Sleep Disturbance and Disorders within Adult Inpatient Rehabilitation Settings: A Systematic Review to Identify Both the Prevalence of Disorders and the Efficacy of Existing Interventions

Abstract

Objectives: Older people who are admitted to inpatient rehabilitation settings often experience sleep disturbance or disorders. Both intrinsic and environmental factors may contribute to reduced sleep quality. Poor sleep quality has been reported to be associated with poorer rehabilitation outcomes. The aim of this review was (1) to describe the prevalence of sleep disturbance or disorder among older people participating in inpatient rehabilitation, and (2) to describe interventions that have been trialed to increase sleep quality and/or quantity in older people in rehabilitation settings and report on their efficacy.

Design: Systematic review involving search of 3 electronic databases and gray literature. Two authors independently reviewed citations and reviewed full text and agreed on included studies. Data were extracted and synthesized and risk of bias was assessed.

Setting and participants: Studies were included if they provided quantitative data about the prevalence of sleep disturbance or disorder in older people in a rehabilitation setting or if they reported the results of a randomized trial evaluating an intervention to improve sleep quality in older people in a rehabilitation setting.

Measures: Studies were included if they reported data from monitoring (such as polysomnography or actigraphy), clinical assessments, or questionnaires.

Results: 16 studies reporting prevalence data and 3 studies reporting evaluations of interventions were included in this review. Studies reported data from stroke and mixed population rehabilitation settings. The prevalence of obstructive sleep apnea was high and ranged from 12% to 92% in stroke rehabilitation settings. Other types of sleep disturbance, such as difficulty initiating sleep, were also common.

Conclusions and implications: Many older people participating in inpatient rehabilitation have sleep disturbance or sleep disorders. Poor sleep quality is associated with poorer health status and recovery; therefore, it is important that rehabilitation settings take steps to enhance sleep quality for inpatients drawing on the principles of good sleep hygiene.

Keywords: Sleep; brain injuries; hospitals; rehabilitation; sleep hygiene; stroke.