How can we protect sleep and our body's internal rhythm when we end up in hospital?

BY Sara Montagnese

When we are admitted into hospital our sleep-wake patterns worsen for reasons including disease itself, an unusual and noisy environment, and modified light, food, and activity cues. As a result, inpatients tend to experience shorter and poorer night sleep, several night awakenings, and daytime sleepiness. This may affect prognosis, also in terms of duration of the inpatient stay. However, it may now be possible to do something about it!

Our study aimed to explore how a personalized hospital management system called CircadianCare could help improve sleep patterns and strengthen the body's internal rhythm for patients staying in the hospital for acute medical problems. Fifty patients were enrolled and randomly assigned to receive either CircadianCare or the standard care provided in hospitals. These patients were evaluated for their sleep patterns when they entered the hospital and continued to track their sleep using diaries and a device called an actigraph - which measures rest-activity cycles - throughout their stay. Additionally, specific markers related to the body's internal clock, such as melatonin levels and skin temperature, were also measured on days 1, 7, and 14 of the patients' hospital stay.

Patients in the CircadianCare group followed a personalized schedule for exposure to light, meals, and physical activity based on their usual habits. They also used special glasses emitting short-wavelength-enriched light after waking up, and wore light-filtering shades in the evening before bedtime. Although the primary goal of reducing the time it takes to fall asleep was not fully achieved based on the actigraphy or sleep diaries, patients in the CircadianCare group tended to go to bed earlier compared to those receiving standard care, as noted in the sleep diaries.

Interestingly, the evening increase in the saliva levels of melatonin, a hormone related to sleep regulation, occurred significantly earlier in the group using CircadianCare, particularly in patients whose data could be compared from the beginning to the end of their hospital stay.

Moreover, patients who slept near a window, and were therefore exposed to more natural light, generally had better sleep quality, regardless of the treatment they received. The study also found that abrupt changes in environmental noise at night (as opposed to constantly high noise levels) led to more nighttime awakenings for patients in both treatment groups.

In conclusion, the CircadianCare system showed promise in advancing sleep schedules and strengthening the body's internal rhythm. Additionally, the study highlighted the importance of environmental factors like noise and lighting in influencing sleep quality during hospital stays. The findings suggest that adjusting these factors could help prevent sleep disturbances in hospitalized patients.

The authors of the study are a large, collaborative, international and interdisciplinary mixture of junior and senior medical doctors, chronobiologists, psychologists and engineers.

Article details

Managing Circadian Disruption due to Hospitalization: A Pilot Randomized Controlled Trial of the CircadianCare Inpatient Management System
Chiara Mangini, Lisa Zarantonello, Chiara Formentin, Gianluca Giusti, Esther D. Domenie, Domenico Ruggerini, Rodolfo Costa, Debra J. Skene, Daniela Basso, Lisa Battagliarin, Antonino Di Bella, Paolo Angeli & Sara Montagnese
First Published: December 28, 2023
DOI: 10.1177/07487304231213916
Journal of Biological Rhythms

About the Author

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Sara Montagnese is a Professor of Chronobiology and Chronobiology Section Lead at the University of Surrey, in the UK and an Associate Professor of Medicine and Honorary Consultant Physician at Padova University Hospital, in Italy.

She has a longstanding clinical and research interest in hepatic encephalopathy, a cerebral complication of liver disease on which she has published extensively, especially in relation to diagnosis and differential diagnosis. She is Past President of the International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) and Vice President and President Elect of the European Biological Rhythms Society (EBRS). She is Associate Editor and Special Section Editor (Snapshots) of Journal of Hepatology, and Associate Editor of Journal of Sleep Research and Frontiers in Physiology - Chronobiology.

She also has a research interest in the sleep-wake disturbances exhibited by patients with cirrhosis and she has made significant contributions to their understanding and their treatment. She is currently using her experience in the liver field as a model, and applying it to several other areas of medicine. In addition, she is working on the management of hospitalization-related sleep-wake and circadian abnormalities, and on the definition of patient-specific tools for circadian assessment. Her research has been funded by the European Association for the Study of the Liver, the University of Padova, the CaRiPaRo foundation, the Italian Ministry of Health, and the EU-H2020.