Less sleep, better sleep characteristics among hospitalized pregnant women vs. outpatients

Key takeaways:

• Mean total sleep duration was 1 hour less among pregnant inpatients vs. outpatients.
• Despite shorter sleep duration, inpatients had less wakefulness after sleep onset and fewer awakenings vs. outpatients.

Mean total daily sleep duration was shorter, but wakefulness and awakenings were lower for inpatient vs. outpatient pregnant women, suggesting better sleep characteristics for inpatients despite shorter duration, researchers reported.

“When people get admitted to the hospital in pregnancy, it can be short, lasting 1 day or so, or it can be prolonged, lasting several months at a time. It’s important to think about ways to optimize people’s health and lifestyle if they’re hospitalized for several months,” Danielle M. Panelli, MD, MS, maternal-fetal medicine physician and instructor in the department of obstetrics and gynecology at Stanford University, told Healio. “Clinically, we all recognize the impact that being in the hospital can have on sleep. But in looking at the literature, we really don’t have a lot out there about how people sleep with affected in pregnancy when they’re hospitalized.”

Panelli and colleagues conducted a prospective cohort study with 58 pregnant women aged 18 to 55 years at 16 weeks gestation or more from 2021 to 2022. Every participant hospitalized for pregnancy complications was matched by gestational age to outpatients recruited from obstetric clinics at the same institution. All participants responded to the Insomnia Severity Index (ISI) and wore actigraph accelerometer watches for up to 1 week.

Primary outcome was total sleep duration per 24 hours, and secondary outcomes included sleep efficiency, ISI score, clinical insomnia, short sleep duration, wakefulness after sleep onset, number of awakenings and sleep fragmentation index.

Overall, 18 women were inpatients (mean age, 35.5 years) and 40 were outpatients (mean age, 34 years). Mean total sleep duration among all participants was less than 7 hours, which is the minimum amount of sleep recommended for adults, according to the researchers.

Results, published in Obstetrics & Gynecology, demonstrated that inpatients had lower total sleep duration compared with outpatients (mean, 4.4 vs. 5.2 hours; P = .01). However, inpatients had fewer awakenings (10.1 vs. 13.8; P = .01) and less wakefulness after sleep onset (28.3 vs. 35.5; P = .03) compared with outpatients.

Compared with outpatients, inpatients were more likely to use sleep aids (12.5% vs. 39.9%; P = .03) with diphenhydramine, melatonin and doxylamine used most frequently.

Researchers observed no differences in sleep efficiency, ISI score, short sleep duration less than 5 hours and clinical insomnia and no interactions for time in the study and inpatient status.

According to Panelli, one possible reason for better sleep characteristics in inpatients vs. outpatients could be that inpatients used more sleep aids, which can cause deeper sleep for the first few hours before wearing off and thus prevent wakefulness and awakenings.

“Our results specifically point to a need for interventions. Before this study, we didn’t have a universal protocol at our hospital, and I think a lot of hospitals across the country probably don’t have one, not even just in pregnancy but for all inpatients regarding sleep protocols,” Panelli said. “Our paper proposes a few potential protocols that people can think about implementing, and our group is thinking about trying to do some more work specifically for the inpatients and what type of interventions might be helpful.”

For more information:

Danielle M. Panelli, MD, MS, can be reached at dpanelli@stanford.edu.