An Assessment of Quality of Sleep and the Use of Drugs with Sedating Properties in Hospitalized Adult Patients

Context

Insomnia is a common subjective complaint that occurs in up to 25% of the general population and frequently occurs in the acute hospital setting. While benzodiazepines are commonly used to treat insomnia, adverse effects with chronic benzodiazepine use are resulting in patients seeking alternatives such as natural or herbal medications.

Objectives

To assess sleep disturbance and to characterize factors influencing sleep including the use of drugs with sedating properties.

Setting

A major Canadian tertiary adult acute care teaching hospital.

Design

This single-centre prospective study involved patients admitted to the General Medicine and Family Practice wards during a 70-day period.

Main Outcome Measures

Consenting patients were requested to provide information regarding pre-admission drug use and sleep patterns. Sleep was assessed using  validated 100mm visual analogue Verran and Snyder-Halpern (VSH) sleep scales.  Questionnaires were completed by patients on a daily basis to characterize 3 sleep dimensions: sleep disturbance, effectiveness and supplementation.  Patients were also asked to identify factors influencing sleep while in hospital. The VSH sleep scale scores in each dimension were then compared to population statistics. The use of drugs with sedating properties prior to and during hospitalization was also assessed.

Results

During the 70-day study period, 100 patients completed 339 study questionnaires. A review of the provincial community prescription database (PharmaNet) revealed that 35% of patients were prescribed a hypnotic or antidepressant drug that was administered at bedtime in the 3-month period prior to admission. During hospitalization, 60% of enrolled patients were prescribed zopiclone or a benzodiazepine for bedtime hypnotic use. Overall, 44% of total patient observations revealed some type of sleep disturbance of which pain was the most common factor, followed by needing to go to the bathroom, shortness of breath (SOB), or a combination of these three factors. The mean total sleep disturbance score was 306 (maximum possible score 700; range 13 – 700). The mean total sleep effectiveness score was 301 (maximum possible score 500; range 61 – 500). The mean total sleep supplementation score was 76 (maximum possible 400; range 0 – 372). Twenty-nine percent of patients had a hypnotic prescription initiated in hospital, while there was no evidence of pre-admission hypnotic use.

Conclusions

Sleep quality in hospitalized adult patients at Vancouver General Hospital (VGH) was similar to that reported for institutionalized patients in the US and poorer than reported for non-institutionalized patients. The results of this study reveals that insomnia continues to be a problem that affects hospitalized adult medical service patients and a relatively high percentage of these patients are being prescribed a hypnotic prior to and during hospitalization.

 

Shakeel Bandali, BSc (Pharm), Kerry Wilbur, BSc (Pharm), PharmD, Luciana Frighetto, BSc (Pharm), FCSHP, Carlo A Marra, BSc (Pharm), PharmD, Terryn L Naumann, BSc (Pharm), PharmD, Peter J Jewesson, PhD, FCSHP

Pharmaceutical Sciences Clinical Service Unit, Vancouver General Hospital , Vancouver Hospital and Health Sciences Center, Vancouver, British Columbia, Canada

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 2001.

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