448 - Understanding and Managing the Impact of Shift-Worker Sleep Disorder on Acute Inpatient Rehabilitation

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Jessie P. Chan, MD (she/her/hers)

Resident Physician
JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States

Co-Author(s)

SJ

Stacey Jou, MD

Resident
JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States
IJ

Iqbal Jafri, MD

Attending Physician
JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States

Case Diagnosis: Shift-worker sleep disorder

Case Description: A 75-year-old night-shift-working male was admitted to acute inpatient rehabilitation for metabolic encephalopathy and deficits in activities of daily living following cardiogenic shock requiring extracorporeal membrane oxygenation. Acute hospitalization was complicated by dysphagia requiring percutaneous gastrostomy tube (PEG) placement. Rehabilitation course was complicated by daytime sleepiness, delirium, and verbal and physical agitation secondary to circadian misalignment impacting participation in therapies. He was prescribed daytime depakote sprinkles for agitation and nightly melatonin and trazodone for sleep; family was often present to assist with reorientation. Within one week, his sleep-wake cycle corrected, and delirium and agitation improved. He began to tolerate and participate in all therapies. By discharge to home he had progressed from tube feeds via PEG and total assistance for functional mobility and ADLs to regular solid, thin liquid oral diet, supervision for community ambulation, supervision with setup assistance for ADLs, and contact guard for transfers.

Discussions: Sleep is fundamental to recovery from injury or illness. Research has demonstrated that sleep deprivation hinders rehabilitation by diminishing functional improvements. Sleep deprivation in the inpatient rehabilitation population is also associated with increased mortality within 1 year after acute rehabilitation. There are no physiatry-focused studies on shift-worker sleep disorder and how to optimally manage its effects on rehabilitation outcomes, although occupational health research has found correlations between shift-worker sleep disorder and the negative effects on physical and mental health associated with sleep loss. In this patient, a combination of medications and regular reorientation were effective methods to treat shift-worker sleep disorder.

Conclusions: This case report underscores the importance of identifying and promptly addressing potential barriers to participation in therapies. This patient’s decadeslong history of night shift work and resulting circadian misalignment were effectively managed with pharmacological and nonpharmacological interventions in order to maximize his functional outcomes in acute rehabilitation.