Improving sleep on the inpatient general, non‐stroke neurology service: A quasi‐experimental interventional trial

BACKGROUND: Hospitalized patients often experience poor sleep, which is associated with worse health outcomes, increased rates of delirium, and readmissions. OBJECTIVE: To improve overnight sleep for clinically stable general neurology patients at a single academic center. METHODS: We conducted a quasi-experimental pre-post clinical trial of two sleep-protective interventions: (1) a sleep-friendly order set that reduced overnight interruptions by discontinuing vital sign checks/neurological examinations and retiming medications/blood draws; and (2) a "sleep menu" of comfort items. The primary outcome measure was sleep duration. Secondary outcomes were awakenings and patient responses to the Richards-Campbell Sleep Questionnaire. Safety outcomes were rates of delirium, ICU transfers, and 30-day readmissions. We compared the groups using linear mixed-effects models to account for repeated measures (multiple nights per participant). RESULTS: We analyzed data from 66 pre-intervention participants (238 nights) and 61 post-intervention participants (244 nights). The interventions did not increase sleep duration (pre-intervention median 5.5 h [interquartile range (IQR) 4.0,6.6], post-intervention median 5.4 h [4.1, 6.7], p = .84). There was marginal improvement in nightly awakenings (pre-intervention 2 [1, 4], post-intervention 2 [1, 3], p = .04). There were no significant differences in subjective sleep measures or safety outcomes. Targeted care team interruptions all significantly decreased post-intervention, though staff intrusions remained a common patient-reported barrier to sleep. CONCLUSION: Fragmented and reduced sleep was common in our general neurology population. Although our interventions did not improve sleep outcomes-apart from a modest drop in nocturnal awakenings-there was a significant decrease in care team interruptions. Poor inpatient sleep is multifactorial, and meaningful change likely requires comprehensive interventions.