In pediatric wards with high nocturnal noise, children slept about one hour less and had poorer sleep quality compared to a sleep at home, according to a study by Southampton Children's Hospital. This could affect the child's behavior, recovery and pain tolerance, the researchers suggest.

The author, Dr. Catherine Hill, explained the results and their significance for Medscape News UK, "We have shown in the biggest group so far that the overall attitude of children's hospitals has a negative impact on the quality and quantity of sleep, and that it is louder in the hospital than at home." We know hearing in sleep makes the most sense, and that is especially relevant in the hospital with the high notes of bleeps and the like. "

She added that sleep is an aspect of care that can be freely provided and that "one hour is important in terms of research effects on cognition, behavioral regulation, pain control and recovery." Theoretically, recovery could also be affected ; and [in addition] They are accompanied by tired, emotionally dysregulated parents. "

The study

Published in the July 17 issue of Archive of the disease in childhoodThe study found that children in the hospital slept on average just under 7.5 hours, which was 62.9 minutes less than at home (p <0.001); while the mothers slept on average 6 hours and 20 minutes in the hospital, which was 72.8 minutes less on average than at home (p = 0.004). Sleep quality was also less in the hospital, with children's sleep efficiency (percentage of minutes rated as sleep from falling asleep to morning waking), which shows an average of 77% in the hospital versus 83.2% at home.

The average median sound level recorded in the hospital was 48.24 dB (decibels), with a difference of about 8 dB between open fields and single occupancy cells. It is noteworthy that children were exposed to significantly higher noise levels than the World Health Organization (WHO) recommendations that the nocturnal noise level in the hospital should not exceed 30 dB, with maximum values ​​not exceeding 45 dB.

Previous studies have investigated noise levels in pediatric oncology and intensive care units, but not in general medical wards, which prompted the research carried out here.

In this study, Hill and colleagues attempted to objectively measure the quality of sleep in both children and their sleeping parents, who were admitted to medical wards at Southampton Children's Hospital, and to compare this with their sleep at home. A secondary goal was to measure bedside noise levels in both environments. Sound levels were expressed as weighted decibels (dBA), which are sound levels perceived by the human ear.

Children between the ages of 3 and 16 and their parents who stayed overnight were objectively measured with the "actigraphy" wristwatch, which is effectively a "fitbit" for sleep, Hill said for up to 5 consecutive nights in the hospital and 5 Nights home. The sound levels were monitored overnight with a sonic level meter at the bedside for up to 2 nights in the hospital and 2 nights at home. Sleep quantity and quality were assessed for 40 children and 16 same-age mothers, and eight children had sound level monitoring. The amount of sleep at the two sites was compared for each child and parent.

Medical education in terms of sleep importance

Hill explained that they did not measure the correlation between sleep quality and noise levels, but that it was reasonable to conclude that the noise affected sleep – "the sleeping brain is highly tuned to sound, an important evolutionary defense against potential threat."

She noted that research drew attention to the importance of sleep in general to paediatricians and doctors. "Sleep is a" black hole "in medical education, and the understanding of physicians for the function and importance of sleep is very limited, but we must remember that sleep has almost all physiological functions, especially cognitive function and endocrine function Health, coverage and growth, but somehow this has not led to medical knowledge.

"By default, wards are designed to break sleep by running routines, shift times, visits, and meals," the sleep specialist explained, explaining why sleep was often disrupted in the hospital. "But how do we take care of the baby in a 24-hour cycle, the toddler sleeping at 6 pm, the teen on the iPad until 10 pm – how do we work all this? One department is usually on adult sleep The children's wards are very bright with pictures of clowns, therapy dogs, anything that appeals to children, but we have lost sight of the fact that even children need to sleep. "

Hill's earlier qualitative research found that sources of noise that interfere with hospital sleep include the timing of medication delivery, for example at midnight, while children would normally receive medications at bedtime at home; Noise from mobile phones, chatting staff, as well as beeps and crash calls. "Some sounds are a necessary part of the hospital function, but there is a great deal of avoidable noise, so it's about training staff."

Sleep for health in the hospital (Shh)

Given the results, Hill has launched a multi-modal quality improvement project called Shh (Sleep for Health in Hospital). After one year in Southampton, it is being introduced in other hospitals in England. "It's based on staff training, with sound level monitors on the stations that provide feedback, giving parents the information on expectations, and applying reasonable and considerate rules of behavior, using the" eight is late "slogan and asking people to turn off TVs or TVs Wear headphones and change the behavior for greater peace, "says Hill.

COI: Hill has not declared any conflicts of interest

Sleep quality and noise: comparisons between hospital and home settings. Published in the July 17 issue Archive of the disease in childhood

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