Patient and Parent Sleep in a Children's Hospital
Participants were drawn from a large (over 400 inpatient beds), tertiary care children's hospital in the mid-Atlantic region of the United States. Families were eligible to participate if the child/adolescent was 1) 8 to 21 years of age (inclusive), 2) had been admitted to the hospital no later than 4:00 p.m. the previous day (ensuring at least 24 hours of hospitalization), 3) did not have surgery in the previous 24 hours, and 4) did not have sedation for a medical procedure (such as an MRI) in the previous 24 hours. Parents of patients were eligible to participate if 1) their child met the above criteria, and 2) the parent had stayed with the child the previous night (roomed-in). Participation by both the patient and the parent was not required (for example, the adolescent participated but the parent did not room-in the previous night).
This study was approved by the hospital's Institutional Review Board. Parent written consent and youth verbal assent were obtained for all participants. During a one-week period, the charge nurse for each non-critical care inpatient unit in the hospital identified potential participants using the inclusion criteria described. Participation rates were 78% for patients and 79% for parents. The two primary reasons given for not wanting to participate included 1) not interested and 2) the child was not feeling well enough to complete the questionnaire. No significant differences were found between youth who did and did not participate in terms of age. Parents who roomed-in had younger children than parents who did not room-in the previous night (12.7 vs. 15.1 years, t(67) = −2.30, p = 0.02).
A member of the research team approached each patient and his or her parents/caregivers between 4:00 p.m. and 8:00 p.m. to explain the study and obtain informed consent and assent. Participants were then given the Sleep in a Children's Hospital (SinCH) survey to complete. The timeframe was selected for several reasons: 1) to ensure patients had been hospitalized at least 24 hours; 2) the hospital units tend to be quieter during these hours because most procedures and rounds are completed prior to this time; 3) by requiring participants to complete the survey that evening, it was ensured that participants were reporting on the previous 24-hours (including the previous night of sleep, as well as sleep during the current day).
There were no existing measures of sleep patterns or sleep quality during pediatric hospitalization available for use; thus, the SinCH and the Sleep in a Children's Hospital – Parent Version (SinCH-P) surveys were created for this study using validated recall methodology (Meltzer, Mindell, & Levandoski, 2007; Monk et al., 2003; Olds, Maher, Blunden, & Matricciani, 2010). The SinCH and SinCH-P are each a 75-item self-report measure of sleep (bedtime, wake time, sleep onset latency) and sleep disturbances during hospitalization (noise, light, pain, vital sign checks). Sleep questions were taken from validated self-report measures of sleep in children and adolescents (Meltzer & Davis, 2008; Wolfson & Carskadon, 1998; Wolfson et al., 2003) and adults (Meltzer et al., 2007). Sleep disturbance questions were selected from two validated measures of sleep for the hospitalized adult: the Disturbances Due to Hospital Noises Scale (Topf, 1985) and the Sleep in the Intensive Care Unit Questionnaire (Freedman, Kotzer, & Schwab, 1999). These questions were modified as needed for this population based on the clinical experience of the research team and a group of 15 youth who had chronic illnesses and a history of multiple hospitalizations.
Youth were given a preliminary version of the SinCH survey. Feedback about content and question format (including wording, length, and age appropriateness) were integrated into the final version. There are no summary scales (only descriptive self-report information) provided by this survey, so no psychometric data are provided. However, the face validity of this survey is appropriate for this type of exploratory study, with the self-reported sleep patterns and sleep disturbances utilized in this measure a well-established and accepted methodology. Similar scales with a similar methodology of using 24-hour recall of sleep patterns and sleep problems have been used in a variety of populations, including studies the authors conducted with children and adolescents of similar ages (Meltzer & Davis, 2008; Monk et al., 2003; Olds et al., 2010). Further, studies have demonstrated that children as young as 8 years of age can provide self-reported health information, including sleep patterns and sleep disturbances (Meltzer & Davis, 2008; Riley, 2004; Varni, Limbers, & Burwinkle, 2007).
The surveys included the following sections: 1) demographic information, 2) typical sleep patterns on weekdays and weekends at home, 3) sleep the previous night in the hospital, 4) noises and worries that may have bothered participants the previous night, and 5) specific sleep disruptors (such as child's pain, vital sign checks) that may have disturbed sleep onset or sleep maintenance (see Figure 1). Each child and parent participant completed the appropriate SinCH survey reporting on his or her own sleep. The SinCH was read aloud to children 8 to 10 years of age, while children over 10 years of age completed the SinCH independently. It took approximately 15 minutes for participants to complete the survey.
(Enlarge Image)
Figure 1.
Sample Items from the Sleep in a Children's Hospital Survey
Descriptive statistics (means, frequencies) were used to describe the study sample. Reported sleep variables included bedtime (time attempted to fall asleep), sleep onset latency (SOL) (minutes to fall asleep at bedtime), night waking frequency, and wake time. Total sleep time (TST) was calculated (time from bedtime to wake time, less SOL). Because developmental differences in sleep may be masked by examining averages for the entire sample, paired t-tests were used to separately examine differences in sleep in hospital and sleep at home for school-aged children (8 to 12 years; n = 33) and adolescents (13 to 21 years; n = 39). Descriptive statistics were used to report the most common noises, worries, and other causes of sleep disruptions. T-tests were used to examine differences in sleep variables for patients and parents who did and did not experience the most common sleep disruptors. Finally, analysis of covariance (controlling for age) was used to examine differences in sleep for both reason for hospitalization and first night effect.
Methods
Participants and Procedure
Participants were drawn from a large (over 400 inpatient beds), tertiary care children's hospital in the mid-Atlantic region of the United States. Families were eligible to participate if the child/adolescent was 1) 8 to 21 years of age (inclusive), 2) had been admitted to the hospital no later than 4:00 p.m. the previous day (ensuring at least 24 hours of hospitalization), 3) did not have surgery in the previous 24 hours, and 4) did not have sedation for a medical procedure (such as an MRI) in the previous 24 hours. Parents of patients were eligible to participate if 1) their child met the above criteria, and 2) the parent had stayed with the child the previous night (roomed-in). Participation by both the patient and the parent was not required (for example, the adolescent participated but the parent did not room-in the previous night).
This study was approved by the hospital's Institutional Review Board. Parent written consent and youth verbal assent were obtained for all participants. During a one-week period, the charge nurse for each non-critical care inpatient unit in the hospital identified potential participants using the inclusion criteria described. Participation rates were 78% for patients and 79% for parents. The two primary reasons given for not wanting to participate included 1) not interested and 2) the child was not feeling well enough to complete the questionnaire. No significant differences were found between youth who did and did not participate in terms of age. Parents who roomed-in had younger children than parents who did not room-in the previous night (12.7 vs. 15.1 years, t(67) = −2.30, p = 0.02).
A member of the research team approached each patient and his or her parents/caregivers between 4:00 p.m. and 8:00 p.m. to explain the study and obtain informed consent and assent. Participants were then given the Sleep in a Children's Hospital (SinCH) survey to complete. The timeframe was selected for several reasons: 1) to ensure patients had been hospitalized at least 24 hours; 2) the hospital units tend to be quieter during these hours because most procedures and rounds are completed prior to this time; 3) by requiring participants to complete the survey that evening, it was ensured that participants were reporting on the previous 24-hours (including the previous night of sleep, as well as sleep during the current day).
Measures
There were no existing measures of sleep patterns or sleep quality during pediatric hospitalization available for use; thus, the SinCH and the Sleep in a Children's Hospital – Parent Version (SinCH-P) surveys were created for this study using validated recall methodology (Meltzer, Mindell, & Levandoski, 2007; Monk et al., 2003; Olds, Maher, Blunden, & Matricciani, 2010). The SinCH and SinCH-P are each a 75-item self-report measure of sleep (bedtime, wake time, sleep onset latency) and sleep disturbances during hospitalization (noise, light, pain, vital sign checks). Sleep questions were taken from validated self-report measures of sleep in children and adolescents (Meltzer & Davis, 2008; Wolfson & Carskadon, 1998; Wolfson et al., 2003) and adults (Meltzer et al., 2007). Sleep disturbance questions were selected from two validated measures of sleep for the hospitalized adult: the Disturbances Due to Hospital Noises Scale (Topf, 1985) and the Sleep in the Intensive Care Unit Questionnaire (Freedman, Kotzer, & Schwab, 1999). These questions were modified as needed for this population based on the clinical experience of the research team and a group of 15 youth who had chronic illnesses and a history of multiple hospitalizations.
Youth were given a preliminary version of the SinCH survey. Feedback about content and question format (including wording, length, and age appropriateness) were integrated into the final version. There are no summary scales (only descriptive self-report information) provided by this survey, so no psychometric data are provided. However, the face validity of this survey is appropriate for this type of exploratory study, with the self-reported sleep patterns and sleep disturbances utilized in this measure a well-established and accepted methodology. Similar scales with a similar methodology of using 24-hour recall of sleep patterns and sleep problems have been used in a variety of populations, including studies the authors conducted with children and adolescents of similar ages (Meltzer & Davis, 2008; Monk et al., 2003; Olds et al., 2010). Further, studies have demonstrated that children as young as 8 years of age can provide self-reported health information, including sleep patterns and sleep disturbances (Meltzer & Davis, 2008; Riley, 2004; Varni, Limbers, & Burwinkle, 2007).
The surveys included the following sections: 1) demographic information, 2) typical sleep patterns on weekdays and weekends at home, 3) sleep the previous night in the hospital, 4) noises and worries that may have bothered participants the previous night, and 5) specific sleep disruptors (such as child's pain, vital sign checks) that may have disturbed sleep onset or sleep maintenance (see Figure 1). Each child and parent participant completed the appropriate SinCH survey reporting on his or her own sleep. The SinCH was read aloud to children 8 to 10 years of age, while children over 10 years of age completed the SinCH independently. It took approximately 15 minutes for participants to complete the survey.
(Enlarge Image)
Figure 1.
Sample Items from the Sleep in a Children's Hospital Survey
Statistical Analyses
Descriptive statistics (means, frequencies) were used to describe the study sample. Reported sleep variables included bedtime (time attempted to fall asleep), sleep onset latency (SOL) (minutes to fall asleep at bedtime), night waking frequency, and wake time. Total sleep time (TST) was calculated (time from bedtime to wake time, less SOL). Because developmental differences in sleep may be masked by examining averages for the entire sample, paired t-tests were used to separately examine differences in sleep in hospital and sleep at home for school-aged children (8 to 12 years; n = 33) and adolescents (13 to 21 years; n = 39). Descriptive statistics were used to report the most common noises, worries, and other causes of sleep disruptions. T-tests were used to examine differences in sleep variables for patients and parents who did and did not experience the most common sleep disruptors. Finally, analysis of covariance (controlling for age) was used to examine differences in sleep for both reason for hospitalization and first night effect.
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