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Sleep for Inpatients: Empowering Staff to Act: Part 1
Course List


  • CME Front Matter

Media

Online Video

Target Audience

Health care providers of all specialties including physicians, nurses, nurse practitioners and physician assistants.

Statement of Need

Getting better sleep in the hospital is especially important due to a variety of adverse health effects that can potentially worsen patient recovery. For example, there is a well-documented relationship between acute sleep deprivation and a host of cardio-metabolic derangements, such as impaired blood glucose tolerance, higher blood pressure, and increased heart rates, which are known complications of hospitalization.1,2

Sleep loss is especially problematic for older adult patients, who are at higher risk of delirium, or may receive sedative-hypnotics perpetuating a vicious cycle of polypharmacy and mental status changes.3,4 Second, sleep loss can impair recovery in hospitalized older patients due to fatigue and excessive daytime sleepiness, which can not only hinder patients’ participation in recovery activities (i.e. physical therapy), but also make it much harder for clinicians to monitor or recognize improvements in acute illness. Sleep loss has also been implicated in impairing a variety of processes vital to health, such as wound healing, immunity, and sensitivity to pain.5,6

Lastly, because hospitalization is often a time that patients are expected to learn new information, sleep loss is especially problematic due to its effect on memory consolidation.7 Patients are often expected to learn new information related to their diagnosis and understand instructions related to their post-discharge care (i.e. follow-up appointments, self-management). Moreover, while acute sleep loss may not seem like a chronic health issue at first, recent studies and expert opinion have implicated poor sleep during acute care hospitalization or shortly after with worse health outcomes, including development of chronic insomnia, higher one year mortality, a “post-hospital syndrome” in which patients are vulnerable to readmission.8,9,10

  1. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11(3):163-78. PMCID: PMC1991337
  2. Buxton OM, Ellenbogen JM, Wang W, Carballeira A, O'Connor S, Cooper D, Gordhandas AJ, McKinney SM, Solet JM. Sleep disruption due to hospital noises: a prospective evaluation. Ann Intern Med. 2012;157(3):170-179.
  3. McDowell JA, Mion LC, Lydon TJ, Inouye SK. A nonpharmacologic sleep protocol for hospitalized older patients. J Am Geriatr Soc. 1998;46(6):700-705.
  4. Bell CM, Fischer HD, Gill SS, Zagorski B, Sykora K, Wodchis WP, Herrmann N, Bronskill SE, Lee PE, Anderson GM, Rochon PA. Initiation of benzodiazepines in the elderly after hospitalization. J Gen Intern Med. 2007;22(7):1024-1029. PMCID: PMC2330138
  5. Ackermann K, Revell VL, Lao O, Rombouts EJ, Skene DJ, Kayser M. Diurnal rhythms in blood cell populations and the effect of acute sleep deprivation in healthy young men. Sleep. 2012;35(7):933-940.
  6. Roehrs TA, Harris E, Randall S, Roth T. Pain sensitivity and recovery from mild chronic sleep loss. Sleep. 2012;35(12):1667-1672.
  7. Mander BA, Rao V, Lu B, et al. Prefrontal atrophy, disrupted NREM slow waves and impaired hippocampal-dependent memory in aging. Nat. Neurosci. 2013. Available at: doi:10.1038/nn.3324. Accessed on January 27, 2013.
  8. Griffiths MF, Peerson A. Risk factors for chronic insomnia following hospitalization. J Adv Nurs. 2005;49(3):245-253.
  9. Martin JL, Fiorentino L, Jouldjian S, Mitchell M, Josephson KR, Alessi CA. Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults. Sleep. 2011;34(12):1715-1721. PMCID: PMC3208850
  10. Krumholz HM. Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100-102.

Learning Objectives

At the conclusion of this activity, participants will be able to:

  1. Describe the importance of proper sleep for hospitalized patients and the high prevalence of undiagnosed sleep disorders.

  2. Screen and refer hospitalized patients who are at high risk for sleep disorders such as obstructive sleep apnea.

  3. Evaluate methods to optimize sleep for hospitalized patients by minimizing environmental and medical disruptions.

Agenda

  1. Pre-test
  2. Video presentation
  3. Post-test

Activity Length

  • Part 1: 13 minutes
  • Part 2: 10 minutes

Faculty Information and Disclosures

Vineet Arora, MD, MAPP is an Associate Professor of Medicine, Assistant Dean of Scholarship & Discovery at Pritzker School of Medicine, and Director of GME Clinical Learning Environment and Innovation at the University of Chicago Medicine. Her research interests focus on evaluating educational and clinical practice innovations that aim to improve the quality, safety, and value of care delivered by trainees in teaching hospitals.

Babak Mokhlesi, MD, MSc is a Professor of Medicine and Director of the Sleep Disorders Center at the University of Chicago. He is a sleep specialist with a background in pulmonary and critical care medicine whose research interests include cardiometabolic consequences of sleep apnea, risk associated with obstructive sleep apnea that is limited to REM sleep, predictors of adherence to CPAP therapy, perioperative management of OSA and obesity hypoventilation syndrome.

Jay Balachandran, MD is an Assistant Professor of Medicine and Director of the Sleep Medicine Fellowship Program. He specializes in pulmonary, critical care, and sleep medicine. His research interests include studying education interventions to improve patient and practitioner awareness of sleep medicine issues and innovating solutions to increase utilization of sleep medicine resources and therapies.

Jeanne Farnan, MD, MHPE is an Associate Professor of Medicine at the University of Chicago and Assistant Dean of Curricular Innovation and Evaluation at the Pritzker School of Medicine. She also co-directs the Clinical Skills curriculum as well as the Director of the Clinical Performance Center at the University of Chicago Pritzker School of Medicine. Her academic work focuses on resident supervision, professionalism and patient handoffs.

The faculty have no conflicts of interest to disclose.

Accreditation Statement

The University of Chicago Pritzker School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The University of Chicago Pritzker School of Medicine designates this live activity for a maximum of .25 AMA PRA Category 1 Credits™ per activity in this two-activity series. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This enduring material is approved for 2 years from the date of original release, January 4, 2016 to January 4, 2018. To successfully earn credit, participants must complete the activity online during the valid credit period. To receive AMA PRA Category 1 Credits™, the participant must complete the activity evaluation and correctly answer 8 out of 8 questions (100% pass rate) on the post-test. The test can be accessed by clicking on the appropriate certificate link at the top of this page. Upon successful completion, the participant may save or print their certificate (PDF).

Nurses and other healthcare professionals will receive a Certificate of Participation. For information on the applicability and acceptance of Certificates of Participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME, please consult your professional licensing board.

Fee

This activity is complimentary.

Contact

If you have any questions regarding this CME activity, please contact Samantha Anderson, Research Specialist, Section of General Internal Medicine, University of Chicago. Email: sanderson7@medicine.bsd.uchicago.edu

Grant Funding

This CME series is made possible with generous funding from the American Sleep Medicine Foundation and the National Heart, Lung, and Blood Institute.

Disclosure(s)

The staff of the University of Chicago Center for Continuing Medical Education have no financial relationships to disclose.

Disclaimer

The information presented in this activity is for continuing medical education purposes only.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of the University of Chicago Pritzker School of Medicine, the University of Chicago Medicine, or the Department of Surgery.