Sleep Variability From Routine Nursing Observation and Wearable Actigraphy and Post-Enrollment Length of Stay in Acute Psychiatric Inpatients: Prospective Observational Study
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Background
Length of stay (LOS) in acute psychiatric inpatient settings is clinically and operationally impo rtant, but practical early markers for identifying patients at risk for prolonged hospitalizatio n remain limited.
Objective
To evaluate whether sleep instability measured during the early inpatient observation period was associated with prolonged post-enrollment hospitalization in acute psychiatric inpat ients.
Methods
This observational study included 94 consecutive patients admitted to an acute psychiatric inpat ient unit. Monitoring began after study enrollment, and participants contributed 5 to 7 available nightly observations from wrist actigraphy and routine nursing observation; observations were not required to occur on consecutive calendar days. The primary exposure was intraindividual sleep variability (IIS V), defined as the within-subjec t standard deviation of nightly total sleep time across available post-enrollment observations. The primary outcome was prolonged post-enrollment length of stay, defined using the 75th percentile of the cohort distribution. Age- and sex-adjusted logistic regression models evaluated associations, discrimination, calibration, and risk stratification. Total length of stay from admission was examined as a temporally distinct sen sitivity estimand.
Sleep instability measured during the early inpatient observation period, derived independently from wearable actigraphy and from routine nursing sleep documentation, was associated with prolonged post-enrollment hospitalization. Because the outcome interval overlaps the period during which the sleep observations were accumulated, these findings describe an association across the early inpatient course rather than a prediction made at enrollment. The results support further evaluation of repeated sleep variability as a longitudinal inpatient measure; the variable observation schedule, single-center sample, and absence of external validation mean that clinical implementation remains premature.
