BOSTON, MA—In the hospital it is not only direct patient care, but also the environment that contributes to recovery. A critical component of a healing environment is a peaceful space for a patient to get enough sleep.
However, according to a new study by researchers at Brigham and Women's Hospital (BWH), Massachusetts General Hospital and Cambridge Health Alliance, there are certain noises in a common hospital setting that can disrupt sleep. Such disruption can negatively affect brain activity and cardiovascular function.
The study will be published online in Annals of Internal Medicine on June 12, 2012.
"Hospitals and actually most urban sleep environments are increasingly noise-polluted," said Orfeu Buxton, PhD, BWH Division of Sleep Medicine, co-lead study author. "This study highlights the importance of sleep for restoration and healing that is particularly important for hospitalized patients."
The researchers recruited 12 healthy volunteers to participate in the three-day study which took place in a sleep laboratory. On the first night, the participants slept without any disruption. On the following two nights, they were presented with 14 recorded sounds commonly heard in a hospital setting.
Among the 14 sounds were an intravenous alarm, telephone, ice machine, voices in the hall, outside traffic and a helicopter. The sounds were presented at increasing decibel levels during specific sleep stages.
As expected, the louder the sound the more likely to disrupt sleep. However, there were unexpectedly large differences in sleep disruption based on sound type—independent of how loud the sound. The researchers found that of all sound types, electronic sounds were most arousing, even at a volume just above a whisper.
Also, a person's sleep stage affected whether sound would lead to arousal. During non-rapid eye movement (NREM) sleep, sound type influenced arousal; whereas, during rapid eye movement (REM) sleep, volume was more influential.
Sleep disruption due to hospital noises also affected cardiovascular function.
"Beyond disturbing sleep itself, we showed that noise-induced sleep disruptions—even subtle ones, beneath conscious awareness—lead to temporary elevations in heart rate," said Jeffrey Ellenbogen, MD, director of Sleep Medicine at MGH, co-lead study author. "While these effects were modest in size, our concern is that repeated disruptions, as might occur in a hospital room, may jeopardize the health of our most vulnerable populations."
The study systematically quantifies the disruptive capacity of hospital sounds on sleep, providing evidence that it is important to improve the acoustic environments of new and existing health care facilities to enable the highest quality of care.
"There are several strategies for protecting patient sleep in hospitals," said Jo Solet, PhD, Cambridge Health Alliance, senior study author. "These include acoustic performance guidelines for design and construction, altered night-care routines, and enhanced technologies for clinician communication and medical alarms."
This research was supported by the Academy of Architecture for Health, Facilities Guidelines Institute and The Center for Health Design.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $750 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine. For more information, visit www.massgeneral.org.
Cambridge Health Alliance is an integrated, award-winning, Harvard-affiliated health system that provides high-quality care in Cambridge, Somerville and Boston's metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Department. For more information, visit www.challiance.org.
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