Sleep disturbances and functional independence improvement in a population of individuals hospitalized in intensive rehabilitation units: observational study

Giovanni Galeoto; Anna Berardi; Maria Letizia Grassi; Alessia Scialpi; Donatella Valente; Marco Tofani; Marco Paoloni

doi:10.5114/areh.2021.110001

Abstract

Introduction

Quality of sleep in hospitals is an important issue, especially for rehabilitation patients. The aim of this study was to evaluate the development of sleep disturbances in a population of individuals hospitalized in intensive rehabilitation units and to investigate relationship with functional independence.

Material and methods

The sample was evaluated with the General Sleep Disturbance Scale (GSDS-IT) and Bartel Index (IcaBI) three times: at admission (t0), seven days after admission (t1), and 25 days after admission (t2). The variation in sleep quality between t0-t1-t2 was calculated by performing a paired samples t-test between the scores’ averages. A comparison of the functional independence level evaluated thorugh IcaBI of subjects with and without sleep disorders according to GSDS-IT cut-off points was performed via an independent samples t-test between the averages of the scores obtained on the IcaBI at times t0 and t2.

Results

138 individuals were included in the study, 77 of whom completed the evaluation at t2. Comparison of the mean scores on the GSDS-IT showed a statistically significant worsening of the quality of sleep between t0-t1-t2 (p < 0.01). Comparison of the mean scores on the IcaBI showed a statistically significant improvement in functional independence between t0-t1-t2 (p < 0.01). The results showed no significant difference between those with or without sleep disorders in terms of improvement of IcaBI scores after 25 days of hospitalization.

Conclusions

This study represent a starting point in highlighting the development of sleep disturbances during hospitalization in rehabilitation units, raising awareness about the importance of adequate sleep among vulnerable hospital population.

References

Hirshkowitz M. Normal human sleep: An overview. Med Clin North Am 2004; 88(3): 551–65.
Search in Google Scholar Back to article
American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 3rd ed. 2014.
Search in Google Scholar Back to article
Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National sleep foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Heal 2015; 1(1): 40–43.
Search in Google Scholar Back to article
Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine: Fifth Edition. 2010.
Search in Google Scholar Back to article
Lee KA. Self-reported sleep disturbances in employed women. Sleep 1992; 15(6): 493–8.
Search in Google Scholar Back to article
Dobing S, Frolova N, McAlister F, Ringrose J. Sleep quality and factors influencing self-reported sleep duration and quality in the general internal medicine in-patient population. PLoS One 2016; 11(6): e0156735.
Search in Google Scholar Back to article
Rahe C, Czira ME, Teismann H, Berger K. Associations between poor sleep quality and different measures of obesity. Sleep Med 2015; 16(10): 1225–8.
Search in Google Scholar Back to article
Wesselius HM, Van Den Ende ES, Alsma J, Ter Maaten JC, Schuit SCE, Stassen PM, et al. Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients. JAMA Intern Med 2018; 178(9): 1201–1208.
Search in Google Scholar Back to article
Sasai T, Inoue Y, Komada Y, Nomura T, Matsuura M, Matsushima E. Effects of insomnia and sleep medication on health-related quality of life. Sleep Med 2010; 11(5): 452–7.
Search in Google Scholar Back to article
Frighetto L, Marra C, Bandali S, Wilbur K, Naumann T, Jewesson P. An assessment of quality of sleep and the use drugs with sedating properties in hospitalized adult patients. Health Qual Life Outcomes 2004; 2: 17.
Search in Google Scholar Back to article
Young JS, Bougeois JA, Hilty DM, Hardin KA. Sleep in hospitalized medical patients, Part 1: Factors affecting sleep. J Hosp Med 2008; 3(6): 473–82.
Search in Google Scholar Back to article
Frohnhofen H, Popp R, Frohnhofen K, Fulda S. Impact of daytime sleepiness on rehabilitation outcome in the elderly. Adv. Exp. Med. Biol., 2013; 755: 103–10.
Search in Google Scholar Back to article
Lewandowska K, Małkiewicz MA, Siemiński M, Cubała WJ, Winklewski PJ, Mędrzycka-Dąbrowska WA. The role of melatonin and melatonin receptor agonist in the prevention of sleep disturbances and delirium in intensive care unit – a clinical review. Sleep Med 2020; 69: 127–34.
Search in Google Scholar Back to article
Lewandowska K, Mędrzycka-Dąbrowska W, Kwiecień-Jaguś K, Czyż-Szypenbejl K. Factors determining sleep in patients hospitalised in ICUs in a hospital in Northern Poland. Sleep Biol Rhythms 2019; 17: 243–50.
Search in Google Scholar Back to article
Tramontano M, De Angelis S, Galeoto G, Cucinotta MC, Lisi D, Botta RM, et al. Physical Therapy Exercises for Sleep Disorders in a Rehabilitation Setting for Neurological Patients: A Systematic Review and Meta-Analysis. Brain Sci 2021; 11: 1176.
Search in Google Scholar Back to article
Palagini L, Ragno G, Caccavale L, Gronchi A, Terzaghi M, Mauri M, et al. Italian validation of the Sleep Condition Indicator: A clinical screening tool to evaluate Insomnia Disorder according to DSM-5 criteria. Int J Psychophysiol 2015; 98 (3 Pt 1): 435–40.
Search in Google Scholar Back to article
Espie CA, Kyle SD, Hames P, Gardani M, Fleming L, Cape J. The Sleep Condition Indicator: A clinical screening tool to evaluate insomnia disorder. BMJ Open 2014; 4: e004183.
Search in Google Scholar Back to article
Espie CA, Farias Machado P, Carl JR, Kyle SD, Cape J, Siriwardena AN, et al. The Sleep Condition Indicator: Reference values derived from a sample of 200 000 adults. J Sleep Res 2018; 27(3): e12643.
Search in Google Scholar Back to article
Galeoto G, Mollica R, Astorino O, Cecchi R. Il consenso informato in fisioterapia: Proposta di una modulistica. G Ital Med Lav Ergon 2015; 37: 245–54.
Search in Google Scholar Back to article
Galeoto G, De Santis R, Marcolini A, Cinelli A, Cecchi R. The informed consent in Occupational Therapy: Proposal of forms. G Ital Med Lav Ergon 2016; 38: 107–15.
Search in Google Scholar Back to article
Galeoto G, Scialpi A, Grassi ML, Berardi A, Valente D, Tofani M, et al. General Sleep Disturbance Scale: Translation, cultural adaptation, and psychometric properties of the Italian version. CRANIO® 2021; 39(4): 326–334.
Search in Google Scholar Back to article
Panuccio F, Galeoto G, Marquez MA, Grassi ML, Scialpi A, Tofani M, et al. General Sleep Disturbance Scale (GSDS-IT) in people with spinal cord injury: A psychometric study. Spinal Cord 2020; 58(11): 1183–1188.
Search in Google Scholar Back to article
Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J 1965; 14: 61–5.
Search in Google Scholar Back to article
Galeoto G, Lauta A, Palumbo A, Castiglia S, Mollica R, Santilli V, et al. The Barthel Index: Italian Translation, Adaptation and Validation. Int J Neurol Neurother 2015, 2: 2.
Search in Google Scholar Back to article
Castiglia SF, Galeoto G, Lauta A, Palumbo A, Tirinelli F, Viselli F, et al. The culturally adapted Italian version of the Barthel Index (IcaBI): Assessment of structural validity, inter-rater reliability and responsiveness to clinically relevant improvements in patients admitted to inpatient rehabilitation centers. Funct Neurol 2017; 22: 221–8.
Search in Google Scholar Back to article
Hoch CC, Reynolds CF, Jennings JR, Monk TH, Buysse DJ, Machen MA, et al. Daytime sleepiness and performance among healthy 80 and 20 year olds. Neurobiol Aging 1992; 13(2): 353–6.
Search in Google Scholar Back to article
Stenholm S, Kronholm E, Sainio P, Borodulin K, Era P, Fogelholm M, et al. Sleep-related factors and mobility in older men and women. Journals Gerontol – Ser A Biol Sci Med Sci 2010; 65A(6): 649–657.
Search in Google Scholar Back to article
Gooneratne NS, Weaver TE, Cater JR, Pack FM, Arner HM, Greenberg AS, et al. Functional outcomes of excessive daytime sleepiness in older adults. J Am Geriatr Soc 2003; 51(5): 642–9.
Search in Google Scholar Back to article
Tamrat R, Huynh-Le MP, Goyal M. Non-pharmacologic interventions to improve the sleep of hospitalized patients: A systematic review. J Gen Intern Med 2014; 29(5): 788–95.
Search in Google Scholar Back to article
Sandoval CP. Nonpharmacological interventions for sleep promotion in the intensive care unit. Crit Care Nurse 2015; 2015(10): CD008808.
Search in Google Scholar Back to article
Miller MA, Renn BN, Chu F, Torrence N. Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions. Gen Hosp Psychiatry 2019; 59: 58–66.
Search in Google Scholar Back to article