Sleep Patterns and Nocturnal Disturbances in Hospitalized Hematopoietic Stem Cell Transplant Patients

Tuesday, 31 July 2012: 11:35 AM

Eileen Danaher Hacker, PhD, APN, AOCN1
Janet L. Larson, RN, PhD, FAAN2
Carol Estwing Ferrans, PhD, RN, FAAN1
Purvi Patel1
Megan Stainthorpe1
(1)College of Nursing, Department of Biobehavioral Health Science, M/C 802, University of Illinois at Chicago, Chicago, IL
(2)School of Nursing, University of Michigan, Ann Arbor, MI

Learning Objective 1: 1. Describe sleep patterns (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings) following hematopoietic stem cell transplantation.

Learning Objective 2: 2. Identify types and frequencies of nocturnal disturbances that occur in the hospital environment following hematopoietic stem cell transplantation.

Purpose: People receiving high-dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) frequently report sleep disturbances during the acute phase of treatment although objective documentation of this is lacking.  This study employed subjective and objective sleep assessments to evaluate sleep patterns and examine relationships among sleep patterns, quality of life, and demographic factors.

Methods: The convenience sample consisted of 40 hospitalized HSCT patients.  Each subject wore a wrist actigraph for five days to assess sleep patterns and completed a quality of life questionnaire that included a sleep disturbance item (EORTC QLQ C-30).  The medical record was retrospectively reviewed to determine the number and type of nocturnal disturbances.

Results: Results indicate there is a high prevalence of sleep disturbances during hospitalization following HSCT. Most subjects (n=82%) reported some sleep disturbance.  The mean total sleep time per 24-hour period was 5:41 hours and sleep efficiency, 55%.  Thirty-five percent of subjects did not experience a major sleep interval (lasting more than 3 hours) during one or more 24-hour period.  Subjects older than 60 spent more time attempting to fall asleep compared to those between 18 and 39 (p< .05). The most common nocturnal disturbance was medication administration. Total sleep time was moderately correlated with pain (r=.363, p< .05) and dyspnea (r =.372, p< .05). Subjective assessment of sleep negatively correlated with age (r= -.375, p< .05) and cognitive function (r= -.380, p< .05) while positively correlated with pain (r= .327, p< .05).

Conclusion: Findings suggest that a substantial number of HSCT patients experience sleep disturbances during the acute phase of HSCT treatment. Reductions in total sleep time were associated with increased pain and dyspnea.  As sleep is an essential biological function, additional research is needed regarding the effects of sleep disturbances on recovery following HSCT and interventions to optimize sleep during hospitalization.