0921 Insomnia Symptoms and Environmental Disruptors: A preliminary evaluation of Veterans within a VA subacute rehabilitation unit

Abstract Introduction Insomnia symptoms during rehabilitation admission are associated with slower rehabilitation progression, increased healthcare utilization, worse functional recovery one-month post discharge, and decreased survival rates one-year post discharge. Insomnia symptoms are complex, multifactorial (e.g., insomnia severity, sleep need, daytime sleepiness), and are often unintentionally worsened by rehabilitation admission due to environmental factors (e.g., light, noise) and behavioral factors (e.g., increased time in bed). The aim of this clinical innovation project was to conduct a preliminary evaluation of Veterans’ sleep at admission and discharge in a VA subacute rehabilitation unit for the purposes of informing clinical interventions. Methods Veterans admitted to the VA subacute rehabilitation unit between March and August 2022 (N=67) were approached within 7 days of admission to complete a brief evaluation (Insomnia Severity Index [ISI], Sleep Need Questionnaire [SNQ], Epworth Sleepiness Scale [ESS]). Veterans also answered questions regarding environmental sleep disruptors. Following the evaluation, Veterans were offered sleep resources and behavioral treatment options. Veterans repeated the evaluation within 7 days of discharge and were offered outpatient referrals for their sleep difficulties. Pearson correlations were used to determine associations between length of stay (LOS), ISI, SNQ, and ESS scores at admission and discharge. Results 33 of 67 (49.2%) Veterans (Mage=73.3±8.8; 96.9% male; 78.8% white) completed admission and discharge evaluations. Over 80% of Veterans reported at least 1 environmental disruptor at admission and discharge. The number of environmental disruptors at discharge was correlated with ISI (r =.549, p=.001) and SNQ (r =.475, p=.005) scores at discharge. LOS was correlated with ESS scores at discharge (r =.524, p=.002). Conclusion This preliminary evaluation demonstrated relationships between higher numbers of environmental disruptors and greater insomnia severity and sleep need at discharge from a VA subacute rehabilitation unit. Additionally, longer durations of admission were associated with higher levels of daytime sleepiness at discharge. Future evaluations should include larger sample sizes to determine causality between these variables in Veteran populations. Given the impact of insomnia symptoms on rehabilitation progression, future evaluations should also consider physical function and sleep variables post-discharge. Support (if any)