Patient-reported sleep and physical function during and after hospitalization

Purpose

Poor sleep is associated with morbidity and mortality in the community; however, the health impact of poor sleep during and after hospitalization is poorly characterized. Our purpose was to describe trends in patient-reported sleep and physical function during and after hospitalization and evaluate sleep as a predictor of function after discharge.

Methods

This is a secondary analysis of trial data with 232 adults followed for 3 months after hospital discharge. Main measures were patient-reported surveys on sleep (Pittsburgh Sleep Quality Index) and physical function (Katz Activities of Daily Living, Lawton Instrumental Activities of Daily Living, and Nagi Mobility Scale) were collected during hospitalization and at 1, 5, 9, and 13 weeks postdischarge.

Results

Patient-reported sleep declined significantly during hospitalization and remained worse for 3 months postdischarge (median Pittsburgh Sleep Quality Index = 8 vs. 6, p < .001). In parallel, mobility declined significantly from baseline and remained worse at each follow-up time (median Nagi score = 2 vs. 0, p < .001). Instrumental activities of daily living similarly decreased during and after hospitalization, but basic activities of daily living were unaffected. In adjusted time-series logistic regression models, the odds of mobility impairment were 1.48 times higher for each 1-point increase in Pittsburgh Sleep Quality Index score over time (95% CI 1.27-1.71, p < .001).

Conclusions

Patient-reported sleep worsened during hospitalization, did not improve significantly for 3 months after hospitalization, and poor sleep was a significant predictor of functional impairment over this time. Sleep dysfunction that begins with hospitalization may persist and prevent functional recovery after discharge.

Trial registration

The primary study was registered at ClinicalTrials.gov NCT03321279.