Dreaming of better care: Measuring, understanding and improving sleep in hospitalized patients

This dissertation examines the measurement, management, and underlying determinants of sleep in clinical care, with a particular focus on hospitalized patients. It combines systematic, interventional, and observational approaches to explore how sleep can be supported through technology, clinical routines, and medication review. Chapter 2 presents a systematic review of EEG-based wearable devices for sleep monitoring. Thirty-four unique devices were identi????ed, showing promising accuracy in sleep staging and good feasibility for at-home use. These ????ndings suggest that wearable EEG offers a viable alternative to polysomnography, particularly in large-scale or real-world settings. Chapter 3 explores inpatient benzodiazepine prescribing patterns in over 700 hospitalized patients. A clear pattern emerged: while newly initiated benzodiazepines were usually discontinued at discharge, pre-admission use was rarely reassessed. This highlights a missed opportunity to review chronic use during hospitalization, especially given the known risks associated with long-term benzodiazepine use. Chapters 4 and 5 evaluate a multicomponent non-pharmacological sleep intervention in medical and surgical wards, the WEsleep study. Among medical patients, the intervention improved subjective sleep quality, demonstrating that environmental and behavioral adjustments can be effective in certain hospital settings. However, no bene????t was seen among surgical patients, underscoring the need for context-speci????c strategies that account for clinical complexity and work????ow constraints. Chapter 6 investigates the relationship between serum estradiol levels and sleep parameters in a large general population cohort. No consistent associations were found, suggesting that under physiological conditions, estradiol is not a major determinant of sleep quality or timing. Together, these studies emphasize that improving sleep in clinical settings requires more than technological solutions or isolated interventions. It demands a systems-based approach— one that includes accurate measurement tools, thoughtful prescribing practices, and tailored strategies that align with patient needs and clinical realities.