Postoperative pain is a prevalent clinical issue that significantly impacts patient recovery, making its management crucial for rehabilitation. Recent studies have shown that postoperative pain not only affects the physiological state of patients but may also disrupt their circadian rhythms, leading to decreased sleep quality and physiological dysfunctions. This review aims to explore the effects of postoperative pain interventions on circadian rhythm disturbances, analyze the underlying mechanisms, and summarize the effective strategies currently used in clinical practice. Through a comprehensive analysis of the relevant literature, we will highlight the importance of pain management during the recovery process and emphasize its potential role in regulating circadian rhythms. Pharmacological treatments like NSAIDs and melatonin have shown efficacy in regulating circadian rhythms and improving sleep quality in postoperative patients. Multimodal analgesia combining pharmacological and non-pharmacological methods (e.g., CBT, acupuncture) can optimize pain relief while minimizing side effects. However, further research is needed to clarify the bidirectional relationship between pain perception and circadian rhythms and translate these findings into clinical practice.

To provide a comprehensive review of sleep disturbances in hospitalized patients, focusing on a case-based approach to illustrate the multifaceted nature of this clinical challenge.

An extensive review of related literature was conducted to determine the common causes of sleep disturbances in hospitalized patients, such as environmental, medical, psychological, and physiological factors. The case of Mrs. Z was used to illustrate how these factors interact in a clinical setting.

The study revealed a high prevalence of sleep disturbances in hospitalized patients, which can lead to significant adverse outcomes. A multidisciplinary approach involving physicians, nurses, pharmacists, and other healthcare professionals is essential to effectively manage sleep disorders due to the interplay of various factors. Nonpharmacological interventions are fundamental to a comprehensive sleep management plan. Pharmacotherapy may sometimes be necessary to improve sleep quality and duration.

Health professionals can significantly enhance the sleep quality of hospitalized piatients by understanding the value of sleep and providing evidence-based strategies for improvement. In return, this improves patient outcomes, reduces healthcare costs, and advances general patient satisfaction.

Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.

Sleep is a fundamental aspect of human health and well-being, but is often interrupted in a hospital setting. Especially after surgery, poor sleep quality can negatively affect postoperative recovery and quality of life. Therefore, the aim of this study was to gain insights into the quality of sleep in patients after autologous breast reconstruction and evaluate factors associated with the quality of sleep.

In this single-center observational cohort study, participants completed a sleep diary, including the Pittsburgh sleep quality index (PSQI) and EQ-5D-5L quality of life questionnaire, before surgery, during hospital admission, and two weeks and three months postoperative. Additional variables such as pain and anesthesia duration were collected.

Twenty-nine patients were included. Before the surgery, 58% of them experienced poor quality of sleep, with a median PSQI score of 5.0. During hospital admission, 83% of the patients had poor quality of sleep, with a PSQI score of 6.0. The PSQI score two weeks postoperative increased to 7.0 and decreased three months postoperative to 5.0. Patients with pain scores >4 ("pain" group), had higher median PSQI scores than patients with pain scores ≤4 ("no pain" group) at all postoperative time points previously mentioned. No correlation was observed between anesthesia duration or quality of life.

Poor sleep quality was experienced by most women after autologous breast reconstruction, especially in those with higher postoperative pain scores. This knowledge offers an opportunity to improve the postoperative care for such patients.

Postoperative cognitive dysfunction (POCD) is a neurological disorder characterized by the emergence of cognitive impairment after surgery. A growing body of literature suggests that the onset of POCD is closely tied to circadian rhythm disruption (CRD). Circadian rhythms are patterns of behavioral and physiological change that repeat themselves at approximately, but not exactly, every 24 h. They are entrained to the 24 h day by the daily light-dark cycle. Postoperative CRD affects cognitive function likely by disrupting sleep architecture, which in turn provokes a host of pathological processes including neuroinflammation, blood-brain barrier disturbances, and glymphatic pathway dysfunction. Therefore, to address the pathogenesis of POCD it is first necessary to correct the dysregulated circadian rhythms that often occur in surgical patients. This narrative review summarizes the evidence for CRD as a key contributor to POCD and concludes with a brief discussion of how circadian-effective hospital lighting can be employed to re-entrain stable and robust circadian rhythms in surgical patients.

Noise and light levels during hospitalizations can disrupt sleep and circadian health, resulting in worsened health outcomes. This study describes patterns of noise and light for inpatient children undergoing stem cell transplants. Objective meters tracked noise and light levels every minute for 6 months. Median overnight sound was 55 dB (equivalent to conversational speech). There were 3.4 loud noises (>80 dB) per night on average. Children spent 62% of the 24-h cycle in nonoptimal lighting, with daytime light dimmer than recommended 98% of the time. Over the 6-month period, the lowest overnight noise level recorded exceeded World Health Organization recommendations for sleep, with frequent spikes into ranges known to cause wakings. During the day, children were rarely exposed to light sufficient to preserve healthy circadian rhythms. Hospitals should address systematic environmental and workflow disruptors to improve the sleep and circadian health of patients, particularly those already at elevated risk for health morbidities.

The ongoing global health crisis due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of life. While the majority of early research following the coronavirus disease caused by SARS-CoV-2 (COVID-19) has focused on the physiological effects of the virus, a substantial body of subsequent studies has shown that the psychological burden of the infection is also considerable. Patients, even without mental illness history, were at increased susceptibility to developing mental health and sleep disturbances during or after the COVID-19 infection. Viral neurotropism and inflammatory storm damaging the blood-brain barrier have been proposed as possible mechanisms for mental health manifestations, along with stressful psychological factors and indirect consequences such as thrombosis and hypoxia. The virus has been found to infect peripheral olfactory neurons and exploit axonal migration pathways, exhibiting metabolic changes in astrocytes that are detrimental to fueling neurons and building neurotransmitters. Patients with COVID-19 present dysregulated and overactive immune responses, resulting in impaired neuronal function and viability, adversely affecting sleep and emotion regulation. Additionally, several risk factors have been associated with the neuropsychiatric sequelae of the infection, such as female sex, age, preexisting neuropathologies, severity of initial disease and sociological status. This review aimed to provide an overview of mental health symptoms and sleep disturbances developed during COVID-19 and to analyze the underlying mechanisms and risk factors of psychological distress and sleep dysfunction.

Determining the prevalence and risk factors related to sleep disturbance in surgical patients would be beneficial for risk stratification and perioperative care planning. The objectives of this systematic review and meta-analysis are to determine the prevalence and risk factors of sleep disturbances and their associated postoperative complications in surgical patients. The inclusion criteria were: (1) patients ≥18 years old undergoing a surgical procedure, (2) in-patient population, and (3) report of sleep disturbances using a validated sleep assessment tool. The systematic search resulted in 21,951 articles. Twelve patient cohorts involving 1497 patients were included. The pooled prevalence of sleep disturbances at preoperative assessment was 60% (95% Confidence Interval (CI): 50%, 69%) and the risk factors for postoperative sleep disturbances were a high preoperative Pittsburgh sleep quality index (PSQI) score indicating preexisting disturbed sleep and anxiety. Notably, patients with postoperative delirium had a higher prevalence of pre- and postoperative sleep disturbances and high preoperative wake after sleep onset percentage (WASO%). The high prevalence of preoperative sleep disturbances in surgical patients has a negative impact on postoperative outcomes and well-being. Further work in this area is warranted.

Sleep breathing, one of the basic human needs, is a physiological need that affects cardiac functions, body temperature, daily vitality, muscle tone, hormone secretion, blood pressure, and many more. In the international literature, studies reported that patients have had sleep problems in the hospital since the 1990s, but no measurement tool has been developed to determine the causes of hospital-acquired insomnia in individuals. These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing. Although patients generally experience hospital-acquired sleep problems, there is no measurement tool to determine hospital-acquired sleep problems. These features show the originality of the research.

To develop a measurement tool to determine the sleep problems experienced by patients in the hospital.

A personal information form, hospital-acquired insomnia scale (HAIS), and insomnia severity index (ISI) were used to collect research data. The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022. The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage. Exploratory factor analysis and confirmatory factor analysis (CFA) analyses were performed using the SPSS 20 package program and the analysis of moment structure (AMOS) package program. Equivalent forms method used.

The HAIS consisted of 18 items and 5 subscales. The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783. The scale explained 58.269% of the total variance. The items that constitute the factors were examined in terms of content integrity and named as physical environmental, psychological, safety, socioeconomic, and nutritional factors. CFA analysis of the 5-factor structure was performed in the AMOS package program. The fit indices of the obtained structure were examined. It was determined that the values obtained from the fit indices were sufficient. A significant correlation was determined between the HAIS and the ISI, which was used for the equivalent form method.

The HAIS is a valid and reliable measurement tool for determining patients' level of hospital-acquired insomnia. It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

To (1) evaluate the use case for tunable lighting in inpatient behavioral health, (2) describe differences in staff lighting exposures between static and tunable lighting conditions using wearable sensors, and (3) document occupant lighting control usage patterns.

Tunable lighting fixtures can vary the amount of light and spectral content, so have been offered as a way to address light and health considerations. Before we can understand potential health benefits of tunable lighting, it is helpful to understand how occupant exposures under tunable lighting differ from those under more traditional lighting systems.

Tunable lighting benefits and challenges for inpatient behavioral health were carefully detailed during design. Light exposure measurements were recorded at an old site with static fluorescent lighting and a new site with tunable light-emitting diode (LED) lighting. Behavioral health inpatient unit staff participants voluntarily wore a light measurement device to estimate light exposure. At the new site, controls usage data were recorded each time a button was pressed on a lighting control station.

While general observations can be made about the data between sites, there is notable variation at both sites depending on the day and hour. Button press data revealed that occupants used the full capability of the tunable lighting system to support different activities and needs.

Understanding the relationship between occupant well-being and light requires a holistic research approach including thoughtful design accounting for real-world constraints, detailed measurement of light exposure, and understanding how occupants interact and make use of new technology.

Despite sleep's fundamental role in maintaining and improving physical and mental health, many people get less than the recommended amount of sleep or suffer from sleeping disorders. This review highlights sleep's instrumental biological functions, various sleep problems, and sleep hygiene and lifestyle interventions that can help improve sleep quality. Quality sleep allows for improved cardiovascular health, mental health, cognition, memory consolidation, immunity, reproductive health, and hormone regulation. Sleep disorders, such as insomnia, sleep apnea, and circadian-rhythm-disorders, or disrupted sleep from lifestyle choices, environmental conditions, or other medical issues can lead to significant morbidity and can contribute to or exacerbate medical and psychiatric conditions. The best treatment for long-term sleep improvement is proper sleep hygiene through behavior and sleep habit modification. Recommendations to improve sleep include achieving 7 to 9 h of sleep, maintaining a consistent sleep/wake schedule, a regular bedtime routine, engaging in regular exercise, and adopting a contemplative practice. In addition, avoiding many substances late in the day can help improve sleep. Caffeine, alcohol, heavy meals, and light exposure later in the day are associated with fragmented poor-quality sleep. These sleep hygiene practices can promote better quality and duration of sleep, with corresponding health benefits.

Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.

Human sleep is a dynamic and complex process comprising sleep stages with REM and NREM sleep characteristics that come in cycles. During sleep, there is a loss of responsiveness or a perceptual loss of conscious awareness with increasing thresholds for wakefulness as sleep progresses. There are brief bursts of wakefulness or Wake After Sleep Onset (WASO) throughout a nocturnal sleep. Conscious experience during nocturnal sleep is known to occur during lucid dreaming when one is aware during dreams when the dream is occurring. Most cultures have known lucid dreaming since antiquity. However, conscious experience during dreamless sleep is relatively lesser known. Nevertheless, selected Indo-Tibetan meditation literature has documented it since antiquity. Minimal Phenomenal Experience (MPE) research describes lucid dreamless sleep as its target phenomenology. "Conscious entry into sleep" posits tonic alertness is maintained post sleep onset through the sleep stages for sustained durations of time until an eventual loss of conscious awareness. Entering sleep consciously and being aware during dreamless sleep, including Slow Wave Activity, is plausibly to be in the state of "Yoga Nidra" or Yogic sleep. An attentive sleepful state provides access to subtler states of consciousness and significantly deepens the levels of silence. It is phenomenologically distinct from hypnagogic hallucinations and lucid dreaming. Unfortunately, sleep studies validating this phenomenology are yet to be done. Therefore, an experimental methodology akin to those used in lucid dreaming experiments is described.

In this narrative review, we describe what is known about non-pharmacological and pharmacological treatments for insomnia in medical inpatients, with a focus on melatonin. Hospital-acquired insomnia is common, resulting in shortened total sleep time and more nighttime awakenings. Sleep disturbance has been shown to increase systemic inflammation, pain, and the likelihood of developing delirium in hospital. Treatment for insomnia includes both non-pharmacological and pharmacological interventions, the latter of which requires careful consideration of risks and benefits given the known adverse effects. Though benzodiazepines and non-benzodiazepine benzodiazepine receptor agonists are commonly prescribed (i.e., sedative-hypnotics), they are relatively contraindicated for patients over the age of 65 due to the risk of increased falls, cognitive decline, and potential for withdrawal symptoms after long-term use. Exogenous melatonin has a comparatively low likelihood of adverse effects and drug-drug interactions and is at least as effective as other sedative-hypnotics. Though more research is needed on both its effectiveness and relative safety for inpatients, small doses of melatonin before bedtime may be an appropriate choice for inpatients when insomnia persists despite non-pharmacological interventions.

Chronotype and sleep quality have been shown to play significant roles in influencing people's physical and mental health. The current study focuses on examining the relationship between chronotype and sleep quality among Chinese college students and exploring the mediating role of bedtime procrastination and the moderating role of sleep hygiene awareness. A sample of 2822 college students (female = 71.4%) aged between 17 and 29 years (M = 19.77, SD = 1.41) were included and completed the measures of the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), Bedtime Procrastination Scale (BPS) and Sleep Hygiene Awareness Scale (SHAS). The results showed that evening-type students reported the lowest sleep quality and highest levels of bedtime procrastination. In contrast, the highest sleep quality and lowest levels of bedtime procrastination were shown by morning-type, exhibiting the neither-type students' intermediate chronotype. Bedtime procrastination partially mediated the relationship between chronotype and sleep quality. Furthermore, sleep hygiene awareness moderated the direct effect of chronotype on sleep quality and the effect of chronotype in the path from chronotype to bedtime procrastination. Specifically, higher levels of sleep hygiene awareness could buffer the adverse effect of chronotype on self-reported sleep quality but bolstered the negative effect of chronotype on bedtime procrastination. Our results suggest that individuals with an evening preference are inclined to postpone their bedtime and further experience poorer sleep quality at night. Sleep hygiene awareness may serve as a protective factor for poor nocturnal sleep. Overall, the findings highlight the importance of reducing bedtime procrastination and improving sleep hygiene awareness in the interventions designed to help college students to own a better sleep quality, especially for those with evening chronotypes.

The objective of this study was to understand the existing practices and attitudes regarding inpatient sleep at the 2020 US News and World Report (USNWR) Honor Roll pediatric (n = 10) and adult (n = 20) hospitals. Section chiefs of Hospital Medicine from these institutions were surveyed and interviewed between June and August 2021. Among 23 of 30 surveyed physician leaders (response rate = 77%), 96% (n = 22) rated patient sleep as important, but only 43% (n = 10) were satisfied with their institutions' efforts. A total of 96% (n = 22) of institutions lack sleep equity practices. Fewer than half (48%) of top hospitals have sleep-friendly practices, with the most common practices including reducing overnight vital sign monitoring (43%), decreasing ambient light in the wards (43%), adjusting lab and medication schedules (35%), and implementing quiet hours (30%). Major themes from qualitative interviews included: importance of universal sleep-friendly cultures, environmental changes, and external incentives to improve patient sleep.

Sleep deficiency is a common problem in the hospital setting. Contributing factors include preexisting medical conditions, illness severity, the hospital environment, and treatment-related effects. Hospitalized patients are particularly vulnerable to the negative health effects of sleep deficiency that impact multiple organ systems. Objective sleep measurement is difficult to achieve in the hospital setting, posing a barrier to linking improvements in hospital outcomes with sleep promotion protocols. Key next steps in hospital sleep promotion include improvement in sleep measurement techniques and harmonization of study protocols and outcomes to strengthen existing evidence and facilitate data interpretation across studies.

The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children.

A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1 and 18 years old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims.

Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g. noise, staff interruptions), most interventions targeted the child level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components.

Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as the main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.

Benzodiazepines and sedative-hypnotic drugs (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, and fractures. Interventions to reduce use of BZD/SHD in hospitals are not well characterized.

The objective was to conduct a scoping review to identify and characterize interventions to reduce the use of BZD/SHD by adults in the acute care setting.

English language studies and abstracts that described an intervention to reduce BZD/SHD in adult hospital patients were included. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) were searched up to July 2018 and updated to February 3, 2021. The grey literature (Opengrey, Grey Matters, Google Advanced) was searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed and charted by three independent reviewers. Stakeholders were consulted to inform the scoping review and collect perspectives on the findings.

There were 13,046 records identified and 43 studies included. The most common study designs were uncontrolled before and after (23/43, 53.5%) and randomized controlled trials (7/43, 16.3%). The majority of studies tested a single intervention (32/43, 74.4%) such as education, deprescribing, relaxation training and sleep protocols. Patients were frequently the target of relaxation training and behavior change interventions; while sleep protocols, multifaceted interventions, education and deprescribing were usually directed at healthcare providers, either alone or in combination with patients. Most studies reported positive results in decreasing BZD/SHD use (27/43, 62.8%).

The scoping review found a variety of interventions to decrease the utilization of BZD/SHD in hospitals. Multifaceted interventions aimed at patients and healthcare providers that include a combination of education, sleep protocols, and deprescribing may support reductions in BZD/SHD use. Stakeholders also recommended policy and system changes such as computer alerts due to feasibility and workload.

Twenty-four-hour rhythms in immune parameters and functions are robustly observed phenomena in biomedicine. Here, we summarize the important role of sleep and associated parameters on the neuroendocrine regulation of rhythmic immune cell traffic to different compartments, with a focus on human leukocyte subsets. Blood counts of "stress leukocytes" such as neutrophils, natural killer cells, and highly differentiated cytotoxic T cells present a rhythm with a daytime peak. It is mediated by morning increases in epinephrine, leading to a mobilization of these cells out of the marginal pool into the circulation following a fast, beta2-adrenoceptor-dependent inhibition of adhesive integrin signaling. In contrast, other subsets such as eosinophils and less differentiated T cells are redirected out of the circulation during daytime. This is mediated by stimulation of the glucocorticoid receptor following morning increases in cortisol, which promotes CXCR4-driven leukocyte traffic, presumably to the bone marrow. Hence, these cells show highest numbers in blood at night when cortisol levels are lowest. Sleep adds to these rhythms by actively suppressing epinephrine and cortisol levels. In addition, sleep increases levels of immunosupportive mediators, such as aldosterone and growth hormone, which are assumed to promote T-cell homing to lymph nodes, thus facilitating the initiation of adaptive immune responses during sleep. Taken together, sleep-wake behavior with its unique neuroendocrine changes regulates human leukocyte traffic with overall immunosupportive effects during nocturnal sleep. In contrast, integrin de-activation and redistribution of certain leukocytes to the bone marrow during daytime activity presumably serves immune regulation and homeostasis.

Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults.

Participants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency >30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits.

Overall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24-2.07, p < 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01-1.65, p < 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88-3.29, p < 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23-1.87, p < 0.001; IRR = 1.21, 95% CI = 1.02-1.44, p < 0.05, respectively) after adjusting for demographic and health characteristics.

Among older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.

Patient mobility or immobility impacts sleep. Sleep is vital in the intensive care unit (ICU) for the healing process. Currently, the number of patients mobilized in the ICU is low. Nurses should prioritize interventions for their patients that promote movement. Mobility of ICU patients is proven to be safe and is recommended by current evidence-based clinical guidelines. Despite the established benefits of early mobility, there are potential barriers to its implementation in practice. Nurses need to collaborate with the interdisciplinary team to safely perform early and ongoing patient mobilization despite barriers.

Coronavirus disease 2019 (COVID-19) pandemic may exert adverse impacts on sleep among populations, which may raise awareness of the burden of sleep disturbance, and the demand of intervention strategies for different populations. We aimed to summarize the current evidence for the impacts of COVID-19 on sleep in patients with COVID-19, healthcare workers (HWs), and the general population. We searched PubMed and Embase for studies on the prevalence of sleep disturbance. Totally, 86 studies were included in the review, including 16 studies for COVID-19 patients, 34 studies for HWs, and 36 studies for the general population. The prevalence of sleep disturbance was 33.3%-84.7%, and 29.5-40% in hospitalized COVID-19 patients and discharged COVID-19 survivors, respectively. Physiologic and psychological traumatic effects of the infection may interact with environmental factors to increase the risk of sleep disturbance in COVID-19 patients. The prevalence of sleep disturbance was 18.4-84.7% in HWs, and the contributors mainly included high workloads and shift work, occupation-related factors, and psychological factors. The prevalence of sleep disturbance was 17.65-81% in the general population. Physiologic and social-psychological factors contributed to sleep disturbance of the general population during COVID-19 pandemic. In summary, the sleep disturbance was highly prevalent during COVID-19 pandemic. Specific health strategies should be implemented to tackle sleep disturbance.

Evidence suggests that a lack of sleep among patients during hospitalization can impact their health and well-being.

On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night.

A pilot intervention to support the initiative, "Don't wake the patient for routine care unless the patient's condition or care specifically requires it," was implemented on 3 units in 3 hospitals. All the 3 units had experienced patient concerns about lack of sleep at night.

Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care.

Positive experiences of those patients who participated in the sleep intervention.

There was multidisciplinary support to promote a better patient experience of nighttime sleep. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.

Older people who are admitted to inpatient rehabilitation settings often experience sleep disturbance or disorders. Both intrinsic and environmental factors may contribute to reduced sleep quality. Poor sleep quality has been reported to be associated with poorer rehabilitation outcomes. The aim of this review was (1) to describe the prevalence of sleep disturbance or disorder among older people participating in inpatient rehabilitation, and (2) to describe interventions that have been trialed to increase sleep quality and/or quantity in older people in rehabilitation settings and report on their efficacy.

Systematic review involving search of 3 electronic databases and gray literature. Two authors independently reviewed citations and reviewed full text and agreed on included studies. Data were extracted and synthesized and risk of bias was assessed.

Studies were included if they provided quantitative data about the prevalence of sleep disturbance or disorder in older people in a rehabilitation setting or if they reported the results of a randomized trial evaluating an intervention to improve sleep quality in older people in a rehabilitation setting.

Studies were included if they reported data from monitoring (such as polysomnography or actigraphy), clinical assessments, or questionnaires.

16 studies reporting prevalence data and 3 studies reporting evaluations of interventions were included in this review. Studies reported data from stroke and mixed population rehabilitation settings. The prevalence of obstructive sleep apnea was high and ranged from 12% to 92% in stroke rehabilitation settings. Other types of sleep disturbance, such as difficulty initiating sleep, were also common.

Many older people participating in inpatient rehabilitation have sleep disturbance or sleep disorders. Poor sleep quality is associated with poorer health status and recovery; therefore, it is important that rehabilitation settings take steps to enhance sleep quality for inpatients drawing on the principles of good sleep hygiene.

American Indian/Alaska Native (AI/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban AI/AN youth may face certain challenges, including specific psychosocial stressors (e.g., discrimination) and environmental factors (e.g., noise, light) that render them particularly vulnerable to poor sleep health. However, few studies have explored AI/AN adolescent sleep. To our knowledge, this is the first study to use systematic qualitative methods with AI/AN youth to explore their sleep environment and sleep behaviors.

In-depth interviews with 26 youth.

Two urban areas in Central and Southern California.

Urban-dwelling AI/AN youth, age 12-16 years.

N/A.

N/A.

We identified five main themes, each with subthemes: sleep patterns and desired sleep, sleep barriers inside the home, environmental factors, sleep facilitators, and cultural dimensions. Key concerns discussed were poor sleep hygiene, excessive use of electronics prior to bedtime, issues with temperature regulation, and noise both within and outside the home. Parents can be an important vehicle for messaging around sleep health and for behavior management. Participating adolescents also indicated differing levels of attachment to Native identity, suggesting that culturally-targeted sleep interventions should build in openness and flexibility to a range of identity starting points. Further, we identified cultural practices, such as sweat lodges and dreamcatchers, that could be incorporated in future sleep interventions for this population.

Findings increase our understanding of urban AI/AN youth's sleep environments and behaviors, thus potentially informing program development around sleep health for this vulnerable population.

Sleep-wake disturbances are underevaluated among children with acquired brain injury surviving critical care. We aimed to quantify severity, phenotypes, and risk factors for sleep-wake disturbances.

We performed a prospective cohort study of 78 children aged ≥3 years with acquired brain injury within three months of critical care hospitalization. Diagnoses included traumatic brain injury (n = 40), stroke (n = 11), infectious or inflammatory disease (n = 10), hypoxic-ischemic injury (n = 9), and other (n = 8). Sleep Disturbances Scale for Children standardized T scores measured sleep-wake disturbances. Overall sleep-wake disturbances were dichotomized as any total or subscale T score ≥60. Any T score ≥70 defined severe sleep-wake disturbances. Subscale T scores ≥60 identified sleep-wake disturbance phenotypes.

Sleep-wake disturbances were identified in 44 (56%) children and were classified as severe in 36 (46%). Sleep-wake disturbances affected ≥33% of patients within each diagnosis and were not associated with severity of illness measures. The most common phenotype was disturbance in initiation and maintenance of sleep (47%), although 68% had multiple concurrent sleep-wake disturbance phenotypes. One third of all patients had preadmission chronic conditions, and this increased risk for sleep-wake disturbances overall (43% vs 21%, P = 0.04) and in the traumatic brain injury subgroup (52% vs 5%, P = 0.001).

Over half of children surviving critical care with acquired brain injury have sleep-wake disturbances. Most of these children have severe sleep-wake disturbances independent of severity of illness measures. Many sleep-wake disturbances phenotypes were identified, but most children had disturbance in initiation and maintenance of sleep. Our study underscores the importance of evaluating sleep-wake disturbances after acquired brain injury.

The Modified Early Warning System (MEWS) is a well-validated tool used by hospitals to identify patients at high risk for an adverse event to occur. However, there has been little evaluation into whether a low MEWS score can be predictive of patients with a low likelihood of an adverse event.

The present study aims to evaluate the MEWS score as a method of identifying patients at low risk for adverse events.

Retrospective cohort study of 5676 patient days and analysis of associated MEWS scores, medical comorbidities and adverse events. The primary outcome was the association of average daily MEWS scores in those who had an adverse event compared with those who did not.

Those with an average MEWS score of >2 were over 9 times more likely to have an adverse event compared with those with an average MEWS score of 1-2, and over 15 times more likely to have an adverse event compared to those with an average MEWS score of <1.

Our study shows that those with average daily MEWS scores <2 are at a significantly lower likelihood of having an adverse event compared with a score of >2, deeming them 'low-risk patients'. Formal recognition of such patients can have major implications in a hospital setting, including more efficient resource allocation in hospitals and better patient satisfaction and safety by adjusting patient monitoring according to their individual risk profile.