sleep supplementation was completed daily by patients and scores were compared to population statistics. Patients were also asked to identify factors influencing sleep while in hospital, and sedating drug use prior to and during hospitalization was also assessed.ResultsDuring the 70-day study period, 100 patients completed at least one sleep questionnaire. There was a relatively even distribution of males versus females, most patients were in their 8th decade of life, retired, and suffered from multiple chronic diseases. The median self-reported pre-admission sleep duration for participants was 8 hours and our review of PharmaNetR profiles revealed that 35 (35%) patients had received a dispensed prescription for a hypnotic or antidepressant drug in the 3-month period prior to admission. Benzodiazepines were the most common sedating drugs prescribed. Over 300 sleep disturbance, effective and supplementation scores were completed. Sleep disturbance scores across all study days ranged 16–681, sleep effectiveness scores ranged 54–402, while sleep supplementation scores ranged between 0–358. Patients tended to have worse sleep scores as compared to healthy non-hospitalized US adults in all three scales. When compared to US non-hospitalized adults with insomnia, our patients demonstrated sleep disturbance and supplementation scores that were similar on Day 1, but lower (i.e. improved) on Day 3, while sleep effectiveness were higher (i.e. better) on both days. There was an association between sleep disturbance scores and the number of chronic diseases, the presence of pain, the use of bedtime tricyclic antidepressants, and the number of chronic diseases without pain. There was also an association between sleep effectiveness scores and the length of hospitalization, the in hospital use of bedtime sedatives and the presence of pain. Finally, an association was identified between sleep supplementation scores and the in hospital use of bedtime sedatives (tricyclic antidepressants and loxapine), and age. Twenty-nine (29%) patients received a prescription for a hypnotic drug while in hospital, with no evidence of pre-admission hypnotic use. The majority of these patients were prescribed zopiclone, lorazepam or another benzodiazepine.ConclusionsThe results of this study reveal that quality of sleep is a problem that affects hospitalized adult medical service patients and a relatively high percentage of these patients are being prescribed a hypnotic prior to and during hospitalization.
Highlights
[1] Insomnia is a subjective complaint of dissatisfaction with the quantity, quality or timing of sleep. [2,3] This disorder is estimated to occur in approximately 12% to 25% of the general population, this is probably an underestimate as there is evidence that many adults do not report their sleep problems to a health care professional. [4,5] It is well recognized that hospitalization can significantly disrupt sleeping patterns. [3,6,7] In hospitalized patients, the most common causes of acute insomnia include the effects of illness, environmental sleep disruption, medication, anxiety, and depression
Benzodiazepines are the most common drugs used for the pharmacological management of acute insomnia in both institutionalized and ambulant patients. [9-20] Of the available agents, short and intermediate-acting benzodiazepines such as lorazepam and oxazepam have become the most commonly prescribed for this indication
When compared to US non-hospitalized adults with insomnia, our patients demonstrated sleep disturbance and supplementation scores that were similar on Day 1, but lower on Day 3, while sleep effectiveness were higher on both days
Summary
In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. [3,6,7] In hospitalized patients, the most common causes of acute insomnia include the effects of illness, environmental sleep disruption, medication, anxiety, and depression. [9-20] Of the available agents, short and intermediate-acting benzodiazepines such as lorazepam and oxazepam have become the most commonly prescribed for this indication. Tolerance to the hypnotic effects of the short and intermediate-acting agents can develop within one to two weeks of use and abrupt discontinuation can result in withdrawal symptoms such as anxiety, confusion, disorientation, insomnia, and perceptual changes. This validated scale encompasses the different parameters of sleep such as sleep disturbances, number of awakenings, difficulty in falling asleep and time spent sleeping is a valuable instrument
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