Sleep Patterns During Hospitalization Following Hematopoietic Stem Cell Transplantation

Sleep is an essential, restorative, biologic process crucial for maintaining and optimizing health. In patients with cancer, sleep disturbance is one of the most frequently reported side effects (Howell et al., 2014). Following hematopoietic stem cell transplantation (HCT), the prevalence and severity of sleep disturbances is likely amplified, given the intensive nature of the chemotherapy, subsequent side effects, and potentially long hospital stays. As many as 77% of patients report problems with sleep during hospitalization following HCT (Rischer, Scherwath, Zander, Koch, & Schulz-Kindermann, 2009). More than 30% report sleep disturbances to be severely distressing on the day of transplantation (Bevans, Mitchell, & Marden, 2008). From a survivorship perspective, this problem may continue for years after transplantation (Bush, Donaldson, Haberman, Dacanay, & Sullivan, 2000; Watson et al., 2004). Although a common complaint, sleep disturbances during hospitalization may be under-recognized as a significant threat to the well-being of patients undergoing HCT. Sleep disturbances frequently worsen during hospitalization when the need for sleep to recover from illness is greatest (McKinley, Fien, Elliott, & Elliott, 2013). Multiple factors potentially contribute to sleep disturbances during hospitalization following HCT, including (a) the simultaneous occurrence of multiple side effects, such as fatigue and diarrhea, from the pretransplantation conditioning regimen (Cohen et al., 2012; Hacker & Ferrans, 2003); (b) required patient care provided during nighttime hours, such as vital sign assessment and/or medication administration (Boonstra et al., 2011; Hacker, Patel, & Stainthorpe, 2013); and (c) hospital environment factors, such as noise and lights (Bernhofer, Higgins, Daly, Burant, & Hornick, 2014). Inadequate sleep has serious consequences (Hublin, Partinen, Koskenvuo, & Kaprio, 2007; Verkasalo et al., 2005). In critically ill patients, sleep disturbances have been linked to slowed recovery from illness, immune dysfunction, changes in mental status, and diminished quality of life (QOL) (Friese, 2008; Kamdar, Needham, & Collop, 2012). Sleeping less than 300 minutes per night is associated with a four-times greater increase in mortality risk compared to those sleeping more than 300 minutes (Kripke, Langer, Elliott, Klauber, & Rex, 2011; Vgontzas et al., 2010). These risks may extend to patients undergoing HCT, but the literature is lacking regarding sleep duration in this patient population. Rischer et al. (2009) reported a mean total sleep time of 337 minutes in hospitalized patients undergoing HCT (n = 44), with 36% reporting 300 minutes or less per night. The data, however, were patient-reported. Discordance between patient-reported and objective measures of sleep have been found in other populations, with objective measures of total sleep time being significantly shorter than patient-reported measures (Van Den Berg et al., 2008). For this reason, a significant need exists to objectively assess sleep in hospitalized patients undergoing HCT. Multiple methods, such as polysomnography, sleep diaries, and wrist actigraphy, have been used to assess sleep in clinical settings. Wrist actigraphy is particularly attractive for objective assessment of sleep in hospitalized patients given the non-intrusive nature of the assessment and the ability to continuously collect data during many days. In addition, growing research supports the use of wrist actigraphy to measure sleep in clinical settings (Morgenthaler et al., 2007). To the authors’ knowledge, no studies have used objective sleep assessment methods, such as wrist actigraphy, in hospitalized patients undergoing HCT while in the acute recovery period. Information related to sleep patterns of patients undergoing HCT and factors contributing to sleep disturbances is needed to identify potential areas for intervention and mitigate the impact of inadequate sleep during hospitalization. The purpose of this study was to describe patient-reported and objective sleep during hospitalization immediately following HCT and conduct a preliminary examination of the relationships among sleep, QOL, demographic factors, and length of hospitalization.