Sleep trajectory of hospitalized medically ill older adults: do sleep medications make a difference?

Sleep disturbances are prevalent during acute hospitalization in medically ill older patients, with undesirable outcomes. Sleep medication use is common, but its effectiveness is questionable. This study explored the trajectory of sleep parameters from home to hospital and assessed the impact of sleep medication use, considering covariates such as physical symptom burden.

A prospective multicenter study was conducted in four Israeli hospitals. Cognitively intact older patients (n = 683), with an admission interview and at least one follow-up, were recruited. Total sleep time (TST), sleep efficiency (SE), sleep quality (SQ), number of awakenings (NOAs), sleep medication use, sleep medication burden (quantity and dosage), and physical symptom burden were recorded daily. Personal and illness-related covariates were included in a repeated measures mixed models design.

Participants (male: 54%, aged 77.31 ± 6.60) showed shorter TST (329.73 ± 111.94 vs. 377.03 ± 101.06 min), lower SE (71.49 ± 19.28% vs. 76.14 ± 15.53%), and higher probability for lower SQ, in the hospital compared to home. Sleep medication use was not correlated with any sleep parameters; sleep medication burden was associated with NOA. Physical symptom burden showed significant main effects on SE, SQ, and NOA, and a significant interaction was found with time points on TST, such that higher burden was more strongly associated with shorter TST at first in-hospital follow-up than at admission, with no differences between all subsequent in-hospital time points.

Sleep declined during acute hospitalization compared to the home, with sleep medications showing minimal effect. Managing symptom burden should be prioritized when addressing sleep disturbances in older patients during hospitalization.