Electronic Health Record-Derived Measures of Sleep After Surgical Aortic Valve Replacement

Postoperative sleep disturbances, often due to overnight patient-staff interactions (PSIs), are common. Electronic health record (EHR) data were used to derive proxy measures of sleep opportunity and interruptions to characterize patients' sleep.

A total of 208 eligible patient-nights in adults having surgical aortic valve replacement were analyzed. Patients completed the Richards-Campbell Sleep Questionnaire daily after surgery. Any PSIs expected to disrupt sleep were retrieved from the EHR and aggregated into interruptive episodes. Nightly PSIs and periods of uninterrupted sleep opportunity were characterized. Associations between EHR-derived measures of sleep opportunity and self-reports of sleep were examined.

Fifty-three patients (mean age, 66.6 years; 64% male) had a median of 7 PSIs (4 interruptive episodes) per night. Median PSIs declined from 21 (7 interruptive episodes) on postoperative night 1 to 4 (3 interruptive episodes) on postoperative night 5. Every patient-night had at least 1 PSI/interruptive episode. The EHR-derived measure most strongly correlated with Richards-Campbell Sleep Questionnaire mean score was total uninterrupted sleep opportunity (Pearson r = 0.39, P < .001).

Electronic health record-derived measures of sleep opportunity, especially total uninterrupted sleep opportunity, correlated with patients' perceptions of sleep quality and captured changes across the postoperative period. These findings indicate that EHR data can be used to monitor sleep opportunity and that improved sleep opportunities can be an outcome measure for sleep-focused quality improvement projects.

Measures of sleep opportunity derived from the EHR may be objective, scalable proxies for self-rated sleep.