The patient room is one of the most important components of the sleep center. Its design and construction can affect not only the quality of data acquired during a PSG procedure but also the facility’s reputation within a community. Design considerations should be made to facilitate not only the night testing procedures but daytime testing procedures as well. In addition, patients will most likely occupy the room for periods of time when no testing is being performed, and ensuring patient satisfaction within a room during this time is just as important as during testing periods. Facility design should include analysis of the type of patients evaluated at the sleep center.

As a general rule, there is no minimum size requirement for a patient room, although 140 ft² is often recommended. The preeminent issues relating to room size include the ability of a medical emergency team to have easy access to the patient from either side of the bed and the ability of the patient to move safely in the space available. The American Academy of Sleep Medicine
(AASM) accreditation standards require that the room be of sufficient size to accommodate emergency personnel access with a minimum of 24 in (60.96 cm) of available clear space on three sides of the bed (1). Consider the need for a code cart, often referred to as a “crash cart,” that is readily accessible to health care workers and strategically placed in a hospital sleep center.

An important goal in designing a patient room is to eliminate a sterile, hospital-based atmosphere and have the room look and feel like either a hotel or a home bedroom. One of the most effective ways to accomplish this is through the selection of bedroom furnishings. A patient room should include a bed, preferably a full-size bed that has an adjustable head and foot section (Fig. 67-2A). A headboard and footboard made of finished wood is also effective in providing a home-like feel. In addition, in the interest of minimizing patient injury, the bed should have side rails that can be used for patient safety during testing conducted for parasomnia disorders or abnormal behaviors during sleep.

Bedside stands are an important furniture component of the patient room. Aside from selecting a more home-style designed stand, the stands should have enough room to store any diagnostic or treatment devices required during testing such as a CPAP flow generator. Some bedside stands incorporate a small drawer that can be very useful for storing commonly used disposable supplies in the room for easy access by the technologist during the night. Other common items placed on a bedside table include a telephone, reading lamp, and tissues. If space permits, it can be useful to incorporate a bedside stand on each side of the bed to accommodate all of the possible items commonly placed on a bedside stand (Fig. 67-2B).

Seating for the patient and guests should be available in each patient room. Some obese patients and visitors may be hesitant to sit on a chair that they perceive may collapse beneath them. Furniture may need to be able to withstand weight of 500 lb (227.27 kg) to 800 lb (363.64 kg). Because the patient will be seated in the chair during hookup, the design of the chair should allow the technologist ease in applying the sensors and electrodes. When selecting patient seating, consider the patient’s comfort and dignity.

It is certainly desirable to have windows in a patient room. If a patient is undergoing a multiple sleep latency test (MSLT) during the day, it is often useful to allow daylight into the room between nap trials to aid the patient in staying awake. However, windows can be a problem during daytime testing, because it can be difficult to totally eliminate the daylight from the room during MSLT nap trials. A type of blind often referred to as a blackout blind should be considered for better control of daylight within the patient room. This blind incorporates tracks on the bottom and sides of the window, thereby blocking out all light coming in through the window. It can be useful during the night as well, because it will block moonlight or street lights in the same manner.

It will be important for the patient to have a closet or armoire available in the room to store and hang daytime clothing. In addition, this space can be used to store extra blankets or pillows that the patient may request during an all-night test.

Other optional furnishings to consider that add to the home-style setting include wall art, waste receptacles, and remote-controlled televisions. If you choose to allow patients to watch television, pay special attention to designing the sleep center patient room with acoustic/sound attenuation in mind. One of the easiest things that can be done in this regard is to construct each wall of a patient room to extend up to, and connect with, the ceiling. This method greatly reduces the amount of noise that can travel above typical hanging or suspended ceiling tiles. Placing insulation in the ceiling can provide some noise reduction. Some of the
more expensive commercially available ceiling tiles have sound attenuation ratings. Disregarding this construction consideration can lead to noise from one patient room disturbing another patient, or even control room noise traveling to patient rooms. Floor carpeting is certainly advantageous in reducing environmental noise, as is the use of inner wall insulation. A thick fire door for the patient room entrance can also reduce noise.

A number of electrical lighting options should be considered for the patient room. Certainly, a general ceiling-mounted light, which illuminates the entire room, should be in place and controlled at the room entrance. A reading lamp located on a bedside stand can also be used. However, many existing sleep centers shy away from allowing patients the opportunity to control any aspect of the environment such as light, as they may inadvertently disrupt testing procedures by turning the lights on and off during the test. Some patients are not able to tolerate total darkness. In such cases, a small night-light plugged into a wall receptacle can be useful. Also, connecting the general ceiling-mounted light to a dimmer control will allow a very small amount of light to illuminate the room for certain patient needs. Incandescent black light illumination is an additional lighting option that can significantly enhance coexisting infrared illumination for video recording. A light fixture with a blacklight bulb, installed somewhere near the patient and connected to a dimmer control, will work quite well to accomplish this method of increasing video display quality.

One of the most important facility considerations related to a patient room is temperature control. A patient’s comfort relative to room temperature can, in many cases, make or break the ability to perform a quality sleep study. In order to most effectively control this aspect of the testing environment, individual thermostat controls assigned to each patient room are the most advantageous. This method will allow one patient’s room to be set much cooler than a nearby patient’s room, thereby allowing both patients a degree of comfort to facilitate a quality test. However, this method can be rather expensive. In cases where individual temperature controls are not an option, every effort should be made to assign the fewest patient rooms to each thermostat control. More than three patient rooms assigned to one temperature control will most certainly result in conflicting patient temperature preferences from time to time, resulting in one or more patients experiencing disrupted, poor-quality sleep during the test. Consideration should also be given to the placement of the thermostat control. If possible, mounting a control outside of a patient room is most desirable. Otherwise, a technologist may be required to enter the room of one patient to adjust the temperature of a different patient’s room, potentially disrupting the sleep of both patients. Making sure that any ceiling or wall-mounted vent used for heating or cooling is not near, or directed specifically toward, the patient can minimize the impact of room temperature on the patients.

Alternatively, placement of fans in the patient rooms allows a degree of flexibility in cooling the room when individual controls are not an option. Many patients sleep at home with a fan, and one should be available on request.

The technologist should also be cognizant of technical considerations for the integrity of the PSG such as sweat artifact caused by overly warm room temperatures and carefully monitor the room temperature. In addition, thought should be given to maintaining an adequate supply of blankets to accommodate the needs of individual patients when individual thermostat controls are not available.

Restrooms for patients and staff are an obvious necessity in a sleep center facility. The most desirable and comfortable design for patients and staff allows for multiple restrooms designated for both patients and staff. This design eliminates the potential scenario of a patient interrupting a PSG procedure to use the restroom, but not being able to do so because the restroom is being occupied by a staff member, thereby increasing the duration of the test interruption. The AASM accreditation standards require that the sleep facility has clean bathrooms with a minimum ratio of one bathroom for every three testing rooms; these bathrooms must each contain a toilet and a sink. Toilet fixtures can be floor mounted or wall mounted. A floor-mounted toilet can support up to 800 lb (363.64 kg) and toilet-to-floor supports can be added as required. Patients often lean on a sink, and floor-mounting the sink helps distribute weight. Each bathroom must have a working privacy door. Sole access to a shared bathroom cannot be through a testing bedroom. All restrooms should be minimally furnished with a toilet, sink, hand soap dispenser, paper towel dispenser, wall-mounted mirror, ceiling light, ceiling vent, and an electrical outlet (1).

An ideal sleep center design relative to restroom facilities allows for a private restroom for each patient room. This provides patient privacy, reduces the duration of restroom breaks during the PSG, and allows patients the option of preparing for and departing directly from the sleep center to their daytime job, following the conclusion of the test in the morning. The option of departing directly to work is certainly desirable and convenient for most patients who are tested during weeknights and can be a pivotal marketing point for a sleep center located within a town or city that offers competing sleep center facilities. A fully functional private patient restroom
should be designed for access from within the patient room and should include shower facilities.

The presence of shower facilities will introduce patient expectations for personal items such as soap, shampoo, and appropriate towels and linen to be provided, as would commonly be found in a hotel. The presence of shower facilities will also demand increased housekeeping/environmental services involvement, which may increase a facility’s operating expenses.

In situations where private restrooms are not possible, a common solution is to incorporate a shared patient restroom design. This can be advantageous from a facility design perspective but may result in patient dissatisfaction. The single shared patient restroom not only limits a patient’s morning personal hygiene options, but during the night, there may be patients who leave the restroom soiled or in an undesirable condition for the next patient. This scenario may require staff members to clean the restroom, which can result in staff dissatisfaction and interrupt the PSG procedure.

Private patient restrooms can be constructed without shower facilities for cases in which construction cost restraints are an issue. A single shower area can then be shared by patients, which will most likely be better tolerated relative to patient satisfaction.

If the sleep center facility will include a patient reception or waiting area used during the day to process physician office or clinic appointments, consideration should be given to the facility’s proximity to the nearest public restroom, as waiting patients or family members will most likely require this. Construction of a public restroom may be required if a nearby access does not exist.

Reasonable accommodations for disabled persons should be made in all patient, public, and staff restrooms. This would include adequate space for patients using wheelchairs and walkers to access and utilize the area, wall-mounted support bars near the toilet and within the shower area, optional sitting stool for use within the shower area, and a mechanism for patients to activate a call for assistance such as a wall-mounted help button or pull chain. The AASM accreditation standards require that at least one testing bedroom and bathroom be handicap accessible as defined either by local building regulations or by sections 6.3 and 6.4 of the Americans with Disabilities Act (1).

A control room must be large enough to comfortably house working space for the PSG technologist staff and required equipment. The control room is the hub of activity within the sleep center, and technologists spend most of their work time within this area. Therefore, it is important to design the control area to be as comfortable as possible for the technical staff, with consideration for the amount of general traffic projected for the area, equipment placement, and individual staff member workstations and related furniture. The AASM accreditation standards require that the dimensions of the control room be not less than 40 ft² in total or 20 ft² per testing bedroom, whichever is larger (1).

Ideally, the control room should be centrally located a relatively short distance away from patient rooms. As patients will commonly call for assistance from technologists during a sleep study, a short distance between the control room and the patient room will reduce the amount of time it takes for the technologist to enter the patient room in response to the call. This is also an important consideration with regard to technologist reaction time in emergencies such as cardiac arrhythmias or seizure events. In addition, some of the monitoring devices used during a PSG that incorporate connected components in both the control area and the patient room specify maximum cabling lengths that are important for proper equipment operation. These specifications may impact the distance requirements between the control room and the patient rooms as well.

Despite the described importance of maintaining a relatively short distance between the patient rooms and the control room, it is important to maintain strict boundaries between employee areas and patient areas. Patient privacy and confidentiality should be considered when designing the control room. Patients should at no time be allowed to physically enter, or visually observe, the control room. Video monitors should be placed in a manner and location where they cannot be visually observed from patient areas. Patients should not see documents containing another patient’s information within the control room. Patients should neither hear telephone conversations within the control room relating to other patients nor be able to hear audio sounds that originate from a patient room. Succeeding in maintaining patient privacy and confidentiality within the control room may result in unique construction or facility renovation requirements (Fig. 67-3).

Once the area of the control room that will house the monitoring equipment has been identified, adequate access to electricity will need to be established in that area. Multiple wall outlets will most likely be required in order to furnish sufficient power to all of the varying monitoring instruments. An ideal wiring design allows for multiple instruments assigned to a particular patient room to be powered by outlets, utilizing a separate independent ground. By providing separate grounds for each patient room, the potential for electrical interference originating in one patient room to travel to the next patient room is significantly reduced. In facilities where emergency auxiliary power is available, such as in a hospital, connecting the primary PSG unit or computer processing unit to an outlet with automatic auxiliary power switching can be advantageous during periods of
power outages in order to minimize the amount of data lost during a power failure. If facility furnished emergency auxiliary power is not available, the use of an uninterrupted battery power supply with surge protection is recommended for the previously mentioned units. If intermittent power outages are common in the facility, then an uninterrupted battery power supply with surge protection is recommended regardless of the presence of emergency auxiliary power.

Cabling is an important consideration in designing the control room area. Many of the monitoring devices housed within the control room are interfaced through cabling to components housed in the patient room. In addition, sleep center entrance security video signals and audio intercom signals may also require a cabled connection to related devices in the control room. The control room design should allow for a designated space, chute, or conduit intended to introduce these multiple cables from above the ceiling, inside the wall, and into the control room near the floor. This design allows for quick access to all incoming and outgoing cables; can improve troubleshooting efficiency; and makes it easier for outside contractors to locate, add, or remove cables. However, it is important to note that when placing multiple cables next to each other such as described, electrical interference originating from within a cable can transmit to other cables. This can be a problem for some instruments that are prone to receiving extraneous AC electrical interference such as a PSG system. In this scenario, using shielded cables can reduce the transmission of this interference. In the case of PSG systems specifically, the use of network or serial cabling is recommended, because it is much less prone to receiving extraneous interference. Network or serial cabling is commonly used with PSG systems.

Lighting preferences within a control area may vary depending on the time of day or the type of job task being performed. Common fluorescent ceiling units can be used in a control room to illuminate the work area. It can be advantageous to wire segments of the ceiling units within the control area to different on/off switches. This gives staff members the ability to alter the amount of illumination in a particular area of the control room. Higher amounts of work area illumination are usually preferred when staff are performing job tasks such as daytime PSG scoring and analysis, and reading or writing patient chart information. When performing PSG procedures during the night, many technologists prefer a lower or softer degree of illumination within the control area. Conversely, in the interest of reinforcing and maintaining the sleep-wake cycle of nightshift technologists, high-intensity fluorescent lights can be used in a control room during the nighttime hours to simulate sunlight. Some research shows this can be of benefit to the nightshift staff, as it can increase employees’ total sleep time as well as the quality of sleep during the daytime hours.