Surgery Clinical Trial
— WEsleepOfficial title:
WEsleep Trial: Improving Sleep With Non-pharmalogical Interventions in Hospitalized Patients
In the WEsleep study, the investigators will perform a cluster randomized controlled trial. 3 surgical and 3 medical departments will be randomized to implement low-cost and simple interventions aimed at improving sleep in admitted patients. Another 3 surgical and 3 medical departments will be randomized to function as control groups. Subjective sleep quality and sleep-wake timing will be assessed in adult medical and surgical patients admitted into one of 12 participating wards, using questionnaires and a sleep diary. In addition, in a subset of participants, objective sleep measures will be assessed in with an EEG headband and a sleep mat.
Status | Recruiting |
Enrollment | 396 |
Est. completion date | April 1, 2024 |
Est. primary completion date | March 1, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Surgical: Patients admitted for elective surgery with planned overnight stay Medical:Patients admitted to the medical ward, with at least two expected nights of admission Inclusion Criteria: Surgical patients: - Adult (18+) patients - Undergoing elective non-cardiac surgery with planned (post-operative) overnight stay - Willing and able to provide informed consent - Able to read and write in Dutch Medical patients: - Adult (18+) patients medical admission with expected stay of at least two nights - Willing and able to provide informed consent - Able to read and write in Dutch Exclusion Criteria: - Surgical patients: ASA score of 4 or higher - Surgical patients: PACU admission during first postoperative night - Admission on ICU-ward at any time during admission (both planned and unplanned, for both surgical and medical patients) - Non-Dutch speaking - Strict isolation (MRSA or aerogenic isolation) - Pre-existing delirium or cognitive impairment NB: After starting inclusions, some patients were found to spend the first postoperative night on post-anesthesia care unit (PACU) instead of a WEsleep intervention or control department and after deliberation this was added as a criterium for exclusion. |
Country | Name | City | State |
---|---|---|---|
Netherlands | Amsterdam University Medical Centers | Amsterdam |
Lead Sponsor | Collaborator |
---|---|
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA) |
Netherlands,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Subjective Sleep Quality during admission | Subjective sleep quality will be assessed with the Richard Campbell Sleep Questionnaire (RCSQ). The RCSQ measures sleep quality on five questions using a visual analogue scale (VAS), ranging from 0 to 100, with higher scores indicating a better sleep quality.
A sixth question was added to assess noise levels (as is quite customary), using a VAS-scale, ranging from 0-100, with a higher score indicating more noise |
Second night of admission (for medical patients), first postoperative night on ward (for surgical patients) | |
Secondary | Night-to night changes in subjective sleep quality | Subjective sleep quality will be assessed with the Richard Campbell Sleep Questionnaire (RCSQ). The RCSQ measures sleep quality on five questions using a visual analogue scale (VAS), ranging from 0 to 100, with higher scores indicating a better sleep quality.
A sixth question was added to assess noise levels (as is quite customary), using a VAS-scale, ranging from 0-100, with a higher score indicating more noise |
The first night until the seventh night of admission; if the patient is discharged before 7 nights of admission, all nights of admission will be analyzed | |
Secondary | Difference in subjective sleep quality between during admission and at home | Subjective sleep quality will be assessed with the Richard Campbell Sleep Questionnaire, with five questions on a visual analogue scale, ranging from 0 to 100, with higher scores indicating better sleep quality. For this outcome, we will assess the subjective sleep quality at home retrospectively at inclusion. | Second night of admission vs. a work- and workfree day 30 days before admission | |
Secondary | Diurnal phase shift of sleep-wake timing | The phase shift of sleep-wake timing will be assessed by comparing midpoint of sleep during admission with midpoint of sleep on a work-free day before admission, both measured with the Consensus Sleep Diary (CSD). For this outcome, we will assess sleep-wake timing at home retrospectively at inclusion. | Second night of admission (for medical patients) or first postoperative night (for surgical patients) vs. a workfree day 30 days before admission | |
Secondary | Night-to-night changes in sleep-wake timing | The changes in sleep-wake timing (i.e. midpoint of sleep, sleep on- and offset time, sleep duration, sleep latency & inertia and daytime napping), as measured by the CSD. | The first night until the seventh night of admission; if the patient is discharged before 7 nights of admission, all nights of admission will be analyzed | |
Secondary | Timing of food intake and sleep quality/timing | The association between food intake timing (i.e. first and last meal of the day and whether food was eaten after 21:00h), as measured by asking patients directly for the time of the first and last meal of the day and whether patients ate after 21:00h), and subjective sleep quality and sleep-wake timing (as measured by the Richard Campbell Sleep Questionnaire (with five questions on a visual analogue scale ranging from 0-100 with higher scores indicating better sleep quality) and Consensus Sleep Diary (with questions on sleep-wake timing) respectively). | The first night until the seventh night of admission; if the patient is discharged before 7 nights of admission, all nights of admission will be analyzed | |
Secondary | Quality of recovery (for surgical patients) and sleep quality/timing | The association between quality of recovery (in surgical patients), as measured by the Quality-of-Recovery 15 item questionnaire (QoR-15), and subjective sleep quality and sleep-wake timing (as measured by the Richard Campbell Sleep Questionnaire and Consensus Sleep Diary respectively). The QoR-15 will be completed twice by patients. | First and third day after surgery | |
Secondary | 30 day mortality | 30-day mortality, assessed by checking the medical record retrospectively 30 days after admission. | 30 days after admission | |
Secondary | 30-day incidence of delirium during admission | 30-day incidence of the clinical diagnosis of delirium during hospitalization, as assessed by a physician during admission. Patients will be assessed for delirium at the request of nursing staff or if the score of the Delirium Observation Screening scale is 3 or higher. The Delirium Observation Screening scale ranges from 0 to 39, with higher scores indicating a higher chance of delirium. | 30 days after admission | |
Secondary | 30-day incidence of surgical site infections (for surgical patients) | 30-day incidence of surgical site infections, as assessed by physicians from the department where patient is admitted during hospitalization. If the patient obtained a surgical site infection after discharge, incidence was assessed in the outpatient clinic by a physician from the department where patient was admitted. | 30 days after admission | |
Secondary | Objective sleep substudy: Sleep efficiency (objectively measured) during admission | Objective sleep quality will be measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep. The primary outcome measure will be sleep efficiency (time slept divided by time in bed spent trying to sleep), compared for patients on intervention and control departments. | Second night of admission (medical patients) and first postoperative night on surgical ward (for surgical patients) | |
Secondary | Objective sleep substudy: Differences in objective sleep measures of sleep-wake timing during admission | Sleep-wake timing will be assessed by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the Withings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep. Changes in sleep-wake timing (i.e. midpoint of sleep, sleep on- and offset time, sleep duration, sleep latency & inertia) will be compared for patients on intervention and control departments. | The first night until the seventh night of admission; if the patient is discharged before 7 nights of admission, all nights of admission will be analyzed | |
Secondary | Objective sleep substudy: Night-to-night changes in objective sleep measures during admission | Objective sleep quality will be measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the WIthings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep. The amount of time in each of these stages and their distribution, as well as total sleep time, will be compared for patients on intervention and control departments. | The first night until the seventh night of admission; if the patient is discharged before seven nights of admission, all nights of admission will be analyzed | |
Secondary | Objective sleep substudy: Difference between objective and subjective sleep measures during admission | Objective sleep quality will be measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the WIthings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep. Subjective sleep quality will be measured by the Richard Campbell Sleep Questionnaire, with five questions with a visual analogue scale with scores from 0 to 100, with higher scores indicating better sleep quality. Subjective sleep quantity will be measured with the Consensus Sleep Diary, with questions on sleep-wake timing. Objective and subjective sleep measures will be compared. | The first night until the seventh night of admission; if the patient is discharged before seven nights of admission, all nights of admission will be analyzed) | |
Secondary | Objective sleep substudy: Quality of recovery after surgery and objective sleep quality/timing | The association between quality of recovery, as measured by the Quality-of-Recovery 15 item questionnaire (QoR-15), and objective sleep quality and sleep-wake timing (as measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the Withings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep.). The QoR-15 will be completed twice by patients. | First and third day after surgery (surgical patients) | |
Secondary | Objective sleep substudy: Correlation 30 day mortality and objective sleep quality/timing | Correlation between 30-day mortality, assessed by checking the medical record retrospectively 30 days after admission and objective sleep quality and sleep-wake timing during admission (as measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the Withings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep. | 30 days after admission | |
Secondary | Objective sleep substudy: Correlation 30-day incidence of delirium during admission and objective sleep quality/timing | 30-day incidence of the clinical diagnosis of delirium during hospitalization, as assessed by a physician during admission. Patients will be assessed for delirium at the request of nursing staff or if the score of the Delirium Observation Screening scale is 3 or higher. The Delirium Observation Screening scale ranges from 0 to 39, with higher scores indicating a higher chance of delirium. Objective sleep quality and sleep-wake timing during admission will be measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the Withings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep.). | 30 days after admission | |
Secondary | Objective sleep substudy: Correlation 30-day incidence of surgical site infections (for surgical patients) and objective sleep quality/timing | 30-day incidence of surgical site infections, as assessed by physicians from the department where patient is admitted during hospitalization. If the patient obtained a surgical site infection after discharge, incidence was assessed in the outpatient clinic by a physician from the department where patient was admitted. Objective sleep quality and sleep-wake timing during admission will be measured by the Dreem-3 headband, using electro-encephalography (EEG) to differentiate between wakefulness, Rapid-Eye-Movement (REM) sleep and non-REM N1, N2 and N3 sleep, and the Withings Sleep Analyzer, differentiating between wakefulness, REM- and light and deep sleep.). | 30 days after admission |
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