Managing circadian disruption due to hospitalisation: a pilot randomised controlled trial of the CircadianCare inpatient management system

The objective of the present study was to test the effects of an inpatient management system (CircadianCare) aimed at limiting the negative impact of hospitalisation on sleep by enhancing circadian rhythmicity. Fifty inpatients were randomised to either CircadianCare (n=25; 18 males, 62.4±1.9 yrs) or standard of care (n=25; 14 males, 64.5±2.3). On admission, all underwent a full sleep-wake evaluation; they then completed daily sleep diaries and wore an actigraph for the whole length of hospitalisation. On days 1 (T0), 7 (T1) and 14 (T2, if still hospitalised) salivary melatonin for dim light melatonin onset (DLMO) and 24-hour skin temperature were recorded. In addition, environmental noise, temperature and illuminance were monitored. Patients in the CircadianCare arm followed one of three schedules for light/dark, meal and physical activity timings, based on their diurnal preference/habits. They wore short-wavelength-enriched light-emitting glasses for 45 min after awakening, and short-wavelength light filter shades from 18:00 until sleep onset. While the first, primary registered outcome (reduced sleep onset latency on actigraphy or diary) was not met, based on sleep diaries, there was a trend (0.05< p< 0.1) towards an advance in bedtime for CircadianCare compared to standard of care patients between T0 and T1. Similarly, DLMO time significantly advanced in the small group of patients for whom it could be computed on both occasions, with untreated ones starting from earlier baseline values. Patients sleeping near the window had significantly higher sleep efficiency, regardless of treatment arm. As noise fluctuation increased, so did the number of night awakenings, also regardless of treatment arm. In conclusion, the CircadianCare management system showed positive results in terms of advancing sleep timing and the circadian rhythm of melatonin. Further, our study identified a combination of environmental noise and lighting indices, which could be easily modulated to prevent hospitalisation-related insomnia.