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The regulation of cardiovascular activity by the parasympathetic nervous system plays an important role in sleep-onset insomnia. Weak vagal modulation and blunted baroreflex sensitivity were evident in this insomnia subtype, which indicates that difficulty in initiating sleep can independently affect morning cardiovascular function. We sought to assess the relationship between Leapfrog minimum volume standards, Hospital Safety Grades, and Magnet recognition with outcomes among patients undergoing rectal, lung, esophageal, and pancreatic