Quantifying sleep wake rhythms in the hospital environment with digital technologies.

Authors

• Carsten Skarke
• Nadim El Jamal
• Michael V Genuardi
• Thomas G Brooks
• Antonijo Mrčela
• Nicholas F Lahens
• Makayla Cordoza
• Sean Sarles
• Amarachi Mbadugha
• Dineth R Karunamuni
• Shikhar Gupta
• Charles J Bae
• Amita Sehgal
• Thomas P Cappola
• Jacob T Gutsche
• Pavan Atluri MDFollow
• Nimesh D Desai
• Michael A Acker
• Gregory R Grant
• Richard J Schwab
• Ilene M Rosen
• Garret A FitzGerald

Publication/Presentation Date

4-21-2026

Abstract

Postoperative clinical care is prone to circadian desynchronization that may influence health outcomes. In an exploratory, feasibility-oriented and signal-exploration effort, we collected 1.8 million data points using 11 remote sensors during preoperative, in-hospital and post-discharge settings in 13 elective cardiac surgery patients (5.2% enrolled from 252 screened). We found that room traffic continued during nighttime with ≥1 visit/h. Sound levels exceeded the recommended 45 dBA threshold (51.9 ± 3.3 vs. 48.3 ± 4.2 dBA during nighttime). Brightness dropped at night (89.9 ± 87.7 to 3.7 ± 9.8 lux), but bright light exposures occurred. Ambient room temperature lacked sleep-inducing diurnal variability. Behavioral-physiological rhythms were disrupted and phase-shifted during hospitalization. Time awake during night hours increased from 10.7 ± 7.9% preoperatively to 34.8 ± 29.1% in-hospital. Cognitive function scores decreased (26.8 ± 2.8 points preoperatively to 24.7 ± 3.9 points in-hospital) with 31% of patients developing transient mild impairment. These data will inform the design of a controlled trial seeking to modify circadian/diurnal disruptors to enhance patient outcomes. Clinicaltrials.gov NCT05828680, November 21, 2022.

ISSN

2398-6352

Published In/Presented At

Skarke, C., El Jamal, N., Genuardi, M. V., Brooks, T. G., Mrčela, A., Lahens, N. F., Cordoza, M., Sarles, S., Mbadugha, A., Karunamuni, D. R., Gupta, S., Bae, C. J., Sehgal, A., Cappola, T. P., Gutsche, J. T., Atluri, P., Desai, N. D., Acker, M. A., Grant, G. R., Schwab, R. J., … FitzGerald, G. A. (2026). Quantifying sleep wake rhythms in the hospital environment with digital technologies. NPJ digital medicine, 10.1038/s41746-026-02639-w. Advance online publication. https://doi.org/10.1038/s41746-026-02639-w

Disciplines

Medicine and Health Sciences

PubMedID

42014445

Department(s)

Department of Surgery

Document Type

Article