Divergent sleep stage responses to hospitalization in pediatric inpatients: A wearable study of environmental, temporal, and demographic modulators.

BACKGROUND

Sleep is crucial for pediatric recovery, but quantitative evidence on how hospitalization characteristics affect objectively measured sleep architecture is limited. This study used consumer wearables to examine how environmental, temporal, and demographic factors affect specific sleep stages.

METHODS

We conducted continuous sleep monitoring via wrist-worn wearables in 61 hospitalized children and adolescents, collecting 200 daily records. Multimodal analyses assessed associations between room occupancy, hospitalization duration, demographic factors (gender/age), and key sleep metrics.

FINDINGS: Environmental factors: Each additional occupant was associated with a 5.762- min reduction in light sleep duration (β = -5.762, p = 0.004) and a 3.813-min increase in REM sleep duration (β = +3.813, p = 0.002). High-density rooms (with >4 occupants) were further linked to longer daytime nap duration (p = 0.022). Temporal factors: Wakefulness duration followed a U-shaped pattern across hospitalization duration, peaking in both short-stay (1-3 days) and extended-stay (≥ 8 days) groups, with significantly lower wakefulness in the medium-stay group (4-7 days, p = 0.006). Demographic factors: Females exhibited longer deep sleep duration compared to males (p = 0.023). No significant differences were observed across age groups (all p > 0.05)

CONCLUSION

Room occupancy, length of stay, and gender were each associated with distinct alterations in specific sleep stages among pediatric inpatients.

IMPLICATIONS TO PRACTICE: Reducing the use of high-density rooms and implementing dynamic, gender-sensitive sleep care protocols may help preserve restorative sleep. These environmental and temporal factors can be incorporated into the design of daily care routines and ward layouts.