Reduced Overnight Vital Signs Improve Sleep in Hospitalized Children: A Nonrandomized Interventional Trial.

Abstract

Objective: This study sought to determine the change in sleep quality and duration among children hospitalized on acute care units when overnight vital signs (VS) monitoring is eliminated, compared with children who receive standard-of-care VS monitoring.

Patients and methods: This is a nonrandomized controlled study among children hospitalized on medical-surgical units (n = 109). The study intervention involved forgoing VS measurement at 0000 and 0400. The primary outcome was actigraphy-measured total sleep time, with secondary outcomes of actigraphy-measured wake status at midnight and 0700; actigraphy-measured and self-reported nocturnal wake frequency and duration; and self-reported total sleep time, restfulness upon waking, and sleep disturbances.

Results: Actigraphy total sleep time in the intervention group was 49.2 minutes longer than in the control group (P = .04). Sleep efficiency, wake after sleep onset, and wake episodes were not different. There was also no difference in the number of children asleep at midnight, but more children in the intervention group were asleep at 0700 than in the control group (77% vs 55%, P = .03). Self-reported restfulness and sleep disturbances were also superior in the intervention group. There were no unplanned pediatric intensive care unit (ICU)/cardiac ICU transfers, rapid response activations, code sepsis alerts, or code blue events.

Conclusions: Forgoing overnight VS measurement among children hospitalized on medical-surgical units was associated with an increase in overnight sleep duration but did not decrease the overall number of nighttime interruptions or time awake during the night. VS measurement reduction was also safe and may be important for children to achieve adequate sleep in the hospital.