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New England Surgical Society

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Deep Sleep and Beeps: Inpatient Sleep Assessment in Elective Surgery Patients
*Robert W Allen, Srinivas J Ivatury
Dartmouth-Hitchcock Medical Center, Lebanon, NH

Objective: To assess postoperative sleep quality in elective surgical patients. Design: Prospective, observational study. Setting: Tertiary medical center. Patients: Interim analysis of 49 patients undergoing elective abdominal surgery. Interventions: Patients wore Fitbit sleep trackers while inpatient to record total sleep time (recommendation=7hrs). At discharge, patients completed the Richards-Campbell Sleep Questionnaire (RCSQ) for inpatient sleep quality. RCSQ combines five sleep domains into a cumulative score (0-100); a higher score means better sleep quality. Patients also completed the outpatient Pittsburgh Sleep Quality Index (PSQI) before surgery (>5=sleep disturbance) to assess baseline sleep. Main Outcome Measure: RCSQ total sleep quality score, RCSQ domain scores. Results: 42 (86%) had pre-op PSQI scores suggesting baseline sleep disturbance. Mean (SD) RCSQ total sleep quality was 46.6 (± 20.6); mean domain scores included Awakenings (37.1 ± 22.6), Sleep Quality (46.0 ± 20.6), and Sleep Depth (46.6 ± 25.8), and Noise Disturbance score was 56.3 (± 27.1). 19 (38%) patients had enough uninterrupted sleep the first postoperative night to accurately record sleep time, which averaged 3.6 hours. Through hospitalization, patients averaged 5.9 hours of sleep per night. Sleep barriers included nighttime noise pollution and awakenings for vital signs/phlebotomy. Conclusions: Elective surgical patients experience severely poor sleep quality during inpatient stay. This is driven by nighttime noise pollution and frequent nighttime awakenings. We will design and pilot a set of healthcare delivery strategies and a Postoperative Pack (POP) for sleep to address these issues.


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