In total, 52 RCSQ surveys were completed; 53.3% of the participating patients reported better sleep over the course of the study, but this was not statistically significant. On average, patients reported RCSQ scores of 38.1 on their first night. These had improved slightly to 38.6 on their last night in the study (see RCSQ comparison).
An open-ended question invited patients to comment on their sleep quality trends, including:
- discomfort or pain
- staff interruptions
- noise from alarms
- uncomfortable beds.
The biomotion sensor data indicated no statistically significant differences over time in minutes for REM, light, or deep sleep, nor were there any differences in sleep score. Additionally, participant sleep durations remained consistent over all 4 nights and were not significantly different either (see Biomotion sensor trend data).
Implications of the study
Although personalized sleep hygiene and biomotion sensor feedback were not associated with any statistically significant changes in sleep quality, researchers gathered key takeaways from the study. Poor sleep among patients is well recognized, having been reported in many settings.5,10,14,23,25 As such, it is not surprising that patients with chronic respiratory disorders experienced poor sleep while hospitalized. The study results support the need for interventions to improve sleep quality in these patients.
Respiratory illness may have a direct correlation with poor sleep hygiene. In a 2016 study, patients with respiratory symptoms reported a higher incidence of insomnia and daytime fatigue.26 Pain or illness, including coughing, was reported as the main barrier to sleep quality in the study RSCQs. Similarly, a systematic review found a strong association between sleep disruption and respiratory-related illnesses.26 A 2017 study supports the hypothesis that patients with respiratory illnesses may cough more frequently during waking hours than while sleeping.27 Coughing helps CF patients clear their secretions, but it may also act as a potential barrier to sleep. Common cough suppressants were contraindicated for use in these patients to promote better sleep quality.
Despite reporting poorer sleep quality (see Respiratory impact on sleep quality), patients with CF and PH noted other considerations to be taken into account to explain their sleep difficulties. For example, to provide care, healthcare professionals are sometimes required to interrupt patients in hospital settings, regardless of whether or not they are sleeping. Although staff interruptions were not specifically considered in this study, they were reported as a hindrance to sleep in the open-ended question featured in the RSCQ.
Patients with CF whose lung disease is more advanced have poorer sleep quality than those with less severe lung disease. Severe lung disease results in increased coughing and sleep fragmentation, as well as decreased oxygen saturation levels. This nocturnal hypoxemia may be correlated with PH.28
Limitations and conclusions
Device-related errors were a reported limitation. In filling out the open-ended RSCQ remarks, some patients noted that they felt as though they had slept better than indicated by the biomotion sensor. The device was selected as a product available for home use. The reliability and validity of commercial products designed for general use is a recognized limitation. The inability to provide the exact number of sleep interruptions was a notable obstacle, and the device did not account for each patient's complicated health history. The comparative use of another sleep measurement device with the biomotion sensor could be helpful in determining accuracy in future studies.
Understanding the impact of outside variables on sleep could further assist in tailoring sleep hygiene to certain patients with CF and PH. Some of the other potentially relevant factors that were not considered in this study include:
- previous or upcoming sleep studies
- noninvasive ventilation, such as BiPAP or CPAP therapy
- medications impacting sleep
- staff interruptions
- daytime sleep and napping habits.
Getting good quality sleep in a new environment can be difficult. This study filled a gap in the literature by examining sleep quality and potential interventions specific to patients with CF and PH. Poor sleep hygiene among these hospitalized patient populations was exacerbated by health-related issues, environmental factors, and interruptions. Although the study did not find statistical significance in the interventions, it was a step in the right direction. Patients in this study were open to seeking a good sleep hygiene regimen to improve their sleep quality while in the hospital. Future studies are needed to explore improvements in sleep quality for these patients.
Respiratory impact on sleep quality5,26
Patients with chronic respiratory disease experience poor sleep quality, leading to:
- delayed healing
- longer periods of hospitalization
- higher incidences of depression and anxiety
- weight fluctuations due to metabolic disturbances, which can lead to or worsen diabetes
- extended use of potent antibiotics or steroids, with adverse drug reactions such as insomnia, restlessness, and hyperglycemia.
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Keywords:Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
biomotion sensors; cystic fibrosis; Pittsburgh Sleep Quality Index; pulmonary hypertension; Richards-Campbell Sleep Questionnaire; sleep hygiene; sleep quality