Hospitalized Patients

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The harmful effect of sleep deprivation is particularly important for people with high risk of infection, such as hospitalized, burn victims and elder patients. In addition, it is known that surgical patients suffer from severe sleep disruptions during postoperative period, such that major surgical procedures result in approximately 20% reduction in slow wave sleep and a complete abolition of REM sleep (Rosenberg-Adamsen, Kehlet, Dodds, and Rosenberg 1996; Cronin, Keifer, Davies, King, and Bixler 2001), even with nonopioid pain control, since opioids are known to alter sleep pattern (Kay, Eisenstein, and Jasinski 1969; Knill, Moote, Skinner, and Rose 1990).

Despite the paucity of data, burned victims, especially those with extensive burning, show an intense change in sleep pattern. A single study assessed the sleep of burn victims by polysomnography and reports reduction of slow wave sleep and of REM sleep, in addition to increased awakenings (Gottschlich et al. 1994). A questionnaire-based study reveals that burned children complain of sleep disturbances, especially nightmares, for as long as one year following hospital discharge (Kravitz et al. 1993). An extensive review (Rose, Sanford, Thomas, and Opp 2001) explores in detail the factors that may alter the sleep in burned children, which include metabolic and hormone alterations, medicine (opioids), pain, and hospital environment are some of these factors. To the best of our knowledge there is no study in which the correlation between sleep disorder-induced immune deficiencies in burned victims and the patient's evolution. Nonetheless, chronic disrupted sleep is known to delay some recovery processes, such as tissue wound healing. Indirect evidence indicate that sleep is crucial for tissue repair, insofar as major repairing factors, such as protein synthesis, cell division and growth hormone secretion, are augmented during sleep. Empirical data show that women exposed to short period of sleep deprivation exhibit an impairment of skin barrier homeostasis. The authors attribute this result to increased production of proinflammatory cytokines induced by sleep deprivation (Altemus, Rao, Dhabhar, Ding, and Granstein 2001), although in rats, sleep deprivation failed to impair the wound healing in rats submitted to tissue biopsy (Mostaghimi, Obermeyer, Ballamudi, Martinez-Gonzalez, and Benca 2005). This discrepancy is very likely attributable to the species-specific factors and to differences in the type of wound healing process. Despite this controversy, it is undisputable that stress is a harmful factor for tissue repair (Padgett, Marucha, and Sheridan 1998; Marucha, Kiecolt-Glaser, and Favagehi 1998).

Finally, there is no doubt that sleep deprivation makes the organism more vulnerable to opportunistic infections, which is a common condition in burned victims. The extensive literature points out to the impair of major immune parameters, including increased size of lymph nodes and of proliferation of several bacteria species in sleep-deprived rats (Everson and Toth 2000). Bacterial infection in a healthy, undamaged tissue, suggests that sleep deprivation produces an insufficient immune response that results in a disease susceptible organism.

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