Sleep Characteristics in Hospitalized Antepartum Patients

Abstract

Objective-To describe sleep characteristics in high-risk antepartum inpatients. Design-Prospective descriptive design. Setting-Tertiary hospital in southern California.Participants-A convenience sample of 39 antepartum women.Methods-Data were collected from participants' medical records, questionnaires (General Sleep Disturbance Scale [GSDS]), actigraphy on days 3-4 after admission, and a sleep diary that included reasons for awakening and morning and evening fatigue ratings.Results-Weeks gestation ranged from 24-35 weeks. Sleep time varied from 310-492 minutes and averaged 6.7 hours/night. The women were awakened 9-32 times/night and averaged 18 awakenings. They napped an average of 124 minutes throughout the day. Women averaged 3.9 on the GSDS when retrospectively considering 7 days prior to hospitalization and scored 4.1 when considering the current 3 days of hospitalization. In the diary, most rated their sleep quality as Fairly Good or Very Good (62-71%), but 29% said Very Bad on night 2, and 38% said Very Bad on night 3.Conclusion-Frequent interruptions during the night do not allow for mothers to receive the restorative sleep they need. KeywordsSleep; Antepartum; Hospitalized Callouts 1. Sleep disturbances are common during pregnancy as a result of physiologic, hormonal, emotional, and physical/anatomical changes. 2.With antepartum patients experiencing long-term hospitalization, it is crucial to assess quality and quantity of sleep of antepartum inpatients.Correspondence to: Ana-Maria Gallo.Correspondence: Ana-Maria Gallo, RNC, PhD, CNS, Nursing Administration, Sharp Grossmont Hospital, 5555 Grossmont Center Drive, La Mesa CA 91942 ana-maria.gallo@sharp.com. Sleep is necessary for the maintenance of good health and well-being, especially during pregnancy. Nevertheless, sleep disturbances are common during pregnancy as the result of physiologic, hormonal, and anatomical/physical changes. Characteristics of sleep in pregnancy differ according to gestation. Women are encouraged during pregnancy to rest often and achieve the maximum hours of sleep. Sleep loss in late pregnancy has been associated with longer labor and increased risk of cesarean delivery, and researchers recommend that obstetric patients be advised to be in bed for 8 hours in order to obtain a minimum of 7 hours sleep during the third trimester . However, much of what is known about sleep in pregnancy is the result of research on healthy pregnant women. High-risk women are being hospitalized at earlier gestations and for longer hospitalizations. Sleep disturbance in hospitals is also a common occurrence, but most studies have focused on patients in intensive care and medical surgical units. These studies have shown that sleep disturbance is universal in acute care settings, yet studies have not been conducted with a focus on antepartum hospitalized women. With the already existing sleep disturbance due to physiologic, hormonal, and emotional changes associated with pregnancy, what additional impact does inpatient hospitalization have ...

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“…In our current sample of hospitalized patients at similar gestation, mean sleep duration on the PSQI was also 7 hours; however, 80% had PSQI scores > 5. Gallo and Lee 12 used wrist actigraphy to monitor sleep in 39 hospitalized antepartum patients and reported a median sleep duration of 7 hours. The current sample of hospitalized antepartum patients reported a similar median and mean of 6.9 hours in their sleep diaries.…”

“…[6][7][8][9] When a pregnant woman is hospitalized for a high-risk issue that threatens the fetus or her own health, her sleep becomes more problematic because of worry, stress, and fear, 10,11 and more fragmented because of the unfamiliar hospital environment with a strange and uncomfortable bed, excess light, and noise exposure at night. 12 For the health of the mother and fetus, hospitalization is likely to continue for weeks until birth occurs. Yet, the hypnotic agents often prescribed for hospital patients may not be advisable for antepartum patients due to potential adverse effects on the fetus.…”