Study compares quality and duration of sleep among hospitalized and non hospitalized pregnant women

Recent research study examines potential differences in sleep duration and disruptions between hospitalized (inpatients) and non-hospitalized (outpatients) pregnant individuals. The study involved a prospective cohort of 58 pregnant participants (18 inpatients and 40 outpatients) with singleton gestations of at least 16 weeks, recruited from a single academic institution between 2021 and 2022. Participants wore actigraph accelerometer watches for up to 7 days, and their sleep data were analyzed using primary and secondary outcomes to measure total sleep duration, sleep efficiency, Insomnia Severity Index (ISI) scores, and other sleep disturbances. The study employed multivariable generalized estimating equations to adjust for confounders such as body mass index (BMI), use of sleep aids, and insurance type.

Differences in Sleep Duration and Quality

The study found significant differences in sleep duration between the two groups. Inpatients had an average sleep duration of 4.4 hours per 24-hour period, compared to 5.2 hours for outpatients (P=0.01). Additionally, though inpatients experienced fewer awakenings (10.1 vs. 13.8, P=0.01) and less wakefulness after sleep onset (28.3 minutes vs. 35.5 minutes, P=0.03), these findings might relate to the higher use of sleep aids among inpatients (38.9% vs. 12.5%, P=0.03). There were no significant differences in other sleep metrics like sleep efficiency and ISI scores, nor was there an interaction term for time in the study and inpatient status, suggesting sleep duration didn't progressively worsen over time for inpatients.

The primary result—lesser total sleep duration among inpatients—highlights important health implications. Inpatients may experience sleep disturbances due to the hospital environment or stress, which could contribute to shorter sleep duration. Notably, inpatients had lower income levels and higher rates of obesity, factors often linked with shorter sleep. Despite these challenges, the study's adjustment for insurance type and BMI indicates that these differences persist beyond those variables.

Subjective survey assessments provided further insights. Both inpatients and outpatients overestimated their sleep duration when compared to objective actigraphy data. While some inpatients reported stress as a barrier to adequate sleep, the self-reported lack of differences in perceived sleep duration suggests that subjective measures of sleep may not align perfectly with objective data.

Implications and Recommendations

This research underscores the critical need for interventions to improve sleep among hospitalized pregnant individuals. Potential approaches could include providing eye masks and earplugs, minimizing overnight monitoring, and coordinating check-ins to reduce disturbances. Improved sleep hygiene during hospital stays might mitigate some of the adverse health outcomes associated with even small decreases in sleep. Overall, the study highlights the importance of addressing sleep quality and quantity to support better health outcomes for hospitalized antepartum patients.

Key Points –

**Differences in Sleep Duration and Disruptions**: The study observed that hospitalized pregnant individuals (inpatients) had significantly shorter average sleep durations (4.4 hours per 24-hour period) compared to non-hospitalized individuals (outpatients), who averaged 5.2 hours (P=0.01). Inpatients also experienced fewer awakenings and less wakefulness after sleep onset, possibly due to a higher use of sleep aids.

**Factors Impacting Sleep**: Inpatients generally exhibited lower income levels and higher obesity rates, which are factors commonly associated with shorter sleep duration. Even after adjusting for confounders such as BMI and insurance type, the differences in sleep duration between inpatients and outpatients remained significant, highlighting the impact of the hospital environment and associated stressors on sleep quality.

**Recommendations for Improved Sleep Hygiene**: The study suggests various interventions to enhance sleep among hospitalized pregnant individuals, including the provision of eye masks and earplugs, minimizing overnight monitoring, and better coordination of check-ins. These measures aim to reduce sleep disturbances and improve overall health outcomes for hospitalized antepartum patients.

Reference –

Panelli, Danielle M. MD, MS; Miller, Hayley E. MD; Simpson, Samantha L. BA; Hurtado, Janet BA; Shu, Chi-Hung MEng; Boncompagni, Ana C. BA; Chueh, Jane MD; Barwick, Fiona PhD, DBSM; Carvalho, Brendan MBBCh; Sultan, Pervez MBChB; Aghaeepour, Nima PhD; Druzin, Maurice L. MD. Evaluation of Sleep in Pregnant Inpatients Compared With Outpatients. Obstetrics & Gynecology 143(6):p 803-810, June 2024. | DOI: 10.1097/AOG.0000000000005591