Inpatient Psychiatric Sleep Disturbances Related to Clinical Outcomes

Self-reported sleep disturbances during inpatient psychiatric treatment contributed to worse short-term and long-term clinical outcomes, according to a study published in the Journal of Affective Disorders.

Researchers examined the relationship between self-reported inpatient sleep disturbances and clinical outcomes, including suicidal ideation, suicide attempts, disability, and overall well-being. Patients who were voluntarily admitted to the hospital completed evaluations to assess depressive symptoms, suicidal ideation and behavior, anxiety symptoms, quality of life, function, and substance use.

Clinical diagnoses were based on structured clinical interviews and medication usage was obtained from medical records. Evaluations were completed at admission, every 2 weeks of inpatient stay, and at discharge. Follow-up evaluations were completed at 2 weeks, 3 months, 6 months, and 1 year after discharge.

Patients were grouped into one of 4 sleep trajectories: no sleep problems (patients without reported sleep disturbances), responders (patients with some improvements in sleep disturbances), resolvers (patients with completely resolved sleep disturbances), and non-responders (patients with continued sleep disturbances).

Of the 2970 patients included in the study, 10.3% were in the no sleep problems cohort, 43.4% were in the responders cohort, 10.6% were in the resolvers cohort, and 35.7% were in the nonresponders cohort. Significant associations between sleep trajectory group and clinical outcomes at discharge were revealed.

Patients diagnosed with major depressive disorder were more likely to be in the nonresponders cohort and less likely to be in the no sleep problems cohort (P <.001, for both), while patients diagnosed with both major depressive disorder and generalized anxiety disorder were more likely to be in the nonresponders cohort (P <.001) and less likely to be in the resolvers cohort (P =.006) and the no sleep problem cohort (P <.001). Patients in the nonresponders cohort had longer inpatient stays (P <.001), higher anxiety (P <.05), more suicidal ideation (P <.05), more disability (P <.05), and lower well-being (P <.05).

Analyzing change from baseline to discharge, patients in the no sleep problems cohort displayed the least amount of absolute change for anxiety, suicidal ideation, disability, and well-being. Analyzing change at the 6-month time point after discharge, patients in the nonresponders cohort displayed more disability and lower well-being (P <.05). Post hoc analysis indicated that patients taking tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, dopaminergic stimulants, mood stabilizers and anticonvulsants, first-generation antipsychotics, second-generation antipsychotics, hypnotic sleep agents, nonopioid analgesics, and pain medications were more likely to be in the nonresponders cohort (P <.001, for all).

Limitations of this study include only using 1 self-reported sleep disturbance question to measure sleep disturbances and not a comprehensive sleep index measure, the inability to assess if patients received components of sleep psychotherapy, and the sample population not being generalizable to a diverse population.

The researchers concluded their “[r]esults indicated a consistent pattern of findings: untreated self-reported sleep disturbance across inpatient psychiatric treatment (in our sample over a third, 35.7% of patients) might contribute to worse clinical outcomes at discharge and at six months post-discharge, including suicidal ideation.”

Please see the original reference for a full list of authors’ disclosures.

Reference
Hartwig EM, Rufino KA, Palmer CA, et al. Trajectories of self-reported sleep disturbance across inpatient psychiatric treatment predict clinical outcome in comorbid major depressive disorder and generalized anxiety disorder [published online March 22, 2019]. J Affect Disord. doi: 10.1016/j.jad.2019.03.069