Abstract
Sleep plays a vital role in pediatric health, particularly for hospitalized children. Sleep disruption is common among hospitalized children and may affect recovery and well-being, with both patients and their parents experiencing reduced sleep duration and fragmented sleep patterns compared with the home environment. Prolonged sleep disturbance during hospitalization has been associated with impaired recovery, emotional distress, and adverse developmental and behavioral outcomes. Environmental factors within hospital settings, including noise from alarms, pain, medical equipment, staff conversations, and routine nighttime care activities, are well-recognized contributors to sleep disruption in pediatric inpatients. Research has indicated that healthcare workers may lack sufficient knowledge about sleep. Despite growing awareness of the importance of sleep for child health, formal education on sleep-supportive practices remains limited among healthcare professionals. Insufficient training may contribute to uncertainty in implementing effective sleep-promoting strategies in hospital environments. This study aimed to assess pediatric healthcare providers’ knowledge, attitudes, and practices toward sleep in hospitalized children and to explore factors associated with sleep-related knowledge and perceptions. A cross-sectional study was conducted at King Abdullah Specialised Children’s Hospital, a large tertiary care hospital in Riyadh, Saudi Arabia. Data were collected through the validated Potential Hospital Sleep Disruption and Noise Questionnaire (PHSDNQ), then analyzed via IBM SPSS version 29.0.0 between March 1st 2024 and June 30 2024. We included 200 participants; mean age 28.9 ± 6.4 years. Drawing blood (3.36 ± 0.71) and pain (3.31 ± 0.74) were the two highest-rated sleep disruptors. Closing doors (61%) and reducing unnecessary alarms (55%) were rated “very effective.” Sleep-education hours were significantly associated with higher knowledge (p = 0.022). Participants recognized the importance of inpatient sleep and endorsed simple environmental strategies. However, limited sleep education suggests a need for training programs to enhance practical approaches to promote better sleep-in pediatric inpatients.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-026-36703-y.
Keywords: Pediatric settings, Sleep deprivation, Sleep disruption, Knowledge, Attitude, Perception
Subject terms: Paediatric research, Health care
Introduction
Sleep is a fundamental biological process that plays a critical role in physical growth, neurocognitive development, emotional regulation, and immune function in children. Adequate and high-quality sleep is particularly important during illness, as it supports recovery, tissue repair, and overall well-being. However, hospitalized children are especially vulnerable to sleep disruption due to unfamiliar environments, acute illness, psychological stress, pain, and frequent clinical interventions. Previous studies have consistently shown that pediatric inpatients experience shorter sleep duration and poorer sleep quality than at home, which may negatively affect recovery and prolong hospital stay1–3,13,19,20.
Environmental and organizational factors within hospital settings are among the most common contributors to sleep disruption. Noise from medical equipment, alarms, staff conversations, routine vital sign checks, and diagnostic procedures has been identified as a major source of sleep fragmentation in pediatric wards and intensive care units4–6. In addition to environmental noise, emotional factors such as anxiety, fear, and separation from familiar surroundings further impair sleep quality in hospitalized children. These disturbances not only affect patients but also extend to parents and caregivers who remain at the bedside, potentially compromising their ability to support their child’s recovery.
Healthcare workers play a central role in both contributing to and mitigating sleep disruption in hospital environments. Staff-related activities, including nighttime procedures, alarm management, and communication practices, directly influence pediatric patients’ sleep experience. Despite growing recognition of the importance of sleep in clinical care, several studies have shown that healthcare professionals often have limited formal education and training in sleep health. Knowledge gaps and uncertainty regarding practical sleep-promoting strategies may hinder the implementation of effective interventions, even when providers acknowledge the importance of sleep for recovery7–9.
Although international studies have explored healthcare workers’ knowledge, attitudes, and practices regarding pediatric sleep in hospital settings, data from Saudi Arabia and the wider Middle East remain scarce. Understanding healthcare providers’ perspectives is essential for identifying gaps in knowledge and practice and for guiding targeted educational initiatives and institutional policies. Therefore, this study aimed to assess pediatric healthcare providers’ knowledge, attitudes, and practices toward sleep in hospitalized children and to explore factors associated with sleep-related knowledge and perceptions within a tertiary care pediatric hospital in Saudi Arabia.
Methodological overview
This cross-sectional observational study was conducted at King Abdullah Specialized Children’s Hospital, a large tertiary healthcare facility in Saudi Arabia, from March 1 2024 to June 30 2024. The participants were selected via convenience sampling method. Inclusion criteria: Pediatric residents, nurses, fellows, consultants, and allied healthcare staff working in pediatric wards, PICU, HDU, or outpatient clinics. Exclusion criteria: Interns, rotating non-pediatric specialties, administrative staff, and participants who submitted incomplete questionnaires.
Ethical considerations
Ethical approval was obtained from King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (IRB No: IRB/0192/23). Written informed consent was obtained from all participants prior to participation. Confidentiality and privacy were maintained throughout the study; no identifiers were collected, and data were stored securely within King Abdulaziz Medical City premises. All methods were performed in accordance with relevant guidelines and regulations and in compliance with the Declaration of Helsinki.
Sample size
The required sample size for this cross-sectional survey was calculated using Cochran’s formula: 
. Because no prior estimate of the proportion of adequate knowledge was available, we used p = 0.50, which yields the maximum required sample size and is recommended for conservative estimation. Using a 95% confidence level (Z = 1.96) and a margin of error of 0.07, the minimum required sample was 196 participants. We successfully enrolled 200 participants, exceeding this requirement.
Questionnaire structure and scoring
Data were collected through a validated modified version of the Potential Hospital Sleep Disruption and Noise Questionnaire (PHSDNQ)2. This survey comprised four domains: Knowledge (10 items), Attitudes/Perceptions (11 items), Perceived effectiveness of environmental interventions (12 items), and Practices (6 items). Knowledge and Attitudes items were rated on a 4-point Likert scale (1 = Strongly disagree, 2 = Disagree, 3 = Agree, 4 = Strongly agree). Effectiveness items used a 3-point scale (Very effective/Effective/Ineffective or unsure). Practices were recorded as Yes/No. Knowledge items were summed into a composite score. Participants scoring above the 50th percentile were classified as ‘high knowledge’. Effectiveness of interventions was rated on a 3-point scale (very effective/effective/ineffective or unsure). A detailed blueprint of the questionnaire, including the number of items per domain, response scales, scoring method, and reliability metrics, is presented in Supplementary Table S1, and the verbatim item list for each domain is provided in Supplementary Table S2. A pilot test was conducted with 10 pediatric healthcare workers to ensure clarity and comprehension of the adapted questionnaire. The pilot data were not included in the final analysis. Internal consistency reliability was assessed for the modified questionnaire. Cronbach’s alpha was 0.81 for the knowledge items and 0.78 for the attitudes/perceptions scale, indicating good reliability. A composite knowledge score was calculated by summing responses to knowledge-related items. For analysis, this score was dichotomized at the 50th percentile to classify participants into ‘high’ versus ‘low’ knowledge groups. Binary logistic regression analysis was performed to identify independent predictors of higher knowledge classification. Covariates included age, gender, professional role, years of experience, parenthood status, hospitalization history, and hours of sleep education. The outcome measures included knowledge about pediatric sleep practices, identification of sleep-disrupting factors, and familiarity with interventions to improve sleep quality in the hospital setting.
Statistical analysis
Data analysis was performed via IBM SPSS version 29.0.0. Descriptive statistics summarized the demographic characteristics and responses using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Inferential statistical tests were employed to explore associations between participant characteristics and knowledge or attitudes regarding sleep. These tests included Chi-square and Fisher’s Exact Tests for categorical variables, independent sample t-tests and ANOVA for continuous data. Logistic regression models were also used to identify predictors of higher knowledge levels. A two-sided p-value of less than 0.05 was considered statistically significant throughout the analysis.
Results
The study included 200 participants, 140 females (70.0%) and 60 males (30.0%). Most participants age 20–30 years (n = 116, 58.0%), followed by those aged 30–40 years (n = 57, 28.5%). The majority were pediatric residents (n = 84, 42.0%) and pediatric nurses (n = 72, 36.0%). The mean professional experience was 6.4 years (SD = 6.1), ranging from less than 1 to 30 years. Most participants had never been hospitalized (n = 124, 62.0%), and 139 (69.5%) were not parents. Among those with children, 27 (31.4%) reported that their child had been hospitalized. With respect to sleep education, 121 (60.5%) participants received 0–5 h. 102 (51.0%) deemed this inadequate. Ninety-three (46.5%) addressed sleep-related issues 1–3 times/month (Table 1).
Table 1.
Sociodemographic and other parameters of the participants (n = 200).
| Parameter | Frequency N (%) | |
|---|---|---|
| Gender | Female | 140 (70.0%) |
| Male | 60 (30.0%) | |
| Age | 20–30 Years | 116 (58.0%) |
| 30–40 Years | 57 (28.5%) | |
| 40–50 Years | 20 (10.0%) | |
| 50–70 Years | 7 (3.5%) | |
| Pediatric Caregivers | Pediatric Consultant/Fellows | 30 (15.0%) |
| Pediatric Nurse | 72 (36.0%) | |
| Pediatric Resident | 84 (42.0%) | |
| Other Pediatric Fields* | 14 (7.0%) | |
| Year of Experience in Profession | Mean (SD) | 6.4 (6.1) |
| Range | < 1–30 | |
| Have You Ever Hospitalized | No | 124 (62.0%) |
| Yes | 76 (38.0%) | |
| Are you a Parent? | No | 139 (69.5%) |
| Yes | 61 (30.5%) | |
| Was your child Ever Hospitalized? | No | 59 (68.6%) |
| Yes | 27 (31.4%) | |
| No. of hours of Sleep Education received throughout the entire School Curriculum | 0–5 h | 121 (60.5%) |
| 5–10 h | 72 (36.0%) | |
| 10–15 h | 7 (3.5%) | |
| Is this an adequate amount of sleep-education training? | No | 102 (51.0%) |
| Not Sure | 38 (19.0%) | |
| Yes | 60 (30.0%) | |
| What is the frequency of addressing sleep-related issues in clinical practice? | Never/Seldom (< 1/Month) | 64 (32.0%) |
| Sometime (1–3/Month) | 93 (46.5%) | |
| Often (> 1/Week) | 43 (21.5%) | |
*Other pediatric fields included dietitians, respiratory therapists, and child-life specialists working in pediatric units.
Major key knowledge items related to sleep-disturbing factors are summarized (Table 2).
Table 2.
Selected knowledge items (5 of 10 items show major key knowledge).
| Knowledge Item | Mean (SD) | Very High/ High N (%) |
Moderate N (%) | Low N (%) |
|---|---|---|---|---|
| Drawing blood or tests disrupt sleep | 3.36 (0.71) | 152 (76%) | 34 (17%) | 14 (7%) |
| Pain disrupts sleep | 3.31 (0.74) | 148 (74%) | 38 (19%) | 14 (7%) |
| Alarms disrupt sleep | 3.10 (0.81) | 128 (64%) | 54 (27%) | 18 (9%) |
| Noise from staff/equipment affects sleep | 3.06 (0.79) | 130 (65%) | 50 (25%) | 20 (10%) |
| Vital sign checks disturb sleep | 2.98 (0.82) | 110 (55%) | 60 (30%) | 30 (15%) |
Knowledge domain contains 10 items rated on a 4-point Likert scale (1–4). Only the most clinically relevant items are presented here; the full list of 10 items is available in Supplementary Table S2.
The attitudes and perceptions of the participants toward child and parent sleep were discussed. For children, the importance of adequate sleep for a child’s health had a mean score of 3.74 (SD = 0.604), with a median score of 4, indicating substantial agreement. The participants believed that children sleep less in the hospital than at home, with a mean of 3.38 (SD = 0.753) and a median of 4. There was moderate agreement regarding how many hours pediatric patients need to sleep (mean = 3.03, SD = 0.795, median = 3). The participants agreed that maximizing pediatric sleep aids recovery (mean = 3.43, SD = 0.712, median = 4) but felt less confident in knowing how to help children sleep better in the hospital (mean = 2.69, SD = 0.823, median = 3). They were somewhat neutral in their efforts to help children sleep (mean = 3.11, SD = 0.792, median = 3). With respect to parental sleep, participants moderately agreed that adequate sleep for parents is essential for their child’s health (mean = 3.36, SD = 0.722, median = 3) and that parents sleep less in the hospital (mean = 3.43, SD = 0.740, median = 4). There was less certainty about the importance of maximizing parent sleep for child recovery (mean = 3.16, SD = 0.790, median = 3). Confidence in helping parents sleep better in the hospital was low (mean = 2.57, SD = 0.818, median = 3), and participants felt only moderately engaged in assisting parents to sleep (mean = 2.89, SD = 0.807, median = 3). (Tables 3 and 4).
Table 3.
Attitude and perception of participants toward child and parents sleep (n = 200) **.
| Child’s Sleep | Mean (SD) | Median |
|---|---|---|
| Getting adequate Sleep is important for a child’s health | 3.74 (0.604) | 4 |
| Children get less Sleep in the hospital than at Home | 3.38 (0.753) | 4 |
| I know how many hours my pediatric patient needs to sleep per night. * | 3.03 (0.795) | 3 |
| Maximizing pediatric patient’s Sleep in the hospital is important in helping them recover | 3.43 (0.712) | 4 |
| I feel confident in helping pediatric patients sleep better in the hospital. | 2.69 (0.823) | 3 |
| I am doing what I can to help pediatric patients sleep in the hospital | 3.11 (0.792) | 3 |
| Parental Sleep | Mean (SD) | Median |
|---|---|---|
| A parent getting adequate Sleep is important for his or her child’s health | 3.36 (0.722) | 3 |
| Parents get less Sleep in the hospital than at home | 3.43 (0.740) | 4 |
| Maximizing parent sleep in the hospital is important in helping children recover | 3.16 (0.790) | 3 |
| I know how to help parents sleep better in the hospital | 2.57 (0.818) | 3 |
| I am doing what I can to help parents sleep in the hospital | 2.89 (0.807) | 3 |
*Children typically require 9–12 h of sleep depending on age and decrease as they grow up reaching adolescence.
**Total attitudes score possible range: 11–44.
Table 4.
Practices used by participants to address sleep issues (n = 136 who frequently encounter sleep disturbances).
| Practice | n (%) |
|---|---|
| Providing sleep-hygiene advice | 105 (77.2%) |
| Using melatonin or sleep medications | 85 (62.5%) |
| Behavioral interventions | 83 (61.0%) |
| Light therapy | 58 (42.6%) |
| Referring to a sleep clinic | 25 (18.4%) |
| Other interventions | 6 (4.4%) |
Participants’ knowledge of the effectiveness of various interventions to reduce noise at night in the hospital was assessed. Staff education was rated as “Very Effective” by 83 participants (41.5%) and “Effective” by 103 (51.5%), with only 14 (7.0%) being unsure or considering it ineffective. Posting signs about noise reduction were considered “very effective” by 67 participants (33.5%) and “Effective” by 94 (47.0%), whereas 39 (19.5%) were unsure or found it ineffective. Turning pagers to vibrate was rated “Very Effective” by 56 participants (28.0%) and “Effective” by 81 (40.5%), but 63 (31.5%) were unsure. Turning down phone ringers was seen as “Very Effective” by 64 (32.0%) and “Effective” by 101 (50.5%), with 35 (17.5%) unsure. Lowering staff voices was rated “Very Effective” by 79 (39.5%) and “Effective” by 99 (49.5%), with 22 (11.0%) being unsure. Closing patient doors was viewed as the most effective intervention, with 122 (61.0%) rating it as “Very Effective” and 69 (34.5%) as “Effective”. Reducing unnecessary monitors and alarms was also considered highly effective, with 110 (55.0%) rating it as “Very Effective” and 70 (35.0%) as “Effective.” (Table 5).
Table 5.
Assessment of participants’ knowledge of effectiveness of interventions reducing noise at night (n = 200).
| Very Effective N (%) |
Effective N (%) |
Ineffective/Unsure N (%) |
|
|---|---|---|---|
| Education of staff in the hospital | 83 (41.5%) | 103 (51.5%) | 14 (7.0%) |
| Posting signs in the unit about noise reduction | 67 (33.5%) | 94 (47.0%) | 39 (19.5%) |
| Turning pagers/portable phones to vibrate | 56 (28.0%) | 81 (40.5%) | 63 (31.5%) |
| Turning down ringers on phones in the room | 64 (32.0%) | 101 (50.5%) | 35 (17.5%) |
| Lowering voices of staff conversations | 79 (39.5%) | 99 (49.5%) | 22 (11.0%) |
| Closing patient doors when appropriate | 122 (61.0%) | 69 (34.5%) | 9 (4.5%) |
| Reducing the use of continuous monitors and alarms when not clinically indicated | 110 (55.0%) | 70 (35.0%) | 20 (10.0%) |
To measure different possible related factors, we aimed to assess the associations between knowledge of pediatric healthcare workers’ interventions to reduce noise at night and various demographic and professional characteristics. Gender did not significantly affect knowledge level (p = 0.711), with similar proportions of females (52.1% with low knowledge) and males (55.0% with low knowledge). Age also showed no significant association (p = 0.903), with the majority of each age group having low knowledge. Similarly, pediatric caregiver role (p = 0.918), years of experience (p = 0.452), hospitalization history (p = 0.616), and being a parent (p = 0.101) were not significantly associated with knowledge level. However, the number of hours of sleep was significantly associated with knowledge levels (p = 0.022). A greater percentage of participants with 0–5 h of sleep had high knowledge (51.2%). There was no significant difference in knowledge levels based on perceived adequacy of sleep (p = 0.545) or the frequency of addressing sleep-related issues in clinical practice (p = 0.323). In logistic regression analysis, sleep-education hours were the only variable significantly associated with higher knowledge (p = 0.022). Other demographic and professional characteristics were not significant predictors. (Table 6)
Table 6.
Association between knowledge about the effectiveness of interventions reducing noise at night and different features.
| Low Knowledge (< 50th Percentile) N (%) |
High Knowledge (> 50th Percentile) N (%) |
Sig. Value |
||
|---|---|---|---|---|
| Gender | Female | 73 (52.1%) | 67 (47.9%) | 0.711 a |
| Male | 33 (55.0%) | 27 (45.0%) | ||
| Age | 20–30 Years | 61 (52.5%) | 55 (47.4%) | 0.903 b |
| 30–40 Years | 32 (56.1%) | 25 (43.9%) | ||
| 40–50 Years | 10 (50.0%) | 10 (50.0%) | ||
| 50–70 Years | 3 (42.9%) | 4 (57.1%) | ||
| Pediatric Caregivers | Other Pediatric Fields | 8 (57.1%) | 6 (42.9%) | 0.918 a |
| Pediatric Consultant/Fellows | 15 (50.0%) | 15 (50.0%) | ||
| Pediatric Nurse | 40 (55.6%) | 32 (44.4%) | ||
| Pediatric Resident | 43 (51.2%) | 41 (48.8%) | ||
| Year of Experience in Profession | < 5 Years | 53 (50.5%) | 52 (49.5%) | 0.452 a |
| > 5 Years | 53 (55.8%) | 42 (44.2%) | ||
| Have You Ever Hospitalized | No | 64 (51.6%) | 60 (48.4%) | 0.616 a |
| Yes | 42 (55.3%) | 34 (44.7%) | ||
| Are you a Parent? | No | 79 (56.8%) | 60 (43.2%) | 0.101 a |
| Yes | 27 (44.3%) | 34 (55.7%) | ||
| Your child Ever Hospitalized? | No | 25 (42.4%) | 34 (57.6%) | 0.255 a |
| Yes | 15 (55.6%) | 12 (44.4%) | ||
| No. of hours of Sleep | 0–5 h | 59 (48.8%) | 62 (51.2%) | 0.022 b |
| 5–10 h | 40 (55.6%) | 32 (44.4%) | ||
| 10–15 h | 7 (100.0%) | 0 (0.0%) | ||
| Is it an Adequate Sleep Amount? | No | 53 (52.0%) | 49 (48.0%) | 0.545 a |
| Not Sure | 18 (47.4%) | 20 (52.6%) | ||
| Yes | 35 (58.3%) | 25 (41.7%) | ||
| Frequency of addressing Sleep-related Issues in Clinical Practice? | Never/Seldom (< 1/Month) | 31 (48.4%) | 33 (51.6%) | 0.323 a |
| Sometime (1–3/Month) | 48 (51.6%) | 45 (48.4%) | ||
| Often (> 1/Week) | 27 (62.8%) | 16 (37.2%) | ||
(a) Chi-Square Test, (b) Fisher’s Exact Test.
We explored the associations between attitudes and perceptions scores and various participant features. Gender was not significantly associated with the attitude and perception scores (p = 0.498), with females scoring a mean of 34.61 (SD = 5.21) and males scoring slightly higher at 35.13 (SD = 4.54). There were no significant differences in the scores across the age groups (p = 0.484), with the highest mean score of 23.28 (SD = 2.98) in the 50–70 years age group. Among pediatric caregivers, pediatric consultants/fellows had the highest mean score of 36.27 (SD = 5.25), but this difference was not significant (p = 0.187). Compared with those with fewer years, those with more than 5 years of experience scored slightly higher (mean = 35.38, SD = 5.08), but this difference was not statistically significant (p = 0.100). Hospital history and being a parent had no significant effect on scores (p = 0.888 and p = 0.109, respectively), although parents tended to score slightly higher. Sleep hours were not significantly associated with scores (p = 0.950). Participants who perceived their sleep education as adequate had a higher mean attitude/perception score; however, this difference did not reach statistical significance (p = 0.080). Finally, those addressing sleep-related issues more frequently (> 1/week) had a higher mean score (36.07, SD = 5.86), although this association was not significant (p = 0.157). (Table 7)
Table 7.
Association between attitudes and perceptions scores and different features.
| Mean (SD) | Sig. Value |
||
|---|---|---|---|
| Gender | Female | 34.61 (5.21) | 0.498 a |
| Male | 35.13 (4.54) | ||
| Age | 20–30 Years | 22.27 (3.81) | 0.484 b |
| 30–40 Years | 23.00 (3.27) | ||
| 40–50 Years | 23.25 (3.98) | ||
| 50–70 Years | 23.28 (2.98) | ||
| Pediatric Caregivers | Pediatric Consultant/Fellows | 36.27 (5.25) | 0.187 b |
| Pediatric Resident | 34.62 (4.44) | ||
| Pediatric Nurse | 34.68 (4.73) | ||
| Other Pediatric Fields | 32.86 (8.14) | ||
| Year of Experience in Profession | < 5 Years | 34.21 (4.91) | 0.100 a |
| > 5 Years | 35.38 (5.08) | ||
| Have You Ever Hospitalized | No | 34.73 (4.68) | 0.888 a |
| Yes | 34.83 (5.56) | ||
| Are you a Parent? | No | 34.39 (4.59) | 0.109 a |
| Yes | 35.62 (5.82) | ||
| Your child Ever Hospitalized? | No | 36.03 (5.58) | 0.177 a |
| Yes | 34.22 (6.02) | ||
| No. of hours of Sleep | 0–5 h | 34.68 (5.24) | 0.950 b |
| 5–10 h | 34.92 (4.48) | ||
| 10–15 h | 34.71 (6.82) | ||
| Is it an Adequate Sleep Amount? | No | 35.41 (4.62) | 0.080 b |
| Not Sure | 33.29 (5.18) | ||
| Yes | 34.60 (5.42) | ||
| Frequency of addressing Sleep-related Issues in Clinical Practice? | Never/Seldom (< 1/Month) | 34.38 (5.00) | 0.157b |
| Sometime (1–3/Month) | 34.43 (4.54) | ||
| Often (> 1/Week) | 36.07 (5.86) | ||
(a) Independent t-test, (b) ANOVA.
Various disruptive factors for sleep in the hospital were assessed as addressed by healthcare workers included in the study. The most critical disruptive factors for sleep are blood draws or other tests (mean = 3.36), closely followed by pain (mean = 3.31) and equipment alarms (mean = 3.1). Noise from all sources also scored highly, with a mean of 3.06. Other disruptions included vital sign checks (mean = 2.98) and feeling anxious (mean = 2.93). The lower-rated disruptions included respiratory therapist interruption (mean = 2.66), staff conversation (mean = 2.58), and continuous pulse oximetry (mean = 2.44). (Fig. 1)
Fig. 1.
Disruptive factors for sleep in hospitals as perceived by the healthcare workers (n = 200).
Interventions to address sleep issues were explored in clinical practice among participants who faced many cases (n = 136). The most common intervention was providing advice related to sleep hygiene and sleep practices (77.2%). Sleep medications such as melatonin are used by 62.5%, whereas behavioral interventions are applied by 61.0%. Light therapy was another notable intervention used by 42.6% of the participants. Referral to a sleep clinic is less common, with only 18.4% making such referrals and 4.4% reporting using other interventions. (Fig. 2)
Fig. 2.
Different interventions to address sleep issues in your clinical practice if you face many cases (n = 136, sometimes too often).
Discussion
Our findings indicate that many participants acknowledge the importance of sleep for hospitalized children, as reflected by the high mean score that adequate sleep is crucial for a child’s health. This aligns with the findings of previous research, which reported that sleeping longer improves general development, behavior, and health outcomes in children and adolescents8. However, the participants expressed uncertainty about how to support sleep effectively in the hospital environment, with lower mean scores for knowing how to help pediatric patients sleep better and actively working to help them. This discrepancy between awareness and practical application reflects a gap in knowledge and skills among healthcare providers, a finding supported by previous studies. For instance, another study reported that healthcare professionals in Dutch pediatric rehabilitation settings had low levels of sleep knowledge, even though they acknowledged its importance6. Similarly, Stremler et al. reported that pediatric caregivers, especially nurses, were more confident in their pediatric sleep knowledge than physicians were. However, both groups lacked adequate formal training in sleep management9.
Pal et al. described various noise sources in ICUs, mainly alarms, monitors, staff communication, and equipment. Most alarms are false positives, and staff conversations near patients contribute significantly10. However, our study shows that interventions to reduce night-time noise, such as closing patient doors and reducing the use of continuous monitors, were considered the most effective, with over half of participants rating them as very effective. Previous quality improvement initiatives targeting environmental modifications, such as alarm optimization and nighttime care bundling, have demonstrated improvements in perceived sleep quality among hospitalized patients11. These findings support the feasibility of system-level interventions to promote sleep-friendly hospital environments. Moreover, fewer participants viewed behavioural interventions, such as turning down phone ringers or lowering staff voices, as highly effective12. This finding aligns with previous studies highlighting noise as a significant factor contributing to sleep disturbances in hospitalized patients. Hospital noise levels frequently exceed recommended thresholds, particularly in intensive care and acute care settings, with alarms representing a major source of sleep disruption13. Excessive alarm burden and false alarms may also contribute to alarm fatigue, reducing staff responsiveness and indirectly affecting patient sleep quality14.
Similarly, Xie et al. identified noise from alarms, staff conversations, and equipment as crucial contributors to sleep disruption in pediatric hospital settings15. However, they emphasized that addressing staff behavior, such as lowering voices, can significantly reduce noise levels. Similarly, Connor et al. showed that initiatives such as training for behavior modification of staff in ICUs could effectively reduce noise levels16. Our study’s relatively low confidence in behavioral interventions may indicate a need for additional training and awareness programs targeting healthcare providers, focusing on the impact of staff behaviour on patient sleep.
This study highlights various negative factors affecting children’s sleep quality in hospitals. Notably, drawing blood or other tests, pain, and alarms on equipment were identified as the most significant disruptive factors for sleep by both pediatric patients and their parents. These findings are consistent with earlier studies that highlighted medical procedures and noise from equipment as primary contributors to sleep disturbances in hospitalized children. Moreover, Kulpatcharapong et al. reported various other factors in hospitalized patients who experienced sleep disturbances, which may be due to disease-related, environmental, psychological, and social factors, leading to impaired recovery, prolonged stays, and potential long-term insomnia17. Interestingly, our study revealed that anxiety and feelings of being overwhelmed were also notable disruptions, emphasizing the emotional and psychological factors that affect sleep in hospital environments18. These findings suggest that addressing physical and emotional factors is crucial in promoting better sleep for pediatric patients.
Notably, regarding sleep knowledge, the number of hours of sleep education received during schooling was significantly associated with knowledge about interventions to reduce noise at night, with participants receiving 0–5 h of education having higher knowledge levels. This finding supports the notion that even a small amount of formal education can improve knowledge regarding sleep management in pediatric patients. Previous research has similarly emphasized the need to integrate sleep education into medical and nursing curricula19.
Interestingly, our study revealed no significant associations between years of professional experience and knowledge or attitude scores. These findings suggest that clinical experience alone may not improve healthcare workers’ knowledge of pediatric sleep and that targeted educational interventions are needed. The lack of a significant difference in knowledge based on professional experience is consistent with findings from other studies, such as the one conducted by Hulst et al., which demonstrated that knowledge gaps persisted among healthcare professionals regardless of their years of experience6.
Our study revealed that although health professionals generally agreed on the importance of good sleep for children and parents, they expressed less confidence in their ability to help parents sleep better in the hospital. This finding provides evidence that parental sleep is critical to a child’s recovery and well-being. A study by Meltzer et al. emphasized the importance of parental sleep in referring their child to the hospital, noting that parents whose children’s sleep is inadequate cannot take good care of their child20. The association between sleep education and higher knowledge levels observed in this study aligns with prior literature emphasizing the need to integrate sleep health into healthcare training curricula21. Structured education may enhance providers’ confidence and ability to translate sleep knowledge into clinical practice.
Limitations
The main limitation of this study was the reliance on self-reported data, which may introduce response bias and overestimate knowledge or attitudes. Furthermore, the study was conducted in a single hospital, which limits its generalizability. The cross-sectional design also restricts the ability to establish causality between variables. Furthermore, the sample size did not detect minor, subtle differences between the demographic groups. Future research should involve more extensive multicenter studies to provide a broader perspective.
Conclusion
This study highlights the need for improved education and awareness among pediatric healthcare providers regarding sleep health in hospitalized children. Although participants consistently recognized the importance of sleep for both children and parents, gaps were identified in practical knowledge and confidence in implementing sleep-supportive strategies. Procedures, alarms, environmental noise, and pain were perceived as the most significant contributors to sleep disruption in hospital settings. No substantial differences in knowledge or attitudes were observed across participant characteristics, suggesting that sleep-related educational needs are broadly shared among pediatric healthcare providers. These findings support the implementation of targeted sleep education, behavioral training, and institutional policies aimed at promoting sleep-friendly hospital environments to enhance recovery and well-being in hospitalized children and their families.
Supplementary Information
Below is the link to the electronic supplementary material.
Author contributions
NA: Writing initial draft, literature review, proposal creationLA: Organizing the data, literature review summary, and data collectionRA: Writing case summary, literature review, final revisionMA: Literature review, data collection, and analysisAF: Writing the final paper, revising the data analysis, organizing the paperTA: Writing the final paper, revising the data, final revision and edits, and the Principal Investigator.
Data availability
All supporting data are available upon request.
Declarations
Competing interests
The authors declare no competing interests.
Consent to participate
Written informed consent was obtained from all participants before participation in the study.
Footnotes
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