Sleep quality and noise: comparisons between hospital and home settings.

BACKGROUND: Children and their parents report poor sleep in hospital and complain about noise. OBJECTIVE: To measure sleep quality and noise levels in hospital and compare these with the home environment. DESIGN: Observational within case-controlled study. SETTING: Paediatric medical wards at Southampton Children's Hospital and bedrooms at home. PARTICIPANTS AND METHODS: Participants were children aged 3-16 years and their co-sleeping parents. Sleep quality was measured using actigraphy for a maximum of 5 nights in each setting. Median sound levels at the bedside were monitored overnight in a subgroup in both settings. MAIN OUTCOME MEASURES: Total sleep time, sleep efficiency, median sound levels overnight. RESULTS: 40 children and 16 mothers completed actigraphy in both settings. Children had on average 62.9 min, and parents 72.8 min, per night less sleep in hospital than at home. Both children and parents had poorer sleep quality in hospital than at home: mean sleep efficiency 77.0% vs 83.2% for children and 77.1% vs 88.9% for parents, respectively. Median sound levels in hospital measured in 8 children averaged 48.6 dBA compared with 34.7 dBA at home and exceeded World Health Organization recommendations of 30 dB. CONCLUSIONS: Children and their mothers have poor quality sleep in paediatric wards. This may affect the child's behaviour, recovery and pain tolerance. Sleep deprivation adds to parental burden and stress. Sound levels are significantly raised in hospital and may contribute to poor sleep. Reduction in the level of noise might lead to an improvement in sleep, affecting the quality of stay of both parent and child.

A qualitative study of sleep quality in children and their resident parents when in hospital.

OBJECTIVE: Poor sleep quality impairs immune responses and pain tolerance, both key to recovery from acute illness. Hospitalised children and their co-sleeping parents also risk emotional lability and impaired coping skills when sleep-deprived. We aimed to study the experiences of children and parents during hospital admissions. DESIGN: Semi-structured interviews were conducted with parents within a week of their child's discharge. Questions explored parent and child sleep quality, factors contributing to this, perceived impact on day-time functioning and suggested improvements to ward sleep environment. SETTING: Southampton Children's Hospital, UK. PATIENTS: 17 co-sleeping parents of 16 children aged 3-12 years completed interviews. Children admitted for surgical procedures and those with established sleep disorders or nocturnal seizures were excluded. MAIN OUTCOME MEASURES: Constant comparative methods identified themes within the data using a grounded theory approach. RESULTS: Parents reported that they, and to a lesser extent their children, experienced reduced sleep quality. Noise and light as well as ward schedules were identified as key factors disrupting sleep. Parents reported that lack of sleep caused difficulties with their own emotional regulation and that of their child, affecting daytime parent-child relationships. Furthermore, they reported a negative impact of sleep deprivation on decision-making about their child's medical care. CONCLUSIONS: Parents identified poor sleep in hospital as a significant additional burden to their child's hospital admission. Importantly, they identified potential improvements to the ward sleep environment. Intervention studies that target modifiable, child-centred alterations to night-time ward culture are recommended, focusing on measurable child and parental outcomes.