Sleep disturbances in hospitalized children: Comparison between acute admission and regular care units

Hospitalization adversely affects children's sleep, primary due to disease-, staff-, psychosocial- and environment-related factors. Clustering discontinuity in Acute Admission Units (AAU's) appears to enhance efficiency in clinical care. However, sleep may be more affected in a pediatric AAU as compared to regular care units (RCUs). In children of 1-12 years of age admitted to the AAU or RCUs, we used actigraphy to observe sleep, assessing Total Sleep Time (TST), Sleep Onset Latency (SOL), Wake After Sleep Onset (WASO), sleep efficiency, and awakenings. Subjective sleep quality was evaluated with PROMIS questionnaires. Sleep disturbances due to disease-, staff-, patient-, environment-, treatment-related factors were examined and compared between wards. Significant differences were observed between the AAU and RCUs in terms of specialty type and admission reasons: surgical patients and exacerbations of chronic diseases were more often admitted to RCUs. No significant differences were found between AAU and RCUs regarding TST (497 (92) (mean (SD)) vs 476 (96)), and WASO (113 (74) in both the AAU and RCU's). There was a trend towards more staff-related disturbances in the AAU (67% vs 56% p=0.07, specifically regarding waking (32% vs 22%, p=0.07). In all wards, sleep disturbances were reported by approximately 93% of the patients. Despite the concentration of clinical discontinuity to enhance efficiency of care in a novel pediatric AAU, no differences with regards to sleep (disturbances) were observed in comparison to the RCUs. Yet substantial sleep disturbances in both settings indicate the need for targeted interventions to improve inpatient sleep.