Sleep after discharge: A northwest regional burn model system cohort study of burn subjects in a home-based virtual rehabilitation randomized trial

Introduction

Major burns and the intensive care required induce numerous physiologic changes and stress responses that impact recovery for months after hospital discharge. Little is known about sleep quantity and quality after index hospitalization discharge. We report on actigraphy and sleep outcome data from subjects enrolled in a prospective trial of home-based virtual rehabilitation (HBVR) after burn injury.

Methods

We conducted a randomized controlled trial of a HBVR program over 12 weeks after index hospitalization. In both HBVR and control (usual care) groups, subjects were provided a wrist actigraphy accelerometer device (Garmin vívofit®) to wear. Sleep data were retrieved remotely and analyzed. Actigraphy data were defined a priori as complete if subjects had 5 out of 7 days of actigraphy wear in a week. Average weekly sleep was calculated and reported by group assignment. Sleep-relevant and fatigue outcomes were measured by PROMIS questionnaires at randomization (discharge + 0–30 days), 12-weeks, and 12-months. Descriptive statistics were used for comparisons and linear mixed effect model were used to evaluate trends in PROMIS T-scores between groups.

Results

Fifty subjects were enrolled and 48 had complete sleep data. Mean age was 38 ± 14 years and mean burn size was 16 ± 13 % TBSA with a majority of subjects male (71 %). Average sleep duration was within general population norms, with little difference between subjects in the intervention and controls groups in the 12 weeks after study randomization (7.3 vs.7.2 h respectively, p = 0.25). Subjects in control group spent more time in light sleep (4.1 vs. 3.9 h, p < 0.01) and experienced a higher proportion of nights with sleep disturbances (0.75 vs. 0.70, p = 0.006). Thirty-two subjects (66 %) completed PROMIS questionnaires at both time of randomization and following the 12-week intervention period. Average PROMIS sleep disturbance T-scores were not significantly different at 3-months. The control group had significant improvement in average PROMIS T-scores at 3-months compared to the HBVR group (p = 0.015). PROMIS scores trended towards improvement over the 12-month study period for both groups.

Conclusions

Actigraphy data complement self-reported sleep data among burn-injured adults after hospital discharge. People with burn injury had mildly increased sleep disturbance, sleep impairment, and fatigue after hospital discharge but trended toward population norms over time.