A systematic review and proposed conceptual model of sleep disturbances during pediatric hospitalizations
Andrea L Fidler1, Sara Voorhees1, Eric S Zhou2,3
1Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
Insights
Hospitalized children experience sleep disturbances primarily due to environmental factors. While interventions show promise, larger studies and environmental modifications are needed to improve pediatric inpatient sleep.
Area of Science:
- Pediatric Sleep Medicine
- Hospital Environment Research
- Intervention Science
Background:
- Hospitalization significantly disrupts sleep in children.
- Environmental factors are major contributors to sleep disturbances in pediatric inpatients.
Purpose of the Study:
- To review factors influencing pediatric inpatient sleep.
- To evaluate the effectiveness of sleep promotion interventions for hospitalized children.
Main Methods:
- Systematic literature search across seven major databases.
- Included studies on children aged 1-18 in non-ICU settings.
- Conducted narrative reviews and synthesized findings from 45 articles.
Main Results:
- Environmental disruptions (noise, interruptions) were primary causes of sleep disturbance.
- Most interventions focused on child-level relaxation techniques.
- Preliminary findings suggest positive impacts of interventions on sleep duration.
Conclusions:
- Larger-scale sleep promotion interventions are necessary.
- Environmental modifications are crucial for reducing night wakings.
- Further research on sleep variability and consequences is warranted.
Study Objectives:
The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children.
Methods:
A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1 and 18 years old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims.
Results:
Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g. noise, staff interruptions), most interventions targeted the child level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components.
Conclusions:
Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as the main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.
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