Effect of a nighttime medical order adjustment protocol on objective and subjective sleep quality in hospitalized...

Sleep disruption is common among hospitalized patients and is often exacerbated by non-essential nighttime medical activities. Evidence from general hospital wards in Latin America remains limited. We evaluated the effect of an adjusted nighttime medical order protocol on sleep quality in hospitalized adults.

In this randomized controlled trial, patients were allocated to standard care or an intervention protocol in which non-essential nocturnal procedures (routine vital sign checks, medication administration, and laboratory sampling) were rescheduled. Objective sleep parameters were monitored with Fitbit Sense over three consecutive nights. The first night served as a baseline, followed by two intervention nights. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline and study completion.

Fifty-one patients were included [mean (SD) age 41.2 (13.0) years; 56.9% female], with 26 (51.0%) assigned to the intervention group. Compared with controls, the intervention group had longer geometric mean [geometric standard deviation (GSD)] total sleep time [398 (1.28) vs. 301 (1.40) min; p = .015] and longer estimated Stage R [rapid eye movement (REM)] sleep duration [79.2 (1.36) vs. 58.0 (1.49) min; p = .010]. In addition, nocturnal awakenings were eliminated by the second intervention night. Subjective sleep quality also improved in the intervention group, with lower PSQI scores at study completion than in the control group [4.6 (2.5) vs. 8.7 (3.2); p = .040].

Reorganizing nighttime medical routines significantly improved objective and subjective sleep quality in hospitalized patients. This low-cost, pragmatic intervention may represent a scalable strategy for implementing sleep-friendly hospital practices.