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Gyawali S, Tiwari S, Sah GS, Panthi B, Upreti A, Pokhrel B, Gyawali B, Khanal P, Shrestha R, Paudel B. Prevalence of sleep disorders in patients with advanced cancer: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:3954-3958. [PMID: 38989183 PMCID: PMC11230787 DOI: 10.1097/ms9.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/20/2024] [Indexed: 07/12/2024] Open
Abstract
Background Patients with advanced cancer are more susceptible to develop sleep disorders like insomnia, restlessness, hypersomnolence, and sleep apnea due to a series of stressful events and side effects of chemotherapeutic agents. Poor sleep quality is associated with bad cancer outcomes and substandard quality of life. The authors assessed the prevalence of sleep disorders among advanced cancer patients in a tertiary center in Nepal. Methods Patients with stage three and four solid malignancies were enrolled from February 2023 to July 2023 to assess their sleep status. The data were collected using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, analyzed using the Statistical Package for the Social Sciences (SPSS) version 27, and subgroup exploration was done to assess the relationship of poor sleep quality with gender, marital status, malignancy type, and treatment received. An ethical clearance was obtained from the Institutional Review Committee (IRC). Results The authors evaluated data from 357 patients in the study. Of them, 58.3% were female and 41.7% were male. The mean age of the patients was 51.1 years. Among total cancer patients, 56% had significant sleep disorders. A significant association was observed between the quality of sleep and gender, type of malignancy, and treatment methods (p value <0.05). A majority of the patients demonstrated increased sleep latency, struggling to fall asleep swiftly. Conclusions More than half of the patients had poor sleep, which has an adverse impact on the prognosis of the disease and quality of life of cancer patients. Therefore, this aspect of cancer management requires special consideration for better quality of life and appropriate end-of-life care.
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Affiliation(s)
- Siddinath Gyawali
- Department of Internal Medicine, Tribhuvan University Teaching Hospital
| | | | - Guru Sharan Sah
- BP Koirala Memorial Cancer Hospital, Bharatpur, Chitwan, Nepal
| | - Bishal Panthi
- Department of Internal Medicine, Tribhuvan University Teaching Hospital
| | - Apil Upreti
- Department of Internal Medicine, Tribhuvan University Teaching Hospital
| | - Biraj Pokhrel
- Department of Internal Medicine, Tribhuvan University Teaching Hospital
| | - Bindu Gyawali
- Curative Service Division, Department of Health Services, Ministry of Health and Population
| | - Pratima Khanal
- Manmohan Memorial Institute of Health Sciences, Kathmandu
| | - Rakshya Shrestha
- Department of Internal Medicine, Tribhuvan University Teaching Hospital
| | - Bishal Paudel
- Department of Internal Medicine, Tribhuvan University Teaching Hospital
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Leclerc C, Gervais C, Hjeij D, Briand MM, Williamson D, Bernard F, Duclos C, Arbour C. Sleep Disruptions in Hospitalized Adults Sustaining a Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2024; 39:E201-E215. [PMID: 37767918 DOI: 10.1097/htr.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Adults sustaining a traumatic brain injury (TBI) are at risk of sleep disturbances during their recovery, including when such an injury requires hospitalization. However, the sleep-wake profile, and internal and external factors that may interfere with sleep initiation/maintenance in hospitalized TBI patients are poorly understood. This review aimed to: (1) identify/summarize the existing evidence regarding sleep and sleep measurements in TBI adults receiving around-the-clock care in a hospital or during inpatient rehabilitation, and (2) identify internal/external factors linked to poor sleep in this context. METHODS A scoping review was conducted in accordance with the PRISMA Scoping Review Extension guidelines. A search was conducted in MEDLINE, PsycINFO, CINAHL, and Web of Science databases. RESULTS Thirty relevant studies were identified. The most common sleep variables that were put forth in the studies to characterize sleep during hospitalization were nighttime sleep time (mean = 6.5 hours; range: 5.2-8.9 hours), wake after sleep onset (87.1 minutes; range: 30.4-180 minutes), and sleep efficiency (mean = 72.9%; range: 33%-96%) using mainly actigraphy, polysomnography, and questionnaires (eg, the sleep-wake disturbance item of the Delirium Rating Scale or the Pittsburgh Sleep Quality Index). Twenty-four studies (80%) suggested that hospitalized TBI patients do not get sufficient nighttime sleep, based on the general recommendations for adults (7-9 hours per night). Sleep disruptions during hospitalization were found to be associated to several internal factors including TBI severity, cognitive status, and analgesia intake. External and modifiable factors, such as noise, light, and patient care, were consistently associated with sleep disruptions in this context. CONCLUSION Although the literature on sleep disturbances in hospitalized TBI patients has been increasing in recent years, many gaps in knowledge remain, including phenotypes and risk factors. Identifying these factors could help clinicians better understand the multiple sources of TBI patients' sleep difficulties and intervene accordingly.
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Affiliation(s)
- Catherine Leclerc
- Author Affiliations: Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada (Mss Leclerc and Hjeij, Mr Gervais, and Drs Williamson, Bernard, Duclos, and Arbour); Department of Psychology, Université de Montréal, Montréal, Québec, Canada (Ms Leclerc and Mr Gervais); Faculty of Medicine (Drs Briand and Bernard), Faculty of Pharmacy (Dr Williamson), and Faculty of Nursing (Dr Arbour), Université de Montréal, Montréal, Québec, Canada; Division of Trauma Research, Departments of Surgery and of Neurological Sciences, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Québec, Canada (Drs Briand, Bernard, Duclos, and Arbour); and Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada (Dr Duclos)
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Cui C, Wang L. Role of social support in the relationship between resilience and sleep quality among cancer patients. Front Psychiatry 2024; 15:1310118. [PMID: 38690201 PMCID: PMC11058993 DOI: 10.3389/fpsyt.2024.1310118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction The present study aimed to investigate the effect of resilience on sleep quality and explore the role of social support between resilience and sleep quality in cancer patients. Methods A multicenter and cross-sectional study was conducted in China from May to November 2021. A total of 202 cancer patients were recruited to complete the questionnaires composed of demographic information, Pittsburg Sleep Quality Index (PSQI), Resilience Scale-14 (RS-14), and Multidimensions Scale of Perceived Social Support (MSPSS). The associations between resilience, social support, and sleep quality were explored through hierarchical regression analysis. Results The prevalence of poor sleep quality was 50% among cancer patients. Resilience, social support, and the interaction between resilience and social support were all found to be significantly associated with sleep quality. Results of simple slope analysis indicated that the association between resilience and sleep quality were gradually decreased with the increasing social support levels (1 SD below the mean, B=-0.225, β=-0.551, P<0.001), mean social support (B=-0.147, β=-0.353, P<0.001) and high social support (1 SD above the mean, B=-0.065, β=-0.156, P<0.001). Additionally, social support mediated the effect of resilience on sleep quality among cancer patients. Discussion Poor sleep quality has been common in cancer patients. Social support could mediate and alleviate the relationship between resilience and sleep quality among cancer patients. Besides providing sufficient social support, interventions based on resilience should be applied to address sleep problems in cancer patients.
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Affiliation(s)
- ChunYing Cui
- School of Humanities and Management, Wannan Medical College, Wuhu, Anhui, China
| | - Lie Wang
- School of Public Health, China Medical University, Shenyang North New Area, Shenyang, Liaoning, China
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Gouldthorpe C, Power J, Davies A. Circadian rhythm disorders in patients with advanced cancer: a scoping review. Front Oncol 2023; 13:1240284. [PMID: 37829342 PMCID: PMC10565850 DOI: 10.3389/fonc.2023.1240284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
Circadian rhythms can be demonstrated in several biomarkers and behavioural activities, with rhythmical patterns occurring roughly over a 24-h period. Circadian disorders occur in patients with cancer and may be associated with poor clinical outcomes. This scoping review aimed to identify circadian rhythm research and reporting practices, circadian rhythm patterns, circadian rhythm disorders, and relevant associations of circadian rhythm disorders in patients with advanced cancer. Studies involved adult patients with locally advanced or metastatic cancer and used objective measures of circadian rhythmicity. Two independent authors completed initial screening of title and abstracts, full text reviews, data extraction, and data checking. A total of 98 articles were highlighted in the scoping review, which utilised physical activity measures (actigraphy and polysomnography), biomarkers (cortisol and melatonin), or a combination. Several circadian rhythms are commonly disordered amongst patients with advanced cancer and have significant implications for symptom burden, quality of life, and survival. It remains unclear which patients are most at risk of a circadian rhythm disorder. Significant heterogeneity exists in research and reporting practices. Standardising this approach may address discrepancies in the current literature and allow for research to focus on the most relevant parameters and approaches to improving circadian rhythmicity.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Jenny Power
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Gouldthorpe C, Ancoli-Israel S, Cash E, Innominato P, Jakobsen G, Lévi F, Miaskowski C, Parganiha A, Pati AK, Pereira D, Revell V, Zeitzer JM, Davies A. International e-Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest-Activity Rhythm Disorders (CARDs) in Patients with Cancer. Cancers (Basel) 2023; 15:3784. [PMID: 37568600 PMCID: PMC10416864 DOI: 10.3390/cancers15153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Circadian rest-Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer. METHODS An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest-activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized. RESULTS Sixteen participants from nine different clinical specialties and seven different countries, with 5-35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds. CONCLUSIONS The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head & Neck Surgery & Communicative Disorders, UofL Healthcare-Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Pasquale Innominato
- Oncology Department, Alaw, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
- Cancer Research Centre, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Francis Lévi
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
- Gastro-Intestinal and General Oncology Service, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA 94143, USA
| | - Arti Parganiha
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
| | - Atanu Kumar Pati
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
- Odisha State Higher Education Council, Government of Odisha, Bhubaneswar 751001, India
- Kalinga Institute of Social Sciences, Bhubaneswar 751024, India
| | - Deidre Pereira
- Department of Clinical and Health Psychology, University of Florida Health, Gainesville, FL 32610, USA
| | - Victoria Revell
- Surrey Sleep Research Centre, University of Surrey, Surrey GU2 7XH, UK
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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Bate GL, Kirk C, Rehman RZU, Guan Y, Yarnall AJ, Del Din S, Lawson RA. The Role of Wearable Sensors to Monitor Physical Activity and Sleep Patterns in Older Adult Inpatients: A Structured Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:4881. [PMID: 37430796 PMCID: PMC10222486 DOI: 10.3390/s23104881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/12/2023]
Abstract
Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials.
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Affiliation(s)
- Gemma L. Bate
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| | - Rana Z. U. Rehman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
| | - Yu Guan
- Department of Computer Science, University of Warwick, Coventry CV4 7EZ, UK;
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
- National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Rachael A. Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (G.L.B.); (C.K.); (R.Z.U.R.); (A.J.Y.); (S.D.D.)
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Price SN, Hamann HA, Halaby L, Trejo JI, Corella F, Weihs KL. Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behav Sleep Med 2023; 21:45-60. [PMID: 35098834 DOI: 10.1080/15402002.2022.2033243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management. METHODS Participants were 140 adults with cancer who screened positive for depression through routine, practice-based assessment with the Patient Health Questionnaire (PHQ-9 ≥ 8) and were referred to a study of collaborative care for depression. Demographics, clinical characteristics, subjective sleep quality, and sleep recommendations received were self-reported by patients prior to intervention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10, and depressive symptoms were measured using the PHQ-9. RESULTS Of 138 patients with complete data, 123 (89.1%) reported poor sleep quality, and 87 (63%) met the threshold for possible insomnia. The strongest correlates of poor subjective sleep were female gender (β = 0.19, p = .02), greater depressive symptom severity (β = 0.28, p = .001), and worse physical health (β = -0.19, p = .04). Of 118 patients reporting problems with sleep since their cancer diagnosis, 95 discussed the issue with a medical provider; medications were recommended most often (37; 38.9%); only 9 (9.5%) received recommendations for cognitive-behavioral therapy for insomnia (CBT-I) or other CBT. CONCLUSIONS Patients with cancer seeking treatment for depression report very high rates of poor subjective sleep quality and insomnia, underscoring the importance of providing and referring to guideline-concordant sleep interventions in oncology supportive care contexts.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.,Departments of Family and Community Medicine and Psychiatry, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Laila Halaby
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Juanita I Trejo
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
| | - Fernanda Corella
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Karen L Weihs
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.,Departments of Family and Community Medicine and Psychiatry, University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
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Bellon F, Stremler R, Rubinat-Arnaldo E, Padilla-Martínez JM, Casado-Ramirez E, Sánchez-Ortuño M, Gea-Sánchez M, Martin-Vaquero Y, Moreno-Casbas T, Abad-Corpa E. Sleep quality among inpatients of Spanish public hospitals. Sci Rep 2022; 12:21989. [PMID: 36539518 PMCID: PMC9764317 DOI: 10.1038/s41598-022-26412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Sleep is a complex process and is needed both in health and illness. Deprivation of sleep is known to have multiple negative physiological effects on people's bodies and minds. Despite the awareness of these harmful effects, previous studies have shown that sleep is poor among hospitalised patients. We utilized an observational design with 343 patients recruited from medical and surgical units in 12 hospitals located in nine Spanish regions. Sociodemographic and clinical characteristics of patients were collected. Sleep quality at admission and during hospitalisation was measured by the Pittsburgh Sleep Quality Index. Sleep quantity was self-reported by patients in hours and minutes. Mean PSQI score before and during hospitalisation were respectively 8.62 ± 4.49 and 11.31 ± 4.04. Also, inpatients slept about an hour less during their hospital stay. Lower educational level, sedative medication intake, and multi-morbidity was shown to be associated with poorer sleep quality during hospitalisation. A higher level of habitual physical activity has shown to correlate positively with sleep quality in hospital. Our study showed poor sleep quality and quantity of inpatients and a drastic deterioration of sleep in hospital versus at home. These results may be helpful in drawing attention to patients' sleep in hospitals and encouraging interventions to improve sleep.
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Affiliation(s)
- Filip Bellon
- grid.15043.330000 0001 2163 1432GESEC Group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Montserrat Roig, 25198 Lleida, Spain ,Healthcare Research Group (GRECS), Institute of Biomedical Research Lleida (IRBLleida), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - Robyn Stremler
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646The Hospital for Sick Children (SickKids), Toronto, ON Canada
| | - Esther Rubinat-Arnaldo
- grid.15043.330000 0001 2163 1432GESEC Group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Montserrat Roig, 25198 Lleida, Spain ,Healthcare Research Group (GRECS), Institute of Biomedical Research Lleida (IRBLleida), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain ,grid.413448.e0000 0000 9314 1427Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Julia M. Padilla-Martínez
- grid.10586.3a0000 0001 2287 8496University of Murcia-Murcia Health Service (IMIB-Arrixaca), Campus Universitario, 1, 30100 Murcia, Spain
| | - Elvira Casado-Ramirez
- grid.512898.f0000 0004 0593 3686Nursing and Healthcare Research Unit (Investén-Isciii), Av. Monforte de Lemos, 5. Pabellón 13, 28029 Madrid, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
| | | | - Montserrat Gea-Sánchez
- grid.15043.330000 0001 2163 1432GESEC Group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Montserrat Roig, 25198 Lleida, Spain ,Healthcare Research Group (GRECS), Institute of Biomedical Research Lleida (IRBLleida), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
| | - Yolanda Martin-Vaquero
- Zamora Healthcare Complex, Zamora Health Care Management, Av. de Requejo, 35, 49022 Zamora, Spain
| | - Teresa Moreno-Casbas
- grid.512898.f0000 0004 0593 3686Nursing and Healthcare Research Unit (Investén-Isciii), Av. Monforte de Lemos, 5. Pabellón 13, 28029 Madrid, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
| | - Eva Abad-Corpa
- grid.10586.3a0000 0001 2287 8496University of Murcia-Murcia Health Service (IMIB-Arrixaca), Campus Universitario, 1, 30100 Murcia, Spain ,grid.512892.5Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Av. Monforte de Lemos, 5. Pabellón 11, 28029 Madrid, Spain
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Burger P, Van den Ende E, Lukman W, Burchell GL, Steur LM, Merten H, Nanayakkara PW, Gemke RJ. Sleep in hospitalized pediatric and adult patients – A systematic review and meta-analysis. Sleep Med X 2022; 4:100059. [PMID: 36406659 PMCID: PMC9672415 DOI: 10.1016/j.sleepx.2022.100059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing. Objective The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors. Methods A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep’ and 'hospitalization’. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines. Results Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6–1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep. Conclusion Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7–3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3–3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery. An overview of the magnitude of sleep deprivation in hospitalized patients. A meta-analysis of studies reporting on some of the main sleep outcomes. An overview of internal and external factors affecting sleep in hospitalized patients. Guidance for potential interventions to improve sleep during clinical admission. Uncovers a knowledge gap regarding the sleep quality of hospitalized children and daytime sleep of hospitalized adults.
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van den Ende ES, Merten H, Van der Roest L, Toussaint B, van Rijn Q, Keesenberg M, Lodders AM, van Veldhuizen K, Vos IE, Hoekstra S, Nanayakkara PWB. Evaluation of Nonpharmacologic Interventions and Sleep Outcomes in Hospitalized Medical and Surgical Patients: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2232623. [PMID: 36129708 PMCID: PMC9494194 DOI: 10.1001/jamanetworkopen.2022.32623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Inadequate sleep negatively affects patients' physical health, mental well-being, and recovery. Nonpharmacologic interventions are recommended as first-choice treatment. However, studies evaluating the interventions are often of poor quality and show equivocal results. OBJECTIVE To assess whether the implementation of nonpharmacologic interventions is associated with improved inpatient night sleep. DESIGN, SETTING, AND PARTICIPANTS In a nonrandomized controlled trial, patients were recruited on the acute medical unit and medical and surgical wards of a Dutch academic hospital. All adults who spent exactly 1 full night in the hospital were recruited between September 1, 2019, and May 31, 2020 (control group), received usual care. Patients recruited between September 1, 2020, and May 31, 2021, served as the intervention group. The intervention group received earplugs, an eye mask, and aromatherapy. Nurses received sleep-hygiene training, and in the acute medical unit, the morning medication and vital sign measurement rounds were postponed from the night shift to the day shift. All interventions were developed in collaboration with patients, nurses, and physicians. MAIN OUTCOMES AND MEASURES Sleep was measured using actigraphy and the Dutch-Flemish Patient-Reported Outcomes Measurement Information System sleep disturbance item bank. Other outcomes included patient-reported sleep disturbing factors and the use of sleep-enhancing tools. RESULTS A total of 374 patients were included (222 control, 152 intervention; median age, 65 [IQR, 52-74] years). Of these, 331 were included in the analysis (195 [59%] men). Most patients (138 [77%] control, 127 [84%] intervention) were in the acute medical unit. The total sleep time was 40 minutes longer in the intervention group (control: median, 6 hours and 5 minutes [IQR, 4 hours and 55 minutes to 7 hours and 4 minutes]; intervention: 6 hours and 45 minutes [IQR, 5 hours and 47 minutes to 7 hours and 39 minutes]; P < .001). This was mainly due to a 30-minute delay in final wake time (median clock-time: control, 6:30 am [IQR, 6:00 am to 7:22 am]; intervention, 7:00 am [IQR, 6:30-7:30 am]; P < .001). Sleep quality did not differ significantly between groups. For both groups, the main sleep-disturbing factors were noises, pain, toilet visits, and being awakened by hospital staff. Sleep masks (23 of 147 [16%]) and earplugs (17 of 147 [12%]) were used most. Nightly vital sign checks decreased significantly (control: 54%; intervention: 11%; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that sleep of hospitalized patients may be significantly improved with nonpharmacologic interventions. Postponement of morning vital sign checks and medication administration rounds from the night to the day shift may be a useful way to achieve this. TRIAL REGISTRATION Netherlands Trial Registry Identifier: NL7995.
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Affiliation(s)
- Eva S. van den Ende
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lisanne Van der Roest
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Belle Toussaint
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Quirine van Rijn
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marjolein Keesenberg
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anne M. Lodders
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim van Veldhuizen
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Iris E. Vos
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Sophie Hoekstra
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Prabath W. B. Nanayakkara
- Section of General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers (Basel) 2022; 14:cancers14163933. [PMID: 36010925 PMCID: PMC9406296 DOI: 10.3390/cancers14163933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
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Smichenko J, Shochat T, Zisberg A. Assessment of Sleep Duration and Number of Awakenings Based on Ankle and Wrist Actigraphy in Medical Hospitalized Older Patients. Biol Res Nurs 2022; 24:448-458. [PMID: 35512136 DOI: 10.1177/10998004221095567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most studies performed in the hospital assess sleep using self-reports; few rely on actigraphy. Although wrist actigraphy is commonly used for sleep assessment in field studies, in-hospital assessment may be challenging and cumbersome because other more necessary monitoring devices are often attached to patients' upper limbs; these may affect interpretation of wrist activity data. Placement on the ankle may be a viable solution. OBJECTIVE To compare total sleep time (TST) and number of awakenings (NOA) using concomitant wrist and ankle actigraphy, as well as self-reports in a sample of older adult patients hospitalized in medical units. METHODS This was a prospective observational study. Objective sleep data were collected using ankle and wrist actigraphy, and subjective data using sleep diary. Repeated measures mixed model analysis was performed, adjusting for age, gender, sleep medications, symptoms severity, interaction between types of measure, and night number. RESULTS Twenty-one older adults (65+) wore ankle and wrist actigraphy devices and subjectively estimated sleep parameters for an average of (2.15 ± 1.01) nights, with 40 nights available for analysis. TST was lower for wrist than ankle actigraphy (F(2,87) = 7.92, p = .0007). Neither differed from self-reports. NOA differed between all types of measure (ankle, 8.58 ± 6.66; wrist, 15.49 ± 7.47; self-report, 1.81 ± 1.83; F(2,85) = 47.66, p < .001). No significant within-subject variations and no interaction between devices and repeated measures were found. CONCLUSIONS Despite differences between ankle and wrist assessments, all three methods provided consistent TST estimation within participants. Findings provide preliminary support for the use of ankle actigraphy for sleep assessment in hospital settings.
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Affiliation(s)
- Juliana Smichenko
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, 61196University of Haifa, Haifa, Israel.,Clalit Health Services, Carmel Hospital, Israel
| | - Tamar Shochat
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, 61196University of Haifa, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Science, 61196University of Haifa, Haifa, Israel
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Effect of Conventional Nursing Combined with Bedtime Oculomotor Training on Sleep Quality and Body Immunity of Advanced Lung Cancer Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4357915. [PMID: 35310178 PMCID: PMC8930206 DOI: 10.1155/2022/4357915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study is to explore the effect of conventional nursing combined with bedtime oculomotor training on sleep quality and body immune of advanced lung cancer patients. Methods. By means of a retrospective study, 120 advanced lung cancer patients admitted to our hospital from January 2019 to January 2020 were selected as the research subject and divided into the intervention group (PSQI (Pittsburgh Sleep Quality Index) score≥10 points, n = 60) and the control group (PSQI score<10 points, n = 60). Conventional nursing was performed to the control group, and an eye movement exercise before sleep was added additionally in the intervention group, 30 min each time, once a day, and 5 times a week for 3 months, so as to compare their sleep quality, body immunity indexes, negative emotion scores, adverse reaction rate (ARR), quality of life, and satisfaction with nursing. Results. After nursing, the intervention group obtained a significantly lower PSQI score (5.54 ± 1.23 VS 7.98 ± 1.65,
), better body immunity indexes (
), lower negative emotion scores (
), lower ARR (
), better quality of life (
), and higher satisfaction with nursing (
) than the control group. Conclusion. Combining conventional nursing with the eye movement exercise before sleep can alleviate negative emotions, improve the sleep quality, promote body immunity, and reduce the ARR, which is more satisfying to patients and should be applied and promoted in practice.
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Effect of Eye Movement Training on Sleep Quality of Patients with Advanced Lung Cancer Based on Pittsburgh Sleep Quality Index. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9811980. [PMID: 34956583 PMCID: PMC8702321 DOI: 10.1155/2021/9811980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of eye movement training on sleep quality of patients with advanced lung cancer based on the Pittsburgh Sleep Quality Index (PSQI). Methods 120 advanced lung cancer patients admitted to our hospital from January 2019 to January 2020 were selected as the research object and divided into group A (PSQI scores ≥ 10 points, n = 60) and group B (PSQI < 10 points, n = 60). Routine nursing was performed to both groups, and patients in group A received the eye movement training additionally, so as to compare their PSQI scores, negative emotion scores, adverse reaction rate (ARR), Cancer Coping Modes Questionnaire (CCMQ) scores, and pain scores. Results After training, group A obtained significantly better sleep quality (P < 0.05), lower negative emotion scores (P < 0.001), lower ARR (P < 0.05), better CCMQ scores (P < 0.05), and lower pain scores (P < 0.001) than group B. Conclusion Eye movement training should be promoted in practice because it can reduce negative emotions, alleviate pain sensation, improve sleep quality and body condition, and lower the ARR for advanced lung cancer patients.
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Heglum HSA, Kallestad H, Vethe D, Langsrud K, Sand T, Engstrøm M. Distinguishing sleep from wake with a radar sensor: a contact-free real-time sleep monitor. Sleep 2021; 44:zsab060. [PMID: 33705555 PMCID: PMC8361351 DOI: 10.1093/sleep/zsab060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
This work aimed to evaluate whether a radar sensor can distinguish sleep from wakefulness in real time. The sensor detects body movements without direct physical contact with the subject and can be embedded in the roof of a hospital room for completely unobtrusive monitoring. We conducted simultaneous recordings with polysomnography, actigraphy, and radar on two groups: healthy young adults (n = 12, four nights per participant) and patients referred to a sleep examination (n = 28, one night per participant). We developed models for sleep/wake classification based on principles commonly used by actigraphy, including real-time models, and tested them on both datasets. We estimated a set of commonly reported sleep parameters from these data, including total-sleep-time, sleep-onset-latency, sleep-efficiency, and wake-after-sleep-onset, and evaluated the inter-method reliability of these estimates. Classification results were on-par with, or exceeding, those often seen for actigraphy. For real-time models in healthy young adults, accuracies were above 92%, sensitivities above 95%, specificities above 83%, and all Cohen's kappa values were above 0.81 compared to polysomnography. For patients referred to a sleep examination, accuracies were above 81%, sensitivities about 89%, specificities above 53%, and Cohen's kappa values above 0.44. Sleep variable estimates showed no significant intermethod bias, but the limits of agreement were quite wide for the group of patients referred to a sleep examination. Our results indicate that the radar has the potential to offer the benefits of contact-free real-time monitoring of sleep, both for in-patients and for ambulatory home monitoring.
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Affiliation(s)
- Hanne Siri Amdahl Heglum
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Novelda AS, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
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Sleep Quality among Breast and Prostate Cancer Patients: A Comparison between Subjective and Objective Measurements. Healthcare (Basel) 2021; 9:healthcare9070785. [PMID: 34206528 PMCID: PMC8304123 DOI: 10.3390/healthcare9070785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Breast and prostate cancer patients may experience physical and psychological distress, and a possible decrease in sleep quality. Subjective and objective methods measure different aspects of sleep quality. Our study attempted to determine differences between objective and subjective measurements of sleep quality using bivariate and Pearson's correlation data analysis. Forty breast (n = 20) and prostate (n = 20) cancer patients were recruited in this observational study. Participants were given an actigraphy device (ACT) and asked to continuously wear it for seven consecutive days, for objective data collection. Following this period, they filled out the Pittsburgh Sleep Quality Index Questionnaire (PSQI) to collect subjective data on sleep quality. The correlation results showed that, for breast cancer patients, PSQI sleep duration was moderately correlated with ACT total sleeping time (TST) (r = -0.534, p < 0.05), and PSQI daytime dysfunction was related to ACT efficiency (r = 0.521, p < 0.05). For prostate cancer patients, PSQI sleep disturbances were related to ACT TST (r = 0.626, p < 0.05). Both objective and subjective measurements are important in validating and determining details of sleep quality, with combined results being more insightful, and can also help in personalized care to further improve quality of life among cancer patients.
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Savage CLG, Orth RD, Jacome AM, Bennett ME, Blanchard JJ. "Assessing the Psychometric Properties of the PROMIS Sleep Measures in Persons with Psychosis.". Sleep 2021; 44:6292152. [PMID: 34086964 DOI: 10.1093/sleep/zsab140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/28/2021] [Indexed: 11/14/2022] Open
Abstract
An accumulation of research has indicated that persons with psychotic disorders experience a variety of sleep disturbances. However, few studies have examined the psychometric properties of sleep assessments that are utilized in this population. We conducted two studies to examine the reliability and validity of the PROMISTM Sleep Disturbance and Sleep-Related Impairment scales in outpatient samples of persons with psychosis. In Study 1, we examined the internal consistency and convergent validity of the PROMIS sleep scales in individuals with various psychotic disorders (N = 98) and healthy controls (N = 22). The PROMIS sleep scales showed acceptable internal consistency and convergent validity in both healthy controls and individuals with psychotic disorders. In addition, replicating prior research, the PROMIS scales identified greater sleep disturbance and sleep-related impairment in participants with psychotic disorders compared to healthy controls. In Study 2, we examined the test-retest reliability (M = 358 days) of the PROMIS sleep scales in a subset (N = 37) of persons with psychotic disorders who previously participated in Study 1. We also assessed the relation between these self-report measures and actigraph sleep parameters. The results showed that PROMIS sleep measures demonstrated modest temporal stability in the current sample. Contrary to our hypothesis, there was a lack of correspondence between these scales and actigraph sleep parameters. Overall, these findings indicate that the PROMIS sleep scales are psychometrically sound measures for populations with psychosis and highlight the importance of utilizing a multi-method approach to assess sleep.
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Affiliation(s)
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Anyela M Jacome
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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Assessment of sleep problems with the Insomnia Severity Index (ISI) and the sleep item of the Patient Health Questionnaire (PHQ-9) in cancer patients. Support Care Cancer 2021; 29:7377-7384. [PMID: 34050799 PMCID: PMC8550304 DOI: 10.1007/s00520-021-06282-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022]
Abstract
Objective The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems. Methods A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined. Results The reliability of the ISI was very good (Cronbach’s alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs). Conclusions The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies.
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Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open 2021; 11:e042510. [PMID: 33972331 PMCID: PMC8112429 DOI: 10.1136/bmjopen-2020-042510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients. METHODS The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported. RESULTS Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group. CONCLUSIONS Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed. PROSPERO REGISTRATION NUMBER CRD42020167783.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, The Netherlands
| | - Esmée Venema
- Maastricht University, Maastricht, The Netherlands
| | - Johannes Jeekel
- Department of Surgery and Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Dasdemir Ilkhan G, Celikhisar H. The effect of incontinence on sleep quality in the elderly. Int J Clin Pract 2021; 75:e13965. [PMID: 33368941 DOI: 10.1111/ijcp.13965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study was conducted to determine the frequency of incontinence in elderly people living in nursing homes and the effect of incontinence on the quality of life and sleep quality. MATERIAL AND METHOD This study was carried out with a total of 1150 individuals aged 65 and over, living in four nursing homes. Pittsburg Sleep Quality Index (PSQI), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and Incontinence Quality of Life Scale (IQOL) were used as data collection tools. The data were collected after obtaining ethics committee and institutional approvals and written consents of the elderly participants. RESULTS The mean age of 1150 elderly individuals included in the study was 75.49 ± 8.62 years. The mean PSQI score of the elderly was 8.33 ± 4.16 and 83.5% of them had poor sleep quality. It was determined that 87.0% of the elderly woke up at night and the most common reason for waking up was the need to use the toilet (60.0%). It was found that the mean ICIQ-SF score of the individuals was 10.65 ± 4.40 and 80.9% of them had bothersome urinary incontinence. The average IQOL score of individuals with incontinence was 63.39 ± 11.26. CONCLUSION It was determined that almost all of the elderly people included in the present study had sleep problems and 20.0% had incontinence. It was found that sleep quality is not affected by incontinence in the elderly, but the quality of life decreases because of incontinence.
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Affiliation(s)
- Gulay Dasdemir Ilkhan
- Chest Diseases Department, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Hakan Celikhisar
- Department of Chest Diseases, Izmir Metropolitan Municipality Esrefpasa Hospita, Izmir, Turkey
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Kreutz C, Müller J, Schmidt ME, Steindorf K. Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy. Support Care Cancer 2020; 29:1015-1023. [PMID: 32556623 PMCID: PMC7767899 DOI: 10.1007/s00520-020-05580-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/13/2020] [Indexed: 12/29/2022]
Abstract
Purpose To characterize sleep problems and to compare subjective and objective assessments in breast cancer patients starting neoadjuvant chemotherapy. Methods Sleep characteristics of 54 breast cancer patients starting neoadjuvant chemotherapy were analyzed. Subjective sleep characteristics were assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep measurements with an accelerometer (ActiGraph wGT3X-BT) worn on the wrist for 7 consecutive days. Results According to the common PSQI cut-off of 8, 10 (18.87%) of the patients were poor sleepers. ActiGraph measures did not mirror this classification as values for poor, and good sleepers did not differ significantly. Overall, Bland-Altman plots illustrated higher ActiGraph values for sleep efficiency and effective sleep time and lower values for sleep latency, compared with PSQI. For total sleep time, less disagreement between both measures was observed. Actigraphy was limited in precise identification of sleep begin and sleep latency but provided supplementary information about number and minutes of awakenings during the night. Conclusion Subjective and objective measurement methods differed substantially in various parameters, with limitations in both methods. A combination of both methods might be most promising. Trial Registration Clinicaltrials.gov: NCT02999074 Electronic supplementary material The online version of this article (10.1007/s00520-020-05580-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Kreutz
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Faculty of Medicine Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Jana Müller
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- Institute of Sports and Sport Science, Heidelberg University, Im Neuenheimer Feld 700, 69120, Heidelberg, Germany
- Working Group Exercise Oncology, Division of Medical Oncology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
- Division of Physical Activity, Prevention and Cancer (C110), German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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