Dev Patel

1/29/19
G/T Independent Research I / English 10 GT

Annotated Source List

Aurell, J., & Elmqvist, D. (1985). Sleep in the surgical intensive care unit: continuous polygraphic
recording of sleep in nine patients receiving postoperative care. Br Med J (Clin Res Ed),
290(6474), 1029–1032. https://doi.org/10.1136/bmj.290.6474.1029

This research paper describes a survey conducted of post-operative patients in the ICU to
determine their levels of sleep disturbance and deprivation. The article states that sleep is a known cause
of patient dissatisfaction, supplemented by the fact that all patients were severely deprived of sleep
compared with normal. The average sleep time (stage 1 excluded) for the first two nights, daytime sleep
included, was less than two hours a night. In stages 3 and 4, REM sleep were severely suppressed. The
time each patient slept was misjudged by hospital staff, leading to potentially increased sleep disturbances
due to this misconception. The authors’ findings are further evidence that severe sleep disturbance is
common after major surgery. Some of the primary causes of sleep disturbance include pain and
environmental factors such as light, noise, as well as nursing activities. The authors recommend that the
hospital staff implement pain-relieving measures and limit the effect of potentially disruptive
environmental factors.

This analysis and discussion of an early study provides substantial evidence that sleep disruption
is a serious issue in hospitals. The researcher can use this information to solidify the claims in the project.
However, since this study took place in 1985, a portion of the study is outdated and some aspects of the
design and hospital environments are bound to have changed over the course of over 30 years. Despite
this article being slightly antiquated, it contains a trove of valuable evidence that emphasizes the
importance of taking action against sleep disruption in hospitals.

Bartick, M. C., Thai, X., Schmidt, T., Altaye, A., & Solet, J. M. (2010). Decrease in as-needed sedative
use by limiting nighttime sleep disruptions from hospital staff. Journal of Hospital Medicine,
5(3), E20–E24. https://doi.org/10.1002/jhm.549

This abstract of a review of a study focuses on reducing the use of sedative by limiting sleep
disruption. Sedatives facilitate sleep, but they also have negative side effects like increasing the chance of
delirium. Delirium is the disorientation and reduced awareness in an individual that can lead to damaging
falls or potentially dangerous behaviors that stem from being in an unknown environment, in hospital
patients. In order to prevent the use of sedatives to artificially promote sleep, the authors of the study
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

aimed to decrease sleep disruption as much as possible, so patients can sleep naturally. Since few other
studies have been carried out with the goal to promote sleep in the hospital and limit sedative use, this
study aimed to find the correlation between these factors. The abstract identifies hospital routines as the
primary cause of sleep disruption. The study used measures such as implementing an 8 hour “Quiet
Time”, which consists of shut-off lights, lullabies, and staff-monitored noise. During this time the hospital
staff also limited patient interventions for vital signs and medications throughout the night. The study
found that decreasing nighttime nurse interventions was most effective in reducing sleep disruption, as
even minor modifications to the intervention times allowed the patient to sleep naturally for greater times.

This study will be useful in the conclusion of the researcher’s paper since this part of the paper
introduces certain measures that can reduce sleep disruption without interfering with hospital procedures.
Specifically, shifting medication administration times or vital sign readings to time that do not disrupt
patients’ sleep can have a major impact of sleep patterns in the hospitals over the long term. However, as
the researcher is only able to access the abstract, so certain technical or statistical terms may not be
clearly established and understood. Despite limited access, the researcher can still utilize this unique study
to form a strong conclusion that establishes viable solutions.

Camargo-Sanchez, A., Niño, C. L., Sánchez, L., Echeverri, S., Gutiérrez, D. P., Duque, A. F., … Vargas,
R. (2015). Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory. The
Open Nursing Journal, 9, 1–9. https://doi.org/10.2174/1874434601509010001

Disturbances in the normal, daily routine are common in the hospital setting, which disrupts the patient’s
circadian systems. Interventions due to medical tests, medications, familial visits, and meals can displace
the timing of a patient’s vital functions. External factors that influence the body’s circadian clock, also
known as zeitgebers, are prevalent in the hospital setting. Some of the most common zeitgebers in a
hospital are noise, light, meals, and medical interventions. These factors play a large role in the sleep-
wake cycle, which varies from individual to individual and can be easily thrown off. However, these
external cues for the sleep-wake cycle can be controlled and manipulated in a hospital. The natural light
and dark cycle can be simulated by reducing light frequency and intensity during night hours and
increasing them during the day. Noise is one of the most influential factors to sleep quality and quantity
and it can be easily controlled by taking deliberate measures to avoid sources of unnecessary sounds. The
scheduling of medication administrations, tests, and medical procedures during ample times according to
the chronotype of an individual can alleviate the mental pressures on a patient and ensure that harmful
side effects are minimized. Aligning meal times with the body’s internal clock can synchronize digestion
with the periods when the body performs metabolic process most efficiently works to prevent metabolic,
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

dietary, and cardiovascular issues. Allowing patients to have adequate social contact with family and
friends can prevent stress, anxiety, and depression in the otherwise solitary hospital setting. Raising
awareness for sleep hygiene, nighttime disturbances, and the factors that influence sleep among nurses
and other caretakers can help to create suitable sleeping times and environment and lead to the control of
said zeitgebers in the hospital.
This academic paper provides a synthesis and theory regarding circadian disturbances in the hospitals, as
well as contributing factors and how to control these factors. The writing is concise and provides a
cohesive path of comprehension. The authors’ clearly state the issue of internal clock disruptions and how
it can be prevented by intelligently manipulating specific environmental cues. In conclusion, this paper
will augment the researcher’s project by adding an array of potential solutions that can be implemented in
the hospital setting.

CHRONOPHARMACOLOGY: AN OVERVIEW | PharmaTutor.

https://www.pharmatutor.org/articles/chronopharmacology-overview. Accessed 8 Oct.
2018.

Chronopharmacology is the effects of a drug as it relates to the biological rhythms and when the
optimal conditions would be for ingestion. Most factors that determine how a drug interacts with the body
oscillate throughout the day, thus the time that a drug is taken affect can heavily its impacts on the body.
The dosage of a drug also varies according to the time of ingestion, thus the conditions in which a drug is
taken should be coordinated with the body’s circadian rhythms in order to optimize the drug’s effect and
minimize it’s side effects.
This source will be useful in providing an overview of chronopharmacology in general since it
gives technical definitions with the processes and biological aspects that relate to chronopharmacology.
Although this source was limited in length, it will still be useful since it gives a different perspective on my
topic from an international and pharmaceutical standpoint.

Delaney, L. J., Currie, M. J., Huang, H.-C. C., Lopez, V., & Van Haren, F. (2018). “They can rest at
home”: an observational study of patients’ quality of sleep in an Australian hospital. BMC Health
Services Research, 18(1), 524. https://doi.org/10.1186/s12913-018-3201-z

This scholarly article describes and analyzes a study conducted on Australian hospital patients. It
is common knowledge that sleep disruption slows recovery, suppresses the immune system, and impairs
certain cognitive functions. This prolonged sleep disruption can still affect a patient’s health even after
discharge. rom hospital or high acuity areas. Sleep disturbance in the hospital environment has been
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

linked to several external factors such as ambient noise, exposure to artificial lighting and clinical
interactions. This environment may also influence the circadian sleep patterns as artificial lighting can
suppress the production of melatonin, which plays an important role in facilitating sleep. Despite these
facts, patients’ sleep in hospital has not been fully studied and explored, especially in Australia. This
study seeks to determine the need for interventions to improve patients’ sleep in a large referral hospital,
by measuring sleep duration and identifying the factors that impede on patient sleep in this setting. The
findings of this study confirm that patients’ sleep duration and quality are severely diminished throughout
their hospital stay. The authors of the study introduce the claim that hospital staff may be failing in their
duty of care as there is increasing evidence that reduced sleep duration and poorer quality of sleep can
lead to clinical events such as falls, infections and medication errors. The two main sleep-disturbing
factors were found to be noise and nurse interventions. Noise in all clinical wards in this study was
primarily attributed to staff and in particular to activities at the nursing station. The most disruptive noises
reported by patients were directly or indirectly controllable by humans such as conversation levels and
television volumes. Nurse interventions, which occur frequently during the night, are responsible for a
large portion of sleep disturbances as well. Clinical staff undertaking routine activities may be unaware
of, or underestimate their effect on patients. This lack of awareness may account for nursing staff
overestimating patients’ sleep quality.

This scholarly article will be immensely useful to the researcher in many parts of the research
paper. This study contains valuable information regarding sleep conditions in hospitals, that will help
prove the researcher’s claim. The level of analysis conducted by the author's will also assist the researcher
in determining potential solutions to the issue of sleep disruption in hospitals. The only drawback to this
article is that the study took place in an Australian hospital, which may have differing conditions than that
of an American hospital. This means that the information in this article must be cross-referenced with a
study in the US in order to confirm it’s validity in the American hospital setting.

dos Santos, M. A., da Conceição, A. P., Ferretti-Rebustini, R. E. de L., Ciol, M. A., Heithkemper, M. M.,
& da Cruz, D. de A. L. M. (2018). Non-pharmacological interventions for sleep and quality of
life: a randomized pilot study. Revista Latino-Americana de Enfermagem, 26.
https://doi.org/10.1590/1518-8345.2598.3079

This study showed the feasibility of the use of nonpharmacological therapies to improve quality
of sleep and health-related quality of life among individuals with heart failure. Phototherapy, the use of
light to induce or prevent sleep, and sleep hygiene measures, including administering eye masks and
earbuds, by themselves or in combination with other therapies, as well as knowledge regarding how to
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

handle symptoms are low-cost interventions, both for patients and the health system, with the potential to
promote sleep improvement. These simple solutions can greatly reduce sleep disruption and deprivation
in diseased individuals, promoting a faster and more effective recovery as well as an increased quality of
life. These low cost, non-pharmacological therapies able to ease the management of the disease are
desirable in any context of health. These therapies have the potential not only to improve quality of life,
but also may lead to a decreased number of medical visits and unplanned hospitalizations. Thus, these
therapies should be investigated and eventually used in clinical practice.

This study will be beneficial in the development of the conclusion of the researcher’s paper. The
efficient therapies introduced and tested in this study can be analysed and modified accordingly by the
researcher in order to maximise patient and hospital staff convenience and then be presented as tentative
solutions.The only drawback to this article is that the study took place in an Brazilian hospital, which may
have differing conditions than that of an American hospital. This means that the information in this article
must be cross-referenced with a study in the US in order to confirm it’s validity in the American hospital
setting.

DuBose, J. R., & Hadi, K. (2016). Improving inpatient environments to support patient sleep.
International Journal for Quality in Health Care, 28(5), 540–553.
https://doi.org/10.1093/intqhc/mzw079

This paper reviews studies of non-pharmacological strategies for improving the nighttime sleep of
patients in hospitals. The significance of sleep disruption in hospitals has been addressed in other papers,
as have the negative consequences for patient outcomes. The authors identified all research papers on
sleep improvement studies in hospitals, as well as studies that sought to make correlations between
existing conditions and sleep outcomes, evaluated the evidence to support the efficacy of those
interventions and provide recommendations for quality improvement initiatives. Sleep is vital for
maintaining health and healing, and is essential for a quality hospital experience. Due to these varied
negative impacts, studies have tried different improvement practices to enhance the quality of patient
sleep in their facilities. After reviewing numerous research articles and studies, the authors were able to
identify key sources of sleep disturbance and conclude that hospitals can make quality improvements to
support better sleep. The constant level of noise and the number of peak noise events in hospitals were
responsible for a portion of sleep disruption, which can be combated through implementing strategically-
placed quiet times and using single-patient rooms to reduce external noise and promote sleep in patients.
Although nursing care activities were also responsible some of the sleep disruption, efforts at limiting
nurse activity have not been demonstrated to improve sleep conditions. The articles claims that offering
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

patients earplugs and eye masks is an easy and affordable solution that may help, but changing the sound
and light environment is more effective.

This article focuses on certain environmental conditions that impact sleep and can be utilized as
evidence in the introduction and conclusion of the researcher’s paper, to prove that sleep disruption is a
viable issue and to introduce potential strategies to prevent and reduce it. This article reviews many other
related scholarly works and the study covers a wide range of factors, allowing the researcher to find
evidence for a many of the claims that appear in the research paper. In conclusion, this article will be
immensely valuable throughout the researcher’s project

Egydio, Flavia, et al. “Wound-Healing and Benzodiazepines: Does Sleep Play a Role in This Relationship?”
Clinics, vol. 67, no. 7, July 2012, pp. 827–30, doi:10.6061/clinics/2012(07)20.

This scholarly journal details the influence of sleep and stress on the application of benzodiazepine (BZD)
drugs to treat patients with burn wounds. Sleep deprivation has been proven to reduce the body’s ability to
fight pathogens due to a decrease in natural killer cells. This shows that sleep deprivation, in general, even
without being diseased, has a debilitating influence on the body. After initial use, BZDs increase sleep
quality and quantity, however, prolonged use can restrict sleep, in which the body recuperates mental
function. Therefore, sleep is essential for a strong immune response toward a disease and the recovery of
the body.
This journal contained numerous medical jargon and was at times difficult to comprehend, but
overall, it will be a noteworthy addition the research project as it specifies the effect of sleep on the immune
system and its subsequent interaction with a certain medication. The connections explored in this journal
can be used as a comparison to other correlations with sleep and other drugs.

Elliott, R., McKinley, S., Cistulli, P., & Fien, M. (2013). Characterisation of sleep in intensive care using
24-hour polysomnography: an observational study. Critical Care, 17(2), R46.
https://doi.org/10.1186/cc12565

This article details a polysomnography study on intensive care patients in an Australian hospital ward.
The average amount of sleep in the patients’ was a 5 hour, much less than what a critically-ill hospital
should be receiving. The patients' transitions from different sleep phases were peculiar irregular. Almost
half of the average sleep took place during the day, indicating circadian rhythm disruption similar to what
is experienced during jet lag. The patients’ mostly slept in stages 1 and 2, with very little sleep in the
REM and delta wave stages, resulting in less long-term memory storage and overall “recharging” of the
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

body. This could possibly be attributed to the frequent nighttime arousals experienced by the patients’
which fragments their sleep and prevents from entering deep sleep for long. Although the sound levels
were high during the day and night, introducing another factor for the reduced sleep efficiency, the
correlation between peaks in noise and nighttime arousals was minimal. The amount of light was
significantly less during the night than day. However, there was a median of about 2 nursing interventions
per hour during the night, which could have led to the fragmented sleep phases. Despite innovations in
ICU design, healthcare technology, and employee training, sleep quantity and efficiency still remain
substandard. The average sound levels during the day and night exceeded the limit set by WHO (>35 dB),
while light levels did not exceed maximum illuminance. However, researchers believe that the light levels
during the day may have been too low, failing to suppress melatonin production and potentially leading to
daytime sleeping. Brighter lights would also keep patients in syncs with the 24-hour diurnal circadian
clock. Certain medications ingested by the patients could have had side effects on sleep, but the patient-
perceived effect of medication on sleep was insignificant. Patients ranked noise as the factor that most
influenced their sleep, followed by staff interventions and light.
This analysis of a study will be used frequently in the research since it details a variety of factors along
with patient perceptions and factual observations of the conditions during the study period. The author's
of this journal supported all of their claims with undisputable evidence and also compared it with other
studies to ensure the accuracy and validity of their own study, making this a reliable source to prove the
real-life applications for the researcher’s project and to use as evidence for an acedemic research paper.

Farrehi, P. M., Clore, K. R., Scott, J. R., Vanini, G., & Clauw, D. J. (2016). Efficacy of Sleep Tool
Education During Hospitalization: A Randomized Controlled Trial. The American Journal of
Medicine, 129(12), 1329.e9-1329.e17. https://doi.org/10.1016/j.amjmed.2016.08.001

This scholarly article describes a study on 120 adults on a non intensive cardiac unit. The authors
of the study ensured that all patients received a set of sleep-enhancing tools such as eye masks, ear plugs,
and white noise machines administered education of the importance of sleep and the use of these tools.
The authors observed a trend toward improvements in multiple other sleep-related domains, including
sleep disturbance, sleep-related impairment, physical functioning, pain severity, or pain interference.
These improvements show that simple measures such as administering basic sleep-promoting tools can
have a significant impact of the patient health and the quality of their stay. The use of these tools greatly
improved patient fatigue as well, indirectly affecting the recovery and healing process of the hospitalized
patients as well. These improvements can increase patient satisfaction and promote the public perception
of the hospital over time and therefore be advantageous to both patient and healthcare workers.
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

This abstract of a scholarly article solidifies the researcher’s solutions in the conclusion of the
research paper, paving a clear route for future action towards implementing these solutions. The
researcher is able to identify several non-pharmological and relatively cheap tools that do not interrupt
with hospital procedures and substantially reduce sleep disruption as well as other sleep-related factors.
However, the researcher is only to access the abstract of this articles and cannot fully comprehend the
technical intricacies of the study itself and the full range of factors involved. This drawback forces the
researcher to cross-reference the sleep-promoting measures introduced here with those of other scholarly
articles to ensure scientific accuracy.

Freedman, N. S., Kotzer, N., & Schwab, R. J. (1999). Patient Perception of Sleep Quality and Etiology of
Sleep Disruption in the Intensive Care Unit. American Journal of Respiratory and Critical Care
Medicine, 159(4), 1155–1162. https://doi.org/10.1164/ajrccm.159.4.9806141

According to ICU patients’ perceptions, sleep quality at the hospital is of lower quality than sleep quality
at home. Polygraphs of patients show that due to certain factors, patients’ sleep is often fragmented, their
Stages 1 and 2 are prolonged, while Stage 3 and REM are reduced, leading to daytime sleepiness and
long-term sleep disruption, depending on the severity of the patient’s illness. Based on the study, a variety
of factors cause this fragmentation of sleep, mainly noise from the hospital environment and tests
conducted during the night that interrupts the patient’s sleep. Noise is a difficult factor to track and it
usually deteriorates the quality of sleep while the patient is sleeping, instead of waking the patient up.
Human interventions for tests throughout occur frequently and can wake a critically-ill patient up hourly
depending on their condition. In addition, older patients are more easily roused than younger patients, and
therefore more susceptible to the environmental factors that disrupt sleep. Other unavoidable factors such
as medication, underlying conditions, and the illness itself can contribute to the decreased quality of sleep
at the hospital than at home. In conclusion, more research is required to determine the extent of the
disparities between sleep at home and sleep at the hospital.
This scholarly analysis and discussion of a study is fascinating and relevant to the researcher’s topic. The
frequent use of evidence from the study to support certain claims adds validity and credibility to this
work. However, the writers’ unnecessary repetition of certain claims interrupts the flow of the discussion,
making this paper cumbersome to comprehend at times. Also, this study has crucial evidence that can be
used to prove the importance of the researcher’s project.

Kamdar, B. B., King, L. M., Collop, N. A., Sakamuri, S., Colantuoni, E., Neufeld, K. J., … Needham, D.
M. (2013a). The effect of a quality improvement intervention on perceived sleep quality and
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

cognition in a medical ICU. Critical Care Medicine, 41(3), 800–809.

https://doi.org/10.1097/CCM.0b013e3182746442

Patients in the ICU are known to experience poor and interrupted sleep, which not affect the
recovery of the patients but also their cognitive function. Reduced sleep quality in the ICU has been
associated with delirium and post-ICU cognitive impairment, which can hinder the patient even after
discharge. The authors of the study implemented several sleep-promoting interventions that helped in
lowered perceived noise levels and decreasing the incidence of daily delirium and coma in patients. In
addition, due to the noise and light controlling measures, post-ICU cognitive impairment was reduced
compared to without the measures, increasing the quality of the patients’ hospital stay and lowering the
negative impacts of sleep disruption on their health. Daytime sunlight was maximised, possibly
contributing to lowered rate of delirium, since light regulates body’s sleep patterns and prevents
sleepiness during the day and sleeplessness during the night that lead to frequent awakenings, daytime
sleeping, and ultimately, delirium. Many medications or sedative administered to sleep-deprived patients
have the negative side effect of facilitating delirium, so the decreased use of medication to treat insomnia
could have correlated to the reduced incidence of delirium.

This article will be utilized to support the researcher’s claim regarding the correlation between
sleep disruption and delirium, since the use of sleep-promoting measures decreased delirium. This means
that a poor quality of sleep (sleep deprivation and disruption) leads to delirium and higher quality of
sleep, characterised by less awakenings and interruptions, can prevent or reduce delirium. However, this
article contains a multitude of advanced statistical terms and vocabulary whose definitions were relatively
unknown to the researcher, resulting in an incomplete comprehension of the article and study in general.

Knauert, M. P., Redeker, N. S., Yaggi, H. K., Bennick, M., & Pisani, M. A. (2018). Creating Naptime.
Journal of Patient Experience, 5(3), 180–187. https://doi.org/10.1177/2374373517747242

This article describes a study that addresses the growing awareness of the importance of sleep in
the intensive care unit (ICU). Sleep disruption in critically ill patients causes them to experience sleep
loss, poor sleep quality, and circadian disruption. Sleep disruption may also lead to delirium and
persistent cognitive impairment after critical illness. Adding on, delirium in the ICU increases the risk of
mortality, increased length of stay, and postdischarge cognitive impairment. Impediments to sleep in the
ICU are multifold and extrinsic. That authors emphasize the factors, noise, light, and in-room patient care
activity as key sleep impediments that can be modified. The article uses evidence from other studies to
demonstrate that average hospital and ICU sound levels are excessive and disruptive to patients. In
addition, irregular light exposure can make critically ill patients more susceptible to circadian disruption,
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

which also contributes to further sleep disruption. Many hospital procedures impede on patients’ sleep
with little regard for patient health, making it difficult to come up with viable solutions to sleep
disruption. To this end, the article proposes the implementation of a 1-2 hour “naptime” to allow patients
to complete a full sleep cycle and attain at least a minor degree of rest.

This article will primarily be used in the conclusion of the researcher’s paper to establish a
concrete, realistic solution that benefits patients and does not impede significantly on hospital processes.
This article can also be utilized to prove that circadian misalignment has a causal relationship with sleep
disruption as sleep disruption can stem from and cause circadian disruption, creating a vicious cycle of
dysrhythmia. This article is unique because it is one of the first scholarly works to propose and carry out a
potential measure to promote sleep, especially in the ICU, where hospital procedures impede notoriously
on patient sleep.

McKenna, H., van der Horst, G. T. J., Reiss, I., & Martin, D. (2018). Clinical chronobiology: a timely
consideration in critical care medicine. Critical Care, 22. https://doi.org/10.1186/s13054-
018-2041-x

The circadian rhythms of the body are aligned with the sun and earth’s rotation, making it a diurnal process.
There are many clinical advantages to keeping the body in tune with the circadian rhythms. Keeping track
of the body’s circadian alignment and using this monitoring to find the right time for certain medications
or tests can more beneficial to a patient in a critically ill state. The physiological effects of circadian rhythm
disruption are well-known such as with jet-lag or shift work, but these applications are often forgotten when
dealing with sick patients, especially those in critical care, who are the most vulnerable to circadian rhythm
disruption. Many factors affect the master clock in the Suprachiasmatic Nucleus (SCN), known as
zeitgebers, such as light, temperature, food, and physical activity, which can also play a role in circadian
disruption. A patient’s chronotype, which is the behavioral result of an individual’s specific bodily rhythms,
is also vital to a personalized and chronobiology-based treatment approach. Since patients with life-
threatening diseases are much more susceptible to circadian disruption, which can weaken the immune
system among many other ramifications, it is important to identify the risk factors that are throwing off the
body’s cycles and then mitigate them. The primary zeitgeber in the ICU. where most critically-ill patients
is light. Blue light during the day increases alertness and performance, but blue light during the night
suppresses melatonin and disrupts the sleep-wake cycle. Light can be used favorably as a zeitgeber in
hospitals by having bright, blue light on during the day and little to no, dim orange light during the night.
This research journal fits exactly with the researcher's topic, making it an extremely useful source for
information and advisors. The applications of circadian rhythms to the hospital setting were particularly
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

intriguing since patients in a hospital should experience less circadian disruption that a healthy person, not
more. The information about chronotype coordination was also interesting, especially when used to
personalize treatment. Overall, this will be a fascinating and relevant resource that the researcher will utilize
in the future to narrow down my topic and gain more depth on chronobiology and chronotherapy in general.

Park, M. J., Yoo, J. H., Cho, B. W., Kim, K. T., Jeong, W.-C., & Ha, M. (2014). Noise in hospital rooms
and sleep disturbance in hospitalized medical patients. Environmental Health and Toxicology, 29.
https://doi.org/10.5620/eht.2014.29.e2014006

Sleep is an essential bodily process, especially in the hospital setting since it helps the body heal and
recover. However, in the hospital, there are many environmental factors that disrupt patients’ sleep cycle.
Other health problems have arisen due to this disruption and overall environmental duress. The
importance of sleep quality in hospitals has increased, but many issues still exist. Based on the study
conducted by the authors of the paper, environmental noise is one of the most prominent factors of sleep
disruption and is associated with longer hospital stays. An average of 50% of patients reported that sleep
latency, quality, and alertness and awareness after awakening were better at home than at the hospital.
Sleep-interfering medications had a negative correlation with sleep quality, but age did not. Most patients
thought the noise that interrupted them was from other patients’ caretakers and visitors or noises caused
by other patients’ themselves (e.g. snoring, eating, TV/phone, etc). The maximum sound level (63.6 dBA)
in the hospital where the study took place exceeded the WHO sound level maximum. Sounds from other
humans can be easily prevented or shut out, by closing doors, wearing earmuffs, or by using
headphones/earbuds. Patients associated high noise levels with being frequently woken up and not feeling
refreshed when waking up. These sleep disturbances can cause patients to use sleep-inducing drugs which
lengthen hospital stays. Thus, in order to improve the patient’s recovery and satisfaction, and shorten
hospitalizations, methods of noise reduction and control are necessary for the hospital setting.
This academic paper regarding a study conducted in a South Korean medical center is a necessary piece
in the researcher’s project. The data and correlations expressed in the article can be used in the
development and implementation of noise control techniques in the future. The large volume of data
collected also covers a variety of aspects of hospital life and helped give the researcher a more inclusive
perspective on sleep disruption in hospital patients. In conclusion, data in this paper is immensely useful
and will be utilized as a citation in the researcher’s own paper.

Samkoff, J. S., & Jacques, C. H. (1991). A review of studies concerning effects of sleep deprivation and
fatigue on residents’ performance. Academic Medicine, 66(11), 687. Retrieved from
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G/T Independent Research I / English 10 GT

https://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=1991&issue=11000&
article=00013&type=abstract

This abstract of a review paper details the possible effects of sleep deprivation and disruption, and it's
associated consequences, on the cognitive abilities of hospital residents. The study found that sleep loss
can impede on the ability to perform basic, routine tasks and tasks that require prolonged vigilance. This
shows that acute sleep loss can have potentially drastic effects on the residents’ health and performance,
placing themselves and others around them at risk of injury or careless errors. In addition, since a large
portion of residents’ tasks require watching patients or other tasks that require excessive vigilance,
patients are also put at risk if their residents area deprived of sleep.

This abstract has many implications for the researcher’s project. The effects of sleep deprivation and
disruptions on hospital residents can also be extended to apply to hospital patients, since all individual's
face similar consequences when deprived of sleep. The cognitive impairment resulting from acute sleep
loss identified in the article can be used to support the researcher’s second control which proves that sleep
disruption causes delirium and cognitive impairments. However, the researcher is only to access the
abstract of this article and cannot fully comprehend the full scope of the review itself and the full range of
factors involved. This drawback forces the researcher to cross-reference the effects of sleep loss
introduced here with those of other scholarly articles to ensure scientific accuracy.

Sulli, G., Manoogian, E. N. C., Taub, P. R., & Panda, S. (2018). Training the Circadian Clock, Clocking
the Drugs, and Drugging the Clock to Prevent, Manage, and Treat Chronic Diseases. Trends in
Pharmacological Sciences, 39(9), 812–827. https://doi.org/10.1016/j.tips.2018.07.003

Sleep disorders and problems have been traditionally treated with drugs with a short half-life which has
little to no effect on the overall rhythmicity of the body, thus they do not provide any long-term sleep
solutions. Slow-acting therapies, such as exogenous melatonin, can be used to strengthen the circadian
rhythmicity overall and result in better sleep. Light has also been proven to be a major circadian zeitgeber,
especially blue light, which during the day can increase alertness and focus, but disrupts the sleep-wake
cycle at night and reduces the urge to sleep at night. The influence of light on the body rhythms is called
circadian photoentrainment, which can work for or against the body, depending on its utilization. For
example, many hospitals, homes, and other building keep their lights on late into the night, decreasing the
efficiency of the workers or residents there. Therefore, the presence of light can be used to “wake oneself
up” or focus better during the day, and the absence of light can facilitate lower sleep latency. In addition,
confining eating to a specific period of time during the day, called time-restricted feeding (TRF), is a viable
 Dev Patel
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G/T Independent Research I / English 10 GT

method of optimizing circadian rhythmicity. Many health problems are alleviated through the use of
medications which are to be taken at a certain time in order to try to relieve the symptoms of a condition
when they are at their worst during the day. These time-based medications are especially prominent in
cancer-related conditions. Also, timing the ingestion of a drug according to the body’s circadian rhythms
to increase efficiency and relieve inflammation or other symptoms that have connections in the body clock
is a new, groundbreaking area of research as well.
This journal was sent to the researcher by a professional in the field, giving it authenticity and credibility
and will greatly benefit the research project as a whole. This journal also fits exactly within the scope of
the chosen topic and will be used often for relevant details, correlations, and to cross-check other sources.
This article will be used primarily in the second control of the researcher’s paper, since it claims that
circadian misalignment stems from sleep disruption.

Tamburri, L. M., DiBrienza, R., Zozula, R., & Redeker, N. S. (2004). Nocturnal Care Interactions with
Patients in Critical Care Units. American Journal of Critical Care, 13(2), 102–113. Retrieved
from http://ajcc.aacnjournals.org/content/13/2/102

This article details a study that focuses nighttime nurse interventions that disrupt sleep in the
hospital setting. The consequences of sleep disruption include suppression of the immune system,
cognitive impairment, delayed healing, and increased stress. The main causes of sleep disruption are also
identified in the article as light, noise, and frequent nighttime staff interactions. This article seeks to
determine the specific patterns and occurrences of these nocturnal nurse interventions and propose the
clustering of these interventions accordingly in order to allow patients the maximum uninterrupted sleep.
The study finds that nighttime interactions occur frequently throughout the night, rarely allowing a patient
to complete even one sleep cycle, since constant interventions are required in order to check the vital
signs of a patient to ensure their safety. The deprivation of sleep at night leads to increased daytime
sleeping which in turn leads to circadian disruption. These issues demonstrate the need to explore
efficiency and safety of clustering nocturnal interactions and technology to constantly show a patient's
vital signs and other biological data so these interventions are not required.

This article will be used throughout the researcher’s paper due to the large range of consequences,
solutions, and methods discussed. The researcher will primarily use this article as evidence to prove that
sleep disruption is a serious problem in hospitals and to recommend further exploration in the topic of
clustering or replacement of nocturnal nurse interventions. This paper contained logical claims and it was
easy for the researcher to follow the author’s train of thought.
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

Tamrat, R., Huynh-Le, M.-P., & Goyal, M. (2014). Non-pharmacologic interventions to improve the
sleep of hospitalized patients: a systematic review. Journal of General Internal Medicine, 29(5),
788–795. https://doi.org/10.1007/s11606-013-2640-9

This abstract of a study states that although sleep deprivation is widely regarded as an
impediment to the recovery process, it is still an unresolved issue in hospital patients for whom the
recovery process in vital. In many hospital environments, sedatives are administered to patients who
suffer delayed sleep latency. However, sedatives are known to lead to delirium, so the authors of the study
emphasize that behavioral interventions are preferable to pharmacological therapies (sedatives). This
study seeks to determine potential non-pharmacological solutions to the prevalence of sleep disruption
and deprivation in intensive and non intensive hospital patient's.

This abstract will be useful in the introduction and conclusion of the researcher’s paper due to it’s
role in proving that sleep disruption and deprivation are viable issues that deserve action in order to
facilitate the quick and effective recovery in countless hospital patients. However, the researcher is only
to access the abstract of this articles and cannot fully comprehend the technical intricacies of the study
itself and the full range of factors involved. This drawback forces the researcher to cross-reference the
claims introduced here with those of other scholarly articles to ensure scientific accuracy.

Van Dongen, H. P. A., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The Cumulative Cost of
Additional Wakefulness: Dose-Response Effects on Neurobehavioral Functions and Sleep
Physiology From Chronic Sleep Restriction and Total Sleep Deprivation. Sleep, 26(2), 117–126.
https://doi.org/10.1093/sleep/26.2.117

This article details a study which intends to determine the neurobehavioral effects of prolonged
sleep deprivation. Although it is common knowledge that a lack of sleep inhibits the body’s abilities to
function efficiently, little is known about the specific effects of total sleep deprivation. This study seeks to
determine and compare the consequences of partial sleep deprivation and total sleep deprivation on the
human body’s ability to function properly. Since the chronic restriction of sleep between 4 h and 6 h per
night for 14 days produced cognitive performance deficits comparable to those found under conditions of
1 to 2 days of total sleep deprivation, the authors suggest that even relatively moderate sleep loss, if
repeated nightly, can seriously impair waking cognitive functions in even healthy young adults. These
results have serious implications for individuals with careers or lifestyles that require chronic sleep
restriction, such as shift workers or hospital personnel.
 Dev Patel
1/29/19
G/T Independent Research I / English 10 GT

This article contains useful evidence that will be utilized primarily in the third control of the
researcher’s paper, which claims that sleep disruption and deprivation lead to delirium and impaired
cognitive and neurobehavioral function. This article is very in-depth and includes many crucial details
that will supplement the overall accuracy and narrow the scope of the researcher’s project.

Weinhouse, G. L., Schwab, R. J., Watson, P. L., Patil, N., Vaccaro, B., Pandharipande, P., & Ely, E. W.
(2009). Bench-to-bedside review: Delirium in ICU patients - importance of sleep deprivation.
Critical Care, 13(6), 234. https://doi.org/10.1186/cc8131

This article reviews key literature regarding delirium and sleep disruption in the hospital setting.
Delirium occurs frequently in critically ill patients and has been associated with both short-term and long-
term consequences. Efforts to decrease delirium prevalence have been directed at identifying and
modifying its risk factors. One potentially modifiable risk factor is sleep deprivation. Critically ill patients
are known to experience poor sleep quality with severe sleep fragmentation. Poor sleep while in the
intensive care unit is one of the most common complaints of patients who survive critical illness.
However, studies have demonstrated many similarities between the clinical and physiologic profiles of
patients with delirium and sleep deprivation. Sleep deprivation may prove to be a modifiable risk factor
for the development of delirium with important implications for the acute and long-term outcome of
critically ill patients.

This review paper contains evidence that can be utilized in the third control, which claims that
sleep disruption plays a major role in the development of delirium. Since this article aims to find a
correlation between sleep disruption and delirium in the ICU, the majority of the information in the article
will be used to supplement or at least mold the course of the researcher’s project. In addition, this article
has a flow between claims, reasoning, and evidence, making it convenient for the researcher to identify
necessary information in an efficient manner.