Quantifying sleep wake rhythms in the hospital environment with digital technologies.

Area of Science:

• Circadian Biology
• Sleep Medicine
• Postoperative Care

Background:

• Postoperative clinical care environments can disrupt circadian rhythms, potentially impacting patient health outcomes.
• Maintaining circadian alignment is crucial for recovery and well-being after surgery.

Purpose of the Study:

• To explore and assess circadian desynchronization in elective cardiac surgery patients during preoperative, in-hospital, and post-discharge phases.
• To identify environmental and behavioral factors contributing to circadian disruption in a hospital setting.

Main Methods:

• Collected over 1.8 million data points using 11 remote sensors across different care settings.
• Monitored environmental factors (light, sound, temperature) and patient behavior (sleep, activity).
• Assessed cognitive function and behavioral-physiological rhythms in 13 elective cardiac surgery patients.

Main Results:

• Hospital environments exhibited frequent nighttime activity, elevated sound levels, and inadequate diurnal temperature variation.
• Circadian rhythms were disrupted and phase-shifted in-hospital, with a significant increase in nighttime wakefulness (10.7% to 34.8%).
• Cognitive function scores decreased, and 31% of patients experienced transient mild impairment.

Conclusions:

• Hospitalization significantly disrupts patient circadian rhythms and sleep patterns, negatively affecting cognitive function.
• Environmental factors within the hospital contribute to circadian desynchronization.
• Findings will inform a controlled trial to mitigate these disruptors and improve patient outcomes.