Sleep Environment Research Articles

O048 Why don’t Australians with Private Health Insurance Prioritise their Sleep Health?

Abstract Introduction This study sought to identify common routines and practices that may help or hinder sleep quality in a heterogenous population of Australians with private health insurance (PHI). Methods Members of a national not-for-profit health fund were invited to complete an online survey about the ‘pillars’ of sleep environment (place & practice), priority (value & knowledge), and impact (personal & community). Question responses were indexed on a scale of 1-100 and ratings were generated as a summation of each pillar (Low: 0-49; Neutral: 50-69; High: 70-100). Results Participants (n=1007) placed a high value on their individual sleep (73.9/100) and rated their place of sleep highly (74.5/100). However, sleep practice outcomes (56.5/100) and sleep impacts (personal: 50.4/100; community: 57.4/100) were considered neutral on average. Only 25% of participants were consistent in their sleep timing. 41% were distracted by other responsibilities (e.g., chores, children, and emails) and 30% indicated they prioritise yet cannot maintain consistency in their sleep routine. 75% of participants indicated they wanted more education on sleep and how to improve it. Discussion Australians with PHI are thought to be proactive in their health, with greater access to funded programs and claimable services to improve their health outcomes. However, the impact of poor sleep and severe lack of consistency was observed within this cohort, despite individuals placing high value on a healthy sleep routine. Conclusion With extensive benefits of good sleep, health funds should look to help improve their members’ sleep education for the 55% of Australians with PHI.

Occupational fatigue and health of gas station workers: A review.

Occupational health factors such as shift work, sleep, fatigue, and work environment jeopardise the health and safety of gas station workers. This calls for new research to investigate how the working environment and characteristics impact the occupational health of workers at gas stations. However, minimal research has been conducted in this field, especially those involving psychological and behavioural factors, occupational stress, and so forth. This review was performed to investigate the present condition of the occupational risk of gas station workers in this safety-critical position. Five databases (Web of Science, ScienceDirect, PubMed, Google Scholar, and PsycINFO) were searched for relevant peer-reviewed studies. Results were selected according to these criteria: studies on fatigue, shift work, sleep, and physical and mental health of gas station employees; published on or before November 11, 2021; papers in English. Twenty studies were considered for the final analysis. The results showed that shift work at gas stations leads to psychological and physiological problems. The psychological consequences included anxiety, stress, and depression, while the physiological consequences included biochemical changes and lifestyle consequences. Shift work and the specific working environment of gas station employees adversely affect their sleep, stress levels, physical and mental health, and turnover intention. This systematic review allowed us to consider the occupational risk factors that can lead to sickness or accidents and contribute to reducing these risk factors. Realistic countermeasures ought to be established and interventions must be explored to mitigate risks to life, property, and the environment in operating gas stations.

Orthopaedic patients' experiences of their sleep during hospitalisation and suggestions for improvements

PurposeTo describe orthopaedic patients' perspectives on their sleep quality and their suggestions for improvement initiatives to achieve better sleep quality during hospitalisation. MethodsIn a qualitative design, 265 (50%) of 533 patients from a questionnaire survey responded to two free-text questions. Data were analysed based on a phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory of narrative and interpretation. ResultsThree themes emerged: 1) Sleeping environment and preferences tailored to the individual patient, 2) The link between orthopaedic surgery care and sleeping, and 3) Noise challenged a good night’s sleep. Good sleep was related to nurses' professional behaviour and the physical environment, such as quality beds and sleeping aids. Single and shared rooms, room lighting, and fresh air all influenced sleep quality. Unfamiliar and uncomfortable sleeping positions posed a challenge for orthopaedic patients but aids such as pillows, and duvets could provide more comfort at night. Offset circadian rhythms could affect sleep quality, as could nausea and vomiting. Pain and lack of pain relief were associated with poor sleep quality. Noise from both nurses and other patients affected sleep quality. Therefore, unnecessary care activities should be kept to a minimum, and a “night noise level” was suggested. ConclusionPatients' sleep disturbance following orthopaedic surgery needs to be addressed by both nurses and hospital management. Patients’ involvement is essential to create a sleep environment tailored to individual needs and to provide strategies patients use at home for addressing sleeping problems.

Evaluation method and experimental study of sleep thermal sensation based on heart rate

Accurate assessment of sleep thermal sensation is the premise of analyzing the thermal environment of bedroom. And human metabolic rate is one of the key parameters affecting thermal sensation. This study aims to explore the evaluation method of sleep thermal sensation. The sleep metabolic rate based on heart rate are studied. And the feasibility of the evaluation method is validated by the performance of the sleep thermal sensation prediction model. The experiment was carried out in the sleep climate chamber at 23, 26, and 29 °C in summer. The sleep thermal environment parameters, physiological parameters, and subjective evaluation of 14 subjects were monitored. The experimental results showed that the mean sleep metabolic rate was 39 W/m2. And this evaluation method based on heart rate can improve the prediction performance of sleep thermal sensation model. The metabolic rate during sleep presents the U-shaped curve with time. However, compared with falling asleep, the metabolic rate was lower when waking up. This resulted in a thermal neutral temperature of sleep being 26.7°C which was 1°C higher than pre-sleep. This study will provide a reference for the operation strategy of sleep air conditioning.

The insensitivity of sleep to an unfamiliar sleeping environment in patients with insomnia disorder.

Sleeping in an unfamiliar environment, such as a sleep laboratory, is thought to disturb sleep in healthy individuals and could express a hyperarousal state called the first night effect. Insomnia disorder (ID) is a highly prevalent health problem characterized by increased arousal during the night and daytime. Whether or nota similar phenomenon occurs in patients with ID is unclear. This study aimed to investigate the effect of an unfamiliar environment on the sleep of patients with ID. In an unfamiliar sleep laboratory, polysomnographic recording testing was performed for two consecutive nights in patients with ID and age- and sex-matched healthy controlsubjects (HC). We collected sleep diaries and questionnaires regarding sleep, medical conditions, psychological status, and health history. Sleep continuity and architecture in both groups were compared and analyzed for two consecutive nights. Participants with ID(n = 39) and HC(n = 35) demonstrated differentially poor sleep on laboratory adaptation after exposure to the sleep laboratory. Patients with ID had longer rapid eye movement (REM) latency on the first night than on the second sleep night. HC showed increased duration and percentage of N1, decreased duration and percentage of N3, and decreased REM percentage during initial nights compared to subsequent nights. The other sleep variables showed no differences between the first and second sleep nights in patients with ID and HC. An unfamiliar sleep environment does not aggravate the disruption of sleep continuity and sleep architecture but only affects the REM latency in patients with ID compared with HC.

94 Understanding Parental Behaviours Related to Infant Sleep Environment

Abstract Introduction/Background Sudden unexplained death in infants continues to make up a significant proportion of infant deaths. Despite wide dissemination of Canadian Paediatric Society and American Academy of Paediatrics safe sleep recommendations, studies demonstrate significant caregiver nonadherence to the recommendations. Few studies have examined caregiver reasons for low uptake of recommendations. There is an urgent need to understand these issues not only for individual providers counseling about sleep, but also for implementation of public health initiatives which attempt to target parental behaviour change. Objectives Our study aimed to explore parental perceptions, beliefs and influences regarding safe infant sleep environment and factors contributing to parental behaviour related to sleep environment. Design/Methods A qualitative study utilizing ground theory methodology was conducted with in-depth individual interviews of 14 parents of infants less than six months admitted to a large paediatric hospital in Toronto, Canada. Data collection occurred from November 2017 to January 2018, until a saturation of themes was reached. Interview transcripts were analyzed for recurrent and emergent themes and a coding structure was developed. Results Interviews with caregivers were completed, and a range of sleep locations and environments were described. Most caregivers reported that a bassinet or crib was the main sleeping location, but most infants were also placed in other locations at various times, including infant swings, couches, and bed-sharing with caregivers. Three dominant themes affecting decision-making about sleep location were identified: 1. safety, 2. feasibility and convenience and, 3. perception of infant preference and developmental needs. These factors were often present simultaneously in parental decision-making, frequently acting in opposition to one another. Caregivers’ methods of mitigating harm were often counter to recommendations, such as using pillows to prevent rolling. Information sources regarding sleep choices typically included family, friends, healthcare providers and media. Most caregivers placed greater significance on healthcare recommendations than the advice of family members. Conclusion This study identified key factors that impact caregivers’ decision-making regarding infant sleep. These results can inform healthcare providers counselling about safe sleep recommendations and public health interventions aimed at increasing adherence to safe sleep recommendations and reducing preventable infant deaths.

Assessment of mothers' awareness of sudden infant death syndrome and safe infant sleep practices in Palestine

ObjectiveOne of the major public health mysteries around the world is a subcategory of infant sleep-related deaths of unknown etiology termed Sudden Infant Death Syndrome (SIDS) which is a common leading cause of infant mortality worldwide and targets infants under a year of age while sleeping. Sleep environment plays a significant role in the risk of SIDS, mothers actions for creating safe infant sleep practices play a protective role in reducing SIDS occurrence. The knowledge gap centered on SIDS is not adequately researched or investigated in Palestine. Correspondingly, the study aims to assess mothers' awareness of SIDS and safe infant sleep practices. MethodsA cross-sectional quantitative design was used. A self-reported questionnaire containing 30 items was distributed to childbearing mothers in various rural and urban areas in Palestine. The 1116 participants were selected based on a non-probability, convenience method in duration from April 1st, 2023 to June 19th, 2023. ResultThe data were analyzed through the SPSS program version 20; specifically, one-way ANOVA, independent sample T-tests, and Pearson's correlation test. The mother's total awareness and practice scores were coded into two categories: 1 signifying poor awareness or practice, and 2 signifying good awareness or practice. The mean total awareness was calculated to be 1.444, while the standard deviation came out to 0.497. The mean total practice was calculated to be 8.0789, while the standard deviation came out to 2.223. To further elaborate, 55.6% of the mothers showed poor awareness regarding SIDS. Moreover, 84.5% of the mothers revealed they had poor practices regarding safe infant sleep practices. ConclusionThe study displayed a positive-moderate correlation between the mothers' awareness and practices. Specifically, mothers’ had poor awareness in addition to poor practices.

Attitudes and beliefs about sleep health among a racially and ethnically diverse sample of overweight/obese adults

ObjectivesTo identify and compare how sleep-related attitudes and beliefs vary among racially and ethnically diverse adults with risk factors for cardio-metabolic disease. MethodsThis exploratory qualitative study used online focus group discussions (N = 4 groups among 17 individuals) to collect information about sleep attitudes, beliefs, and practices following participation in the Mindfulness Intervention to Improve Sleep and Reduce Diabetes Risk Among a Diverse Sample in Atlanta (MINDS) study. A rapid analyses approach was used to identify shared themes related to attitudes and beliefs about sleep health and sleep practices across participants. ResultsParticipants on average were 31years old, 88% female, and identified as Black/African American (52.9%), White (17.7%), Asian (11.8%), and Hispanic (17.7%). Three themes related to attitudes and beliefs about sleep health were identified: prioritization of sleep to improve one’s overall health, re-evaluating sleep needs, and interpersonal barriers to sleep. For Black/African American participants prioritizing sleep was coupled with a want to minimize stress as a long-term health promotion strategy, whereas individuals of other races/ethnicities were more focused on the immediate benefits of getting sufficient sleep. Individuals had reappraised their sleep needs and worked to improve their sleep hygiene accordingly, yet still experienced barriers to sleep. The most common barrier to sleep was sharing a sleep environment with someone who had conflicting sleep routines and practices. ConclusionThe results of this study suggest perceived benefits of and barriers to sleep vary by race/ethnicity, thus future interventions should be culturally tailored to enhance effectiveness.

Sleep quality and comfort in fully automated vehicles: A comparison of two seat configurations

As autonomous driving technology advances, the possibility of using vehicles as sleeping environments becomes increasingly relevant. To investigate the feasibility of this concept, a sleep study was conducted with twelve participants who were given a 4-h opportunity window to sleep in both reclined and flat seat configurations. The evaluation involved both objective measures, including polysomnographic (PSG) data analysis, and subjective measures through questionnaires, assessing sleep quality and comfort. While the sleep quantity results were comparable between the two sleeping positions, the reclined position showed a slight advantage in sleep quantity (TST and WASO). Interestingly, a trend highlighting a possible difference was found between the seat positions regarding non-rapid eye movement stage 3 (NREM 3). NREM 3 tended to be in a higher proportion of total sleep time in the flat seat position. Sleep onset latency (SOL) also showed a trend of a shorter latency by participants in the flat position. Additionally, most participants reported a preference for the flat position over the reclined position. These findings suggest that a flat seat configuration could offer a more comfortable and restful sleep environment for passengers in autonomous vehicles.

Standardized Image-Based Polysomnography Database and Deep Learning Algorithm for Sleep Stage Classification.

Polysomnography (PSG) scoring is labor intensive, subjective, and often ambiguous. Recently several deep learning (DL) models for automated sleep scoring have been developed, they are tied to a fixed amount of input channels and resolution. In this study, we constructed a standardized image-based PSG dataset in order to overcome the heterogeneity of raw signal data obtained from various PSG devices and various sleep laboratory environments. All individually exported European data format files containing raw signals were converted into images with an annotation file, which contained the demographics, diagnoses, and sleep statistics. An image-based DL model for automatic sleep staging was developed, compared with a signal-based model and validated in an external dataset. We constructed 10,253 image-based PSG datasets using a standardized format. Among these, 7,745 diagnostic PSG data were used to develop our DL model. The DL model using the image dataset showed similar performance to the signal-based dataset for the same subject. The overall DL accuracy was greater than 80%, even with severe obstructive sleep apnea. Moreover, for the first time, we showed explainable DL in the field of sleep medicine as visualized key inference regions using Eigen-class activation maps. Furthermore, when a DL model for sleep scoring performs external validation, we achieved a relatively good performance. Our main contribution demonstrates the availability of a standardized image-based dataset, and highlights that changing the data sampling rate or number of sensors may not require retraining, although performance decreases slightly as the number of sensors decreases.

Job burnout among workers with different shift regularity: interactive factors between sleep, depression, and work environment.

We investigated burnout and associated factors in non-shift workers (NSWs), shift workers with regular rotating shifts (RRSWs), and shift workers with irregular or unpredictable rotating shifts (IRSWs). In total, 5,125 adult workers (1,966 NSWs, 1,936 RRSWs, and 1,223 IRSWs) participated in an online self-reported survey. Job burnout and three dimensions thereof (exhaustion, cynicism, and professional efficacy) were assessed using the Maslach Burnout Inventory-General Survey (MBI-GS). The Center for Epidemiological Studies Depression Scale (CES-D) (depressive symptoms), Pittsburgh Sleep Quality Index (PSQI) (subjective sleep quality), and Korean Occupational Stress Scale (KOSS) (stressful job environment) were also used. Both types of shift workers scored higher in terms of exhaustion, cynicism, and poor professional efficacy on the MBI-GS compared with NSWs after controlling for age and gender. IRSWs exhibited higher scores on the exhaustion and professional efficacy dimensions of the MBI-GS compared with RRSWs. After controlling for the CES-D and PSQI scores, we found no significant difference in cynicism among the groups. After controlling for the KOSS score, we found no significant difference in professional efficacy. All MBI-GS dimensional scores were correlated significantly with the CES-D, PSQI, and KOSS scores in all three groups. The job burnout level of rotating shift workers, especially those with irregular shifts, was higher than that of other workers. Cynicism in shift workers may be largely attributable to poor sleep or depression; the poor efficacy of shift workers may be explained by their stressful work environment.

Thermal sensation and sleep quality in different combinations of indoor air temperature and bedding system conditions

Thermal factor is one of the crucial factors affecting human sleep. The purpose of this study is to explore the effects of combinations of indoor air temperature and bedding system on sleep thermal sensation and sleep quality and to provide new insights into the cognition of relationship between thermal environment and sleep quality. Sleep experiments were conducted in the climate chamber and the indoor air temperature was set as 16 °C, 18 °C, 20 °C, 22 °C, and 24 °C in five conditions. The bedding system was consistent across all temperature conditions. The sleep stage, heart rate and skin temperature of subjects were continuously monitored. Meanwhile, the quilt coverage form was recorded by an infrared thermal imager. Under different temperature conditions, although the quilts were consistent, the subjects adjusted the coverage form to get close to thermal neutrality. The difference in bedding insulation was 1.32clo between the coolest condition and warmest condition. When the bedding system and indoor temperature matched to achieve thermal neutrality, the subjects had the highest sleep efficiency and the highest deep sleep proportion. The greater the degree of deviation from thermal neutrality, the more obvious the reduction of sleep efficiency and deep sleep proportion. The tendency of subjective evaluation in ease of falling asleep, calmness of sleep and sleep satisfaction was consistent with the change of objective parameters. It was suggested that when creating sleep thermal environment, the indoor temperature should not be considered as the single key parameter, the suitable matching of indoor temperature and bedding system should be pursued.

An Experimental Study on Human Thermal Comfort with Thermal-Conductive Bed during Sleep in Summer

Sleep is vital for human health, while sleep quality is affected by indoor thermal environments. This study aims to investigate human thermal comfort with a thermal-conductive bed during sleep in summer. A series of experiments were conducted in a climatic chamber of a university. Subjects slept on a thermal-conductive bed, with or without the supply of water cooling them by flowing through the pipes embedded in the bed. The supply water was set at 20, 25, 28, and 30 °C. The indoor temperature was set at 32 °C. The bed surface temperature (back, buttock, thigh, and calf) and the subject’s skin temperature were measured. Questionnaires after waking up the next morning were conducted. The results show that when there was no water supply in the pipes of the thermal-conductive bed, the bed surface temperature was 0–1.5 °C higher than the indoor temperature, and subjects felt slightly warm. When the supply water temperature was 28 or 30 °C, subjects felt thermally comfortable during a night’s sleep. This study demonstrates that the proposed thermal-conductive bed with supply water temperatures of 28–30 °C can create a comfortable sleep environment for residents who have no air-conditioning systems in summer, which can also help save building energy.

Parents' Experiences and Perspectives of Their Child's Sleep Quality During Hospitalization.

Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements.

Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology.

The unique requirements of shift work, such as sleeping and working at variable times, mean that current sleep hygiene guidelines may be inappropriate for shift workers. Current guidelines may also contradict fatigue management advice (e.g. advising against daytime napping). The present study utilized a Delphi methodology to determine expert opinion regarding the applicability of current guidelines for shift workers, the appropriateness of the term "sleep hygiene," and develop tailored guidelines for shift workers. The research team reviewed current guidelines and existing evidence to draft tailored guidelines. Seventeen individual guidelines, covering sleep scheduling, napping, sleep environment, bedtime routine, substances, light exposure, diet, and exercise were drafted. Experts from sleep, shift work, and occupational health fields (n = 155) were invited to review the draft guidelines using a Delphi methodology. In each round, experts voted on individual guidelines, with 70% agreement considered consensus. Where consensus was not reached, written feedback from experts was discussed and incorporated into subsequent iterations. Of the experts invited, 68 (44%) agreed to participate, with 55 (35%) completing the third (final) round. Most experts (84%) agreed that tailored guidelines were required for shift workers. Consensus was reached on all guidelines after three rounds. One additional guideline (sleep inertia) and an introductory statement were developed, resulting in a final set of 18 individual guidelines, termed "healthy sleep practices for shift workers." This is the first study to develop tailored sleep hygiene guidelines for shift workers. Future research should investigate the acceptability and effectiveness of these guidelines amongst shift workers.

A sleep staging model for the sleep environment control based on machine learning

A sleep staging model for the sleep environment control based on machine learning

Knowledge Discovery in Ubiquitous and Personal Sleep Tracking: Scoping Review.

Over the past few decades, there has been a rapid increase in the number of wearable sleep trackers and mobile apps in the consumer market. Consumer sleep tracking technologies allow users to track sleep quality in naturalistic environments. In addition to tracking sleep per se, some sleep tracking technologies also support users in collecting information on their daily habits and sleep environments and reflecting on how those factors may contribute to sleep quality. However, the relationship between sleep and contextual factors may be too complex to be identified through visual inspection and reflection. Advanced analytical methods are needed to discover new insights into the rapidly growing volume of personal sleep tracking data. This review aimed to summarize and analyze the existing literature that applies formal analytical methods to discover insights in the context of personal informatics. Guided by the problem-constraints-system framework for literature review in computer science, we framed 4 main questions regarding general research trends, sleep quality metrics, contextual factors considered, knowledge discovery methods, significant findings, challenges, and opportunities of the interested topic. Web of Science, Scopus, ACM Digital Library, IEEE Xplore, ScienceDirect, Springer, Fitbit Research Library, and Fitabase were searched to identify publications that met the inclusion criteria. After full-text screening, 14 publications were included. The research on knowledge discovery in sleep tracking is limited. More than half of the studies (8/14, 57%) were conducted in the United States, followed by Japan (3/14, 21%). Only a few of the publications (5/14, 36%) were journal articles, whereas the remaining were conference proceeding papers. The most used sleep metrics were subjective sleep quality (4/14, 29%), sleep efficiency (4/14, 29%), sleep onset latency (4/14, 29%), and time at lights off (3/14, 21%). Ratio parameters such as deep sleep ratio and rapid eye movement ratio were not used in any of the reviewed studies. A dominant number of the studies applied simple correlation analysis (3/14, 21%), regression analysis (3/14, 21%), and statistical tests or inferences (3/14, 21%) to discover the links between sleep and other aspects of life. Only a few studies used machine learning and data mining for sleep quality prediction (1/14, 7%) or anomaly detection (2/14, 14%). Exercise, digital device use, caffeine and alcohol consumption, places visited before sleep, and sleep environments were important contextual factors substantially correlated to various dimensions of sleep quality. This scoping review shows that knowledge discovery methods have great potential for extracting hidden insights from a flux of self-tracking data and are considered more effective than simple visual inspection. Future research should address the challenges related to collecting high-quality data, extracting hidden knowledge from data while accommodating within-individual and between-individual variations, and translating the discovered knowledge into actionable insights.

Sudden Infant Death Syndrome: Risk Factors and Newer Risk Reduction Strategies.

Sudden infant death syndrome (SIDS) continues to be one of the top causes of infant death in the U.S. Despite significant public health initiatives focused on high-risk populations to enhance sleep environments and techniques. The SIDS rate has remained stable in recent years. Risk factors and newer risk reduction strategies for SIDS are the focus of this review article. We conducted a comprehensive literature search on Medline, Cochrane, Embase, and Google Scholar until July 2022. The following search strings and Medical Subject Heading (MeSH) terms were used: "SIDS," "Sudden Infant Death" and "SUID". We explored the literature on SIDS for its epidemiology, pathophysiology, the role of various etiologies and their influence, associated complications leading to SIDS, and preventive and treatment modalities. Despite a more than 50% drop-in rates since the start of the "Back to Sleep" campaign in 1994, sudden infant death syndrome (SIDS) continues to be the top cause of post-neonatal mortality in the United States, despite continued educational initiatives that support safe sleep and other risk reduction strategies. The new American Academy of Pediatrics guidelines for lowering the risk of SIDS include a lot of emphasis on sleeping habits, bedding, and environment but also include elements that are frequently ignored (i.e., prenatal care, smoking, alcohol and drug use, and childhood vaccinations). This study highlights these less-frequently discussed aspects and identifies treatments that have produced beneficial behavioral shifts that benefit newborns as well as their mothers' health and wellbeing.

Steering the Titanic: One tertiary care children's hospital's experience navigating safe sleep for hospitalized infants

BackgroundSudden Unexpected Infant Death (SUID) is the leading cause of death in infants 1 month to 1 year of age in the United States. Despite extensive efforts in research and public education, rates of sleep-related infant death have plateaued since the late-1990s, largely due to unsafe sleep practices and environments. Local problemA multidisciplinary team assessed our institution's compliance with its own infant safe sleep policy. Data was collected on infant sleep practices, nurses' knowledge and training on the hospital policy, and teaching practices for parents and caregivers of hospitalized infants. Zero crib environments from our baseline observation met all the American Academy of Pediatrics recommendations for infant safe sleep. MethodsA comprehensive safe sleep program was implemented in a large pediatric hospital system. The purpose of this quality improvement project was to improve compliance with safe sleep practice from 0% to 80%, documentation of infant sleep position and environment every shift from 0% to 90%, and documentation of caregiver education from 12% to 90% within 24 months. InterventionsInterventions included revision of hospital policy, staff education, family education, environmental modifications, creation of a safe sleep taskforce, and electronic health record modifications. ResultsDocumented compliance with infant safe sleep interventions at the bedside improved from 0% to 88%, while documentation of family safe sleep education improved from 12% to 97% during the study period. ConclusionsA multifaceted, multidisciplinary approach can lead to significant improvements in infant safe sleep practices and education in a large tertiary care children's hospital system.

A Hospital-Based Infant Safe Sleep Intervention and Safe Sleep Practices Among Young Women: A Prospective Longitudinal Study.

The rates of sudden unexpected infant death (SUID) are still high in the U.S. The longitudinal effects of SUID preventive education on infant safe sleep practices are less known. The current study evaluated the effects of a comprehensive hospital-based, SUID preventive intervention on safe infant sleep practices in the first six months of life and to identify factors associated with infant sleep practices. Using a one-group pretest and multiple posttest design, the current quantitative study examined the impacts of the infant safe sleep intervention among 411 women recruited at a large, urban, university medical center. Participants were prospectively followed and completed four surveys from childbirth. Linear mixed models were used to evaluate the effects of the SUID prevention program on four sleep practice outcomes, including removing unsafe items from the sleeping environment, bed sharing, room sharing without bed sharing, and placing the infant in a supine sleep position. Compared to the baseline, participants were less likely to use unsafe items (e.g., soft bedding) in infants' sleeping areas over time. However, we found that participants reported more frequent bed sharing at 3-month and 6-month follow-ups, compared to the baseline. Overall, maternal education and family income were positively related to healthy infant safe sleep practices. A hospital-based preventive intervention pairing an educational initiative with home-visiting services might improve safe sleep practices to remove accidental suffocation risks from the infant sleep environment.