Most Patients Experience Nocturnal Care Disturbances Following Hematopoietic Stem Cell Transplantation


Key Points

  • Approximately 77% of patients undergoing hematopoietic stem cell transplantation report some problems with sleep during hospitalization.
  • Most patients (73%) had a sleep disturbance recorded in their chart by nurses, but physicians documented sleep disturbances for only 28% of patients.
  • Medication administration was responsible for 40% of nocturnal sleep interruptions.

In a study reported in the Clinical Journal of Oncology Nursing, Eileen Danaher Hacker, PhD, APN, AOCN, of the University of Illinois College of Nursing, and colleagues attempted to identify and quantify nocturnal care disruptions in patients undergoing hematopoietic stem cell transplantation. They found that many nocturnal clinical tasks and activities have the potential to disrupt sleep in hospitalized patients undergoing hematopoietic stem cell transplantation.

Study Details

In this retrospective study, 1,642 cases of nocturnal care interactions were reported over 160 nights. All patients received hematopoietic stem cell infusion after high-dose chemotherapy. Data on nocturnal care interactions and sleep disturbance recognition were collected starting on the fourth day after stem cell infusion, continuing until day 8.

The study had a number of goals. They included determining the types and frequency of health-care provider and patient interactions occurring between 9:00 PM?7:00 AM, and also determining the frequency of sleep-wake disturbance recognition by health-care providers. In addition, the study aimed to examine the relationship between nocturnal care disruptions and sociodemographic factors.

All medical record data were collected utilizing a standardized activity checklist, which included 21 common patient-care activities that have the potential to disturb patient sleep, such as medication administration, vital sign assessment, and dressing changes Comments were recorded by nurses, physicians, radiology technicians, and others. In addition, in order to gather more personalized and detailed information on nocturnal sleep disturbances, the investigators analyzed written notes from the medical and nursing staff.

Frequency of Sleep Disturbances

More than 50% of all nocturnal care interactions occurred within the timeframes of 12:00 AM?12:59 AM and 4:00 AM?4:59 AM. In addition, each patient experienced an average of 41 interactions over the 4 days, or about 10 per night. Five nocturnal care interactions accounted for 88% of the total number of interactions. The most common in descending order were medication administration (40%), measurement of vital signs (21%), obtaining blood samples (11%), IV and catheter maintenance (10%), and patient assessment (6%). At least one alteration in vital signs (defined as a temperature above 100°F, or a pulse, respiratory rate, or blood pressure reading outside of the patient’s normall documented rates) occurred in 45% of patients, which may have been due to these patients being immunocompromised. The number of interactions did not appear to be associated with age, gender, or allogeneic vs autologous transplantation.

As previously noted, the interaction most responsible for nocturnal sleep disturbance was medication administration, with many patients receiving medication hourly for 3 to 4 consecutive hours. This area was identified by the researchers as the one most requiring streamlining, a process that will require interdisciplinary collaboration by nurses and pharmacists

Investigators found that registered nurses reported more sleep disturbances (73%) compared with physicians (28%). This disparity may have been due to the frequency of nurses’ visits to patients’ rooms at night and the likelihood that patients may be more willing to share their concerns with nurses rather than physicians. Physician comments centered on admission history, physical, and inpatient progress notes from the 5 days following hematopoietic stem cell transplantation.

Regarding the management of interrupted sleep, nearly two-thirds of patients had an as-needed prescription for a sleep aid. Moreover, for patients with documented sleep disturbance problems, 88% had a prescription for a sleep aid medication.

The authors stated, “[This study] is the first to provide actual documentation of the timing and frequency of nocturnal care disturbances that place patients at risk for sleep-wake disturbances while recovering from high-dose chemotherapy and hematopoietic stem cell transplantation.” They suggested that nurses better cluster patient activities on the night shift, thereby intentionally improving the sleep cycle for patients on hematopoietic stem cell transplantation.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.