TIRR Researchers to Study Effect of Hospital Sleep Enviornment on Delirium

Farhaan S. Vahidy, PhD, MBBS, MPH, FAHA, associate vice president and chief scientific officer at TIRR Memorial Hermann, is the principal investigator for a study grant funded by the Patient-Centered Outcomes Research Institute to investigate whether improving in-hospital sleep environment can influence hospital acquired delirium.

“Delirium presents itself as a complex and troublesome neurological syndrome,” explains Dr. Vahidy, who will lead this project across four Houston-area hospitals. “Delirium is characterized by an acute change in attention, awareness and cognition. Patients who are either predisposed or who experience precipitating factors undergo transient states of altered arousal, from reduced responsiveness to severe agitation.”

Delirium is particularly common in the older adults who are critically ill and have preexisting dementia or cognitive impairment. The condition can be difficult to study due to its transient nature and as such there are no effective treatments.

While much is unknown about management of delirium, research is conclusive that individual patients who experience delirium during their hospitalization do poorly on multiple outcomes. “Patients who experience delirium have been shown to have longer hospital stays, higher rates of readmission, higher mortality, increased cost of care and poor long-term cognitive and functional outcomes,” Dr. Vahidy says. “So, prevention and mitigation of delirium is imperative. Understanding which patients are more likely to experience delirium, what factors can contribute to delirium and getting ahead of it by minimizing such factors is the key.”

Based on these findings, Dr. Vahidy and his colleagues began thinking about the effect that sleep may have on delirium, and how hospital environment can often be antagonistic to sleep. “Research has shown that reduced sleep can have a negative effect on the blood–brain barrier and the brain’s glymphatic system, both of which prevent toxic substances from accumulating in the brain,” Dr. Vahidy notes.

Due to the connection between sleep and delirium, Dr. Vahidy and his colleagues started exploring what can be done for patients so they can sleep better in the hospital setting. “There are many reasons why sleep in the hospital can be difficult,” he says. “The workflow across our hospitals is fragmented, with several clinical and ancillary activities such as monitoring, medication administration, blood draws, room cleaning and so on, each having its own schedule. This often results in our patients being repeatedly or even continuously disturbed throughout the night. Often, there is little differentiation between daytime and nighttime.

The study, which started in April, is built around a sleep hygiene intervention that is aimed at creating a more sleep-friendly environment in the hospital. The five-year project is hoping to eventually record data on approximately 11,000 patients. It has been designed to alter the workflow of a typical hospital unit and focuses on a multimodal bundled intervention that includes reducing disturbances during the night by limiting staff interactions, changing unit workflows to be more cohesive, reducing light and sound intensity, keeping patients more active during the daytime and using smart technology for patient monitoring and producing a sleep-friendly environment.

“When we look at hospital data for patient satisfaction, one of the top persistent complaints in an acute care environment is that patients have frequent sleep and nighttime disturbances,” Dr. Vahidy says. “This study was really driven by patients’ feedback and the findings will potentially benefit everyone. Patients will get better sleep and have improved outcomes, which will also help their caregivers, and the health care system will benefit from enhanced patient satisfaction and reduced costs.”