Comparison of Objective and Subjective Sleep Time and Quality in Hospitalized Recipients of Hematopoietic Stem Cell Transplantation

Abstract PurposeThis study investigated the sleep time and efficiency of recipients of hematopoietic stem cell transplantation (HSCT) throughout treatment and compared objective measurements with subjective self-reported data.MethodsSleep time and efficiency were measured using both objective and subjective methods throughout the treatment period in inpatients receiving HSCT. The participants were recruited among HSCT inpatients at a tertiary hospital in Seoul, South Korea, between August 2019 and August 2020. Actigraphy was used to measure objective sleep time and efficiency, and patients self-reported their sleep time during the same periods. Sleep quality was measured using the Insomnia Severity Index (ISI).ResultsMeasurement data from 40 patients were analyzed. The objective total sleep time was the lowest in the conditioning period, and there was a significant gap between treatment time points after accounting for the corresponding differences in measurement methods. There were no significant differences between subjective and objective results for sleep time (p=0.414), and the interaction between the two methods over time was not significant (p=0.345). However, meaningful differences were found among the groups in sleep efficiency throughout the treatment period (p= 0.001) and between objective and subjective methods (p<0.001), as well as a statistically significant interaction between the two methods over time (p= 0.002).Conclusion.Actigraphy misclassified patients’ low-energy state with little movement due to immune system impairment during treatment as sleep, resulting in high measured sleep efficiency, whereas their self-reported sleep efficiency was very low. Therefore, subjective measures might be more accurate for measuring sleep efficiency in HSCT patients.