Validation of the Pittsburgh Sleep Quality Index (PSQI) with Arabic cancer patients

Sleep Habits and Disturbances Among Tunisian Adults: A Cross-Sectional Online Survey

Background

Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims to assess sleep-wake habits and disturbances in Tunisian adults.

Methodology

This cross-sectional study employed an online questionnaire to assess 3074 adults ≥ 18 years. Primary outcomes, including sleep quality, daytime vigilance, mood, and subjective well-being, were measured using validated questionnaires [the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire (PHQ)-9, and the World Health Organisation-Five Well-Being Index (WHO-5)].

Results

Less than two-thirds (n= 1941; 63.1%) of participants were females and the mean age was 36.25±13.56. The prevalence of poor sleep quality was 53.8% when defined as a PSQI > 5. The prevalence of insomnia, short sleep duration, long sleep duration, EDS, severe depression, and poor well-being were 14.5%, 34.7%, 12.3%, 32.4%, 7.4%, and 40.2%, respectively. Some factors were associated with an increased likelihood of poor sleep quality, including female gender, chronic hypnotics use, internet use close to bedtime, daily time spent on the internet >3 hours, smoking, university- level education, nocturnal work, severe depression, impaired well-being status, insomnia, and EDS.

Conclusion

The high prevalence of sleep-wake disturbances among Tunisian adults emphasizes the need for an appropriate screening strategy for high-risk groups. Individuals with unhealthy habits and routines were significantly more likely to experience these kinds of disturbances. Consequently, there is a pressing need for educational programs on sleep to foster healthier sleep patterns.

Retrospective study on the emotional status of healthcare workers in a COVID-19 field hospital in Oman

Overview

To combat the overwhelming demand for medical services and care during the COVID-19 Pandemic, the Sultanate of Oman launched the COVID-19 Field Hospital in 2020, designed to respond and alleviate the burden on the medical infrastructure. Several studies globally and from the Middle East suggested that frontline healthcare workers (HCW) were at risk of developing markers of psychological distress. It was further understood through research findings that HCW were resilient during times of crisis. However, there is a dearth in studies evaluating the emotional status of frontline HCW posted in the COVID-19 field hospitals in Gulf Countries, including Oman. This study attempts to shed light on the emotional status of HCW that were on the frontlines in the field hospital in the Sultanate of Oman.

Aim

This study aims to quantify and evaluate the emotional status of HCW in the frontline field hospital by screening for symptoms of depression, anxiety, and sleep quality.

Method

The data was collected by a local private mental healthcare facility as part of digital feedback to design and implement supportive strategies. Data was collected between September 2021 and October 2021 from 121 HCW in the COVID-19 Field hospital in Oman via 'WhatsApp'.

Results

Chi square and binary logistic regression tests were administered to evaluate the data. The participants comprised of 63.6% females and 79.3% were between 30 and 39 years of age. Majority of the participants (65.2%) described themselves as 'financially unstable' and possess an average of 7.5 years of work experience. Of the participants 73.6% of the HCW were based solely in the field hospital for 6-9 months at the time of the survey. Majority of the participants denied the presence of emotional distress expressed through depression (92.6%), anxiety (92.6%) and poor quality of sleep (59.5%).

Conclusion

The findings of the present study reflect the HCW ability to cope during challenging situations likely owing to a variety of environmental, social and personal protective factors. The findings of this study can translate into further research on identifying and addressing stressors and targeting the enhancement of protective factors to safeguard the well-being of HCW.

Examining the structure validity of the Pittsburgh Sleep Quality Index among female workers during New Zealand's initial COVID-19 lockdown

Sleep is important for good physical and mental health. The COVID-19 pandemic lockdown created a unique context that impacted psychological and social drivers for sleeping well. The Pittsburgh Sleep Quality Index (PSQI) is a widely used measurement tool assessing subjective sleep quality. The traditional model of the PSQI (a one-factor model), whilst validated and used across different populations, has also been questioned with regards to data fit and representativeness of its global score in different social and work-related circumstances. Examination of the structure validity of the PSQI in the unique context of the pandemic has been scarce. This study determined the PSQI structure validity amongst employed women considered to experience increased stressors during the pandemic lockdown. The subjectively reported PSQI data from 498 female workers (mean age 44.6 years) collected during New Zealand's first national COVID-19 lockdown (April, 2020) was used. Confirmatory factor analyses compared the original one-factor model of the PSQI with the two- and three-factor models used by Jia et al. (2019) within this pandemic context. Results showed that the two-factor model provided a superior fit of the PSQI data compared to the original one-factor or a three-factor model. These findings suggest that a sub-score of the PSQI with two factors appears to be better at describing the sleep quality of healthy working women during the constrained situation of the pandemic lockdown compared to a single global sleep quality score. This indicates the importance of considering the validity of subjective sleep measures when used within unique social contexts and stressors.

Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study

BACKGROUND

Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation.

METHOD

A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated.

RESULTS

The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women.

CONCLUSION AND RECOMMENDATION

This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.

Predictors and disturbances of sleep quality between men and women: results from a cross-sectional study in Jordan

BACKGROUND

Sleep disturbances, a public health concern that may lead to critical physiological conditions, are associated with personal characteristics such as gender. Limited evidence is available from the Middle East population on the gender disparities in sleep quality. Therefore, the current study examined gender-specific differences in sleep quality and disturbances among Jordanian citizens.

METHOD

A cross-sectional design was used to recruit a convenient sample of 1,092 adults from different Jordanian cities. Data was collected using a self-reported questionnaire comprising the Pittsburgh Sleep Quality Index (PSQI), which was distributed online via social media networks. The participants were categorized according to their global PSQI scores into poor (PSQI ≥ 5) and good sleepers (PSQI < 5). The analysis focused on finding differences between women and men in terms of sleep quality and the effects of demographic, lifestyle, and socioeconomic factors on reported sleep problems.

RESULTS

Women were revealed to have a higher prevalence of all types of sleep disturbances than men. Women who were over 55 (compared to younger than 20 years), did not smoke, had multiple jobs or part-time employment (compared to unemployed women), and had a monthly income of more than 500 JD (compared to those with an income of < 500 JD) were less likely to experience poor sleep than other women. In contrast, men who neither smoked nor drank coffee, ate no sweets or only one to two pieces daily (compared to participants who ate more than two pieces daily), and worked fixed night shifts (compared to alternating shifts workers) were less likely to experience poor sleep than other men.

CONCLUSION

This study builds a more nuanced understanding of how different demographic, lifestyle, and socioeconomic factors - such as a participant's age, time of working duty, income, daily sweet consumption, daily caffeine consumption, and smoking - affect the sleep quality of men and women. Thus, promoting a healthier lifestyle for both genders by modifying risk factors - such as smoking cessation, as well as reducing their intake of caffeine and sweets - is the first step toward improving their sleep quality. Further studies are needed to examine how the social role of Arabic women affects their sleep.

The effect of a mindfulness intervention (MI) on sleep disturbance (SD) among nurses

Sleep disturbance (SD) makes it difficult for nurses in intensive care units (ICUs) to perform activities that require focused and continual concentration, which raises the risk of medical errors, health issues, loss of sleep, and patient care mistakes. The mindfulness intervention (MI) was created to give participants the capacity to approach their own emotions with non-judgmental awareness and to become more conscious of their thoughts and feelings, and it reduced psychological symptoms. This study examined the effect of MI on SD among nurses. A randomized control trail (RCT) was conducted and recruited 100 nurses from intensive care and medical-surgical units from three hospitals located at the northern and middle regions of Jordan. Bivariate analysis including independent T-test and multiple linear regressions were used to study the differences between the interventional group (MI) and the comparison group (watching mindfulness videos) in terms of the impact on the SD. Nurses reported significant and high levels of SD. MI significantly reduced the level of SD and improved sleep quality among nurses. MI should be integrated into nursing competences to combat the negative impacts of poor sleep quality on nurses and organizational-sensitive outcomes.

Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis

OBJECTIVE

Poor sleep quality is common in patients with cancer, but the prevalence rates varied widely across studies. This systematic review and meta-analysis examined the pooled prevalence of poor sleep quality among patients with cancer.

METHODS

Systematic literature searches were independently conducted in the major databases (Web of Science, PubMed, EMBASE and PsycINFO). Studies that reported the prevalence of poor sleep quality in patients with cancer were analyzed using a random effects model. Funnel plots and Egger's tests were used to assess publication bias. Statistical analyses were performed using R software.

RESULTS

A total of 59 epidemiological studies involving 16,223 patients were included. The pooled prevalence of poor sleep quality in patients with cancer was 57.4% [95% confidence interval (CI): 53.3% - 61.6%]. Additionally, three comparative studies with 372 patients and 412 healthy controls were included. Compared to healthy controls, patients with cancer had a significantly higher risk for poor sleep quality [odd ratio (OR) = 3.0; 95%CI: 1.2-7.2; P < 0.05]. Subgroup analyses of the studies revealed that studies from Middle East & North Africa region and low income countries, and on gynecological cancer as well as those with a lower cut-off value of sleep quality (all P < 0.01) reported a higher prevalence of poor sleep quality. Meta-regression analyses showed that higher prevalence of poor sleep quality was associated with higher prevalence of comorbid depression (P < 0.05) and anxiety (P < 0.01), but was associated with a lower education level (P < 0.05) and alcohol use ratio (P < 0.05).

CONCLUSION

Poor sleep quality is common among patients with cancer. Considering the overall high prevalence rate and negative impact of poor sleep quality, appropriate measures to identify and improve poor sleep quality are needed to enhance the clinical outcomes in this group.

Quality-of-life among women with breast cancer: application of the international classification of functioning, disability and health model

Background

This study aimed to identify the factors that influence Breast Cancer (BC) women's quality of life (QoL) based on the International Classification of Functioning, Disability and Health (ICF) framework.

Method

A cross-sectional study was conducted among 188 women with BC. The dependent variable, QoL, was measured using the Quality of Life Index (QLI-c). The independent variables were measured using the following Arabic-validated questionnaires: Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ).

Results

There was a significant positive correlation between monthly income (r = 0.17, p = 0.016) and QoL, and significant negative correlation between the stage of disease (r = -0.221, p = 0.002) and duration of first diagnosis (r = -0.280, p = 0.004) with QoL. Poor sleep quality, sexual dysfunction, fatigue, depression, and anxiety had significant negative correlations with QoL (p < 0.01). Multiple regression analysis revealed that among the various factors that might affect QoL, sexual dysfunction, poor sleep quality, depression, and anxiety were significant predictors of QoL (p ≤ 0.05).

Conclusion

The ICF provided an excellent framework to explore the factors influencing QoL among women with BC. This study has given evidence for the relationship of demographic, clinical, and body functional factors with QoL among women with BC. Interestingly, sexual dysfunction, poor sleep quality, depression, and anxiety factors are predictors of QoL. Awareness of these factors that predict QoL will guide healthcare professionals to improve the health and QoL of BC women.

The Effect of a Supportive Educational Intervention Through Virtual Social Networks on Sleep Quality and Insomnia of Patients with Cancer

Sleep disturbances are very common among cancer patients, and they need more support in this regard. More access to technology has provided opportunities to use virtual teaching methods to educate and support cancer patients. This study aimed to investigate the effect of supportive educational intervention (SEI) through virtual social networks (VSNs) on the sleep quality and the severity of insomnia of cancer patients. The study was conducted on 66 patients with cancer: intervention (n = 33) and control (n = 33) groups (CONSORT). Intervention group received supportive educational intervention on sleep for 2 months through virtual social networks (VSNs). All participants completed the Pittsburgh Sleep Quality Index and insomnia severity index (ISI) before and after the intervention. The mean scores of sleep quality (p = .001) and insomnia severity (p = .001) in the intervention group had a statistically significant decrease. Moreover, quality, latency, duration, efficiency, disturbances of sleep, and daytime dysfunction showed significant improvement in the intervention group, every two times after the intervention (p < .05). However, the participants' sleep quality deteriorated progressively in the control group (p = .001). Supportive educational intervention (SEI) through VSNs can be an effective method to improve sleep quality and decrease insomnia severity of patients with cancer.Trial registration number: RCT20220528055007N1Date of registration: 2022-08-31(retrospectively registered).

Sleep Quality and Its Affecting Factors among Hemodialysis Patients: A Multicenter Cross-Sectional Study

(1) Background: Sleep quality is one of the most important clinical outcomes of hemodialysis (HD) patients, as it can affect their physical and mental health. This study aimed to investigate sleep quality and its affecting factors among patients with HD. (2) Methods: A cross-sectional design was used to investigate the quality of sleep among HD patients in two cities in Saudi Arabia. The data were collected during the period from January to December 2022. A convenience sample of 250 HD patients was selected in this study. Data were collected using the Arabic version of the Pittsburgh Sleep Quality Index (PSQI). (3) Results: About two-thirds of participants (63.6%) had normal sleep, while one-third had poor sleep (36.4%). There was a significant relationship between the participants' age and the quality of sleep, where participants who were aged more than 50 had poorer sleep than those who were younger (p < 0.001). Male and married participants significantly had poor sleep more than female and single participants (p = 0.011 and 0.015, respectively). In addition, participants who were retired, had a higher number of dependents, did not adhere to exercise, and had more comorbidities had significantly poorer sleep than other groups (p = 0.002, 0.016, 0.023, and <0.001, respectively). The level of education, financial status, distance from home to dialysis center, and participants' satisfaction at the time of dialysis had no influence on the quality of sleep among HD patients. The multiple linear regression shows that exercise (p = 0.017), the number of comorbidities (p = 0.008), and the duration of dialysis (p < 0.020) were the independent factors affecting the quality of sleep among HD patients. (4) Conclusions: About one-third of HD patients in this study had poor sleep. There were significant differences between patients' age, gender, marital status, and sleep-quality levels. Moreover, participants who retired, had a higher number of dependents, did not adhere to exercise, and had more comorbidities had significantly poorer sleep than other groups. Future studies should develop appropriate interventions to address the problem of poor sleep quality among HD patients.

Sleep Quality Among People with Type 2 Diabetes Mellitus During COVID-19 Pandemic: Evidence from Qatar's National Diabetes Center

Purpose

Sleep disturbance is suspected to increase during the COVID-19 pandemic, and people with type 2 DM are known to have a higher risk of sleep disturbance. We aimed to determine the prevalence and determinants of sleep disturbance through Pittsburgh Sleep Quality Index (PSQI) during the COVID-19 pandemic.

Patients and Methods

We randomly selected two hundred eighty-eight people with T2DM from the outpatient clinics of the National Diabetes Centre in Qatar. We used Chi-square, Mann-Whitney, Spearman, and Point Biserial correlation tests to examine the association between sleep quality and the independent variables. Finally, we conducted multiple logistics regression to identify the predictors of poor sleep quality and set the alpha level at 0.05.

Results

In our sample, the mean age (±SD) was 51.4 (± 9.5) years, and 64.3% of the study participants were males. The median (IQR) duration of diabetes was 10 (11) years. Additionally, 6.3% of the participants were on insulin. The median HbA1c was 7.6% (2.4). Three in ten patients reported poor sleep quality (PSQI>5); (n=103; 35.8%). Poor sleep quality was statistically associated with young age, previous history of sleep disturbance, prior diagnosis of sleep disorders, high depression score, and high perceived stress score. After adjusting for confounders, only high depressive symptoms score and previous history of sleep disorder were significant predictors of poor sleep quality (p < 0.001), with adjusted odd ratios of (aOR = 1.421; 95% CI: 1.242-1.625) and (aOR = 3.208; 95% CI: 1.574-6.537), respectively.

Conclusion

The prevalence of poor sleep quality among people with T2DM during the COVID-19 pandemic is high. Physicians must screen for depression, stress, and previous history of sleep disorder to tackle poor sleep among T2DM.

The Role of Exercise on Fatigue Among Patients With Multiple Sclerosis in the King Fahad Hospital, Madinah, Saudi Arabia: An Analytical Cross-Sectional Study

Background Multiple sclerosis (MS) is a chronic autoimmune disease caused by multiple factors. It can lead to many physical and mental symptoms. Fatigue is one of the most commonly mentioned complaints among MS patients that can affect their quality of life. Physical activity has many benefits for the physical and mental health of patients with MS. Aim To assess the role of exercise on fatigue among patients with multiple sclerosis and identify the relationship between depression, sleep quality, sociodemographic variables, and fatigue. Methods This is an analytical cross-sectional study based on a sample size of 235 patients recruited from the MS clinic at King Fahad Hospital (KFH) in Madinah. The outcome of the study was fatigue among MS patients. Data were collected through telephone calls from February to May 2022 using a structured questionnaire and scales, such as the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Modified Fatigue Impact Scale (MFIS), Patient Health Questionnaire (PHQ2), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed through SPSS version 20 (IBM Corp., Armonk, NY, USA). The correlation coefficient (r), Chi-square tests, and simple and multiple logistic regression were used as found appropriate. Results Out of the total samples, 37.4% were male and 62.6% were female. The median age of patients was 36 years. The prevalence of fatigue was 37% among patients, with a reported median fatigue score of 26. It was found that 63% of the patients were physically inactive; 32.2% were overweight, 14.2% were obese; 63.8% of patients had poor sleep quality. The fatigue score was negatively correlated with the GLTEQ score, but the results were not significant (r=-0.066; P-value (level of significance)=0.335). Nonetheless, a moderately significant correlation was observed between the MFIS and PSQI and MFIS and PHQ2 (r=0.505, P=<0.001 and r=0.520, P=<0.001, respectively). The Chi-square test showed a significant association between fatigue and progressive types of MS, the primary progressive MS (PPMS), secondary progressive MS (SPMS), and relapsing-remitting MS (RRMS) (odds ratio (OR)=4.4; 95% confidence interval (CI): 2.1-8.9), P=<0.001). Depressed patients were 9.7 times more likely to develop fatigue compared to non-depressed patients (P=<0.001). Those with poor sleep quality were 4.6 times more likely to develop fatigue compared to those with good sleep quality (P=<0.001). Fifty-six percent of fatigue among MS patients were predicted by low income, progressive types, unemployment, obesity, depression, and poor sleep quality. Conclusion Fatigue is a major complaint among MS patients. Most of the patients were found to be physically inactive, depressed, and have poor sleep quality. This study found an association between physical inactivity and fatigue, but the results were not significant. There was a significant association between sociodemographic factors like low income and unemployment, poor sleep quality, obesity, progressive types of MS, depression, and fatigue. Encouraging exercise practice and implementing a regular exercise program are needed, along with weight management plans. Further studies and psychological support meetings are required, with the importance of a holistic approach to patient care.

Adverse childhood experiences and sleep disorders among Tunisian adolescents: The mediating role of internet addiction

BACKGROUND

Adverse childhood experiences (ACEs) are a prevalent health problem worldwide. Different side effects have been linked to this issue such as sleep disorders. This matter is well known. However, its influencing mechanisms are not well investigated in literature.

OBJECTIVE

To investigate the mediating role of internet addiction in the relation between adverse childhood experiences (ACEs) and sleep disorders among a population of high-school students in the region of Gafsa (Tunisia).

PARTICIPANTS AND SETTING

We performed a cross-sectional study, in February 2020, including adolescents registered in all secondary schools of Gafsa city.

METHODS

Sleep disorders were evaluated via the Pittsburgh Sleep Quality Index, internet addiction via the Internet Addiction Test and adverse childhood experiences via the Adverse Childhood Experiences-International Questionnaire.

RESULTS

A total of 414 students were enrolled in our study with a mean age of 17.18 ± 1.5 years. Exposure to intra-familial violence was more reported than social adversities with 99.1 % and 84 % respectively. Males showed higher rates of internet addiction (82.9 % vs 78.3 %, p < 0.001). Sleep disorders were reported in 94 % of students, predominantly among females (95.4 % vs 91 %, p < 0.001). Our results revealed that ACEs predict sleep disturbances through internet addiction (% mediation =18.3 %, p = 0.005). More particularly, an important mediation effect of internet addiction on the relationship between ACEs and sleep disorders was found among females (% mediation =30 %).

CONCLUSION

Internet addiction was found to be a mediating factor in the relation between ACEs and sleep disturbances among Gafsa high school students.

Sleep habits and quality among war and conflict-affected Palestinian adults in the Gaza strip

OBJECTIVES/BACKGROUND

Sleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip.

PATIENTS/METHODS

A population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9.

RESULTS

Three out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality.

CONCLUSION

Poor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.

The Association Between Dry Eye and Sleep Quality Among the Adult Population of Saudi Arabia

Background and objective

Dry eye disease (DED) is one of the most prevalent ocular diseases worldwide. DED symptoms can result from disturbances to the homeostasis of the middle tear film layer (aqueous layer), including inflammation, pain, and eye discomfort, which can have a negative impact on individuals’ quality of life and daily activities. Sleep disorders are highly prevalent among patients with DED, and the incidence of sleep disturbances in DED patients has been reported to be as high as 40%. Decreased sleep quality can aggravate dry eye symptoms by increasing tear osmolarity and decreasing tear production. In this study, we aimed to investigate the association between DED and sleep quality in the adult population of Saudi Arabia.

Methods

This cross-sectional study was conducted among adult patients aged 18 years and above in Saudi Arabia in August 2021. A validated Arabic version of the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and the Ocular Surface Disease Index (OSDI) questionnaire was employed to diagnose DED. Data collection and analysis were performed using the SPSS Statistics software (IBM, Armonk, NY).

Results

A total of 234 subjects were analyzed, and 59.8% of the participants were women. Our tool suggested that 71.4% of the included participants had severe DED, 15% had moderate DED, and 13.7% had mild DED. However, 40.6% of the participants reported that they had not been diagnosed with DED previously and 34.6% had no previous DED symptoms. The mean total PSQI score was 8.63 ±2.23, with the highest score recorded for component 2: sleep latency (1.73) and the lowest score recorded for component 4: habitual sleep efficiency (0.20). Poor sleep quality as assessed by PSQI showed a significant positive correlation with the severity of DED as assessed by OSDI.

Conclusion

The significant positive correlation between poor sleep quality and DED indicated that patients with DED had a higher risk of poor sleep quality compared to healthy patients. Patients with DED should be educated about the steps and techniques to improve their sleep patterns.

Sleep Quality and Cancer-Related Fatigue in Patients with Cancer

Introduction: Sleep problems and fatigue are common symptoms reported by cancer patients. In this study, the researchers used a specialized tool to measure fatigue in cancer patients and its relationship with sleep quality in Yazd, Iran.

Methods: This descriptive correlational study included 149 cancer patients (age range: over 18 years) referred to Shahid Sadoughi Hospital in Yazd, Iran. Data were collected by the Pittsburgh Sleep Quality Index (PSQI) and Cancer-Related Fatigue Questionnaire. A PSQI score of ≥5 indicated a poor sleep. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA), Pearson’s correlation, t test, analysis of variance (ANOVA), and linear regression.

Results: The mean (SD) PSQI score of patients was 13 (4.85) out of 21. About 69.3% of patients had a poor sleep quality. While the mean (SD) of sleep duration was 5.57 (0.54) hours, it was 69.44 (46.58) minutes for sleep latency. Also, with increasing the mean of sleep quality, the mean of fatigue significantly increased (P < 0.001, R=0.63).

Conclusion: According to the results, there was a relationship between the sleep quality and fatigue in cancer patients, so that patients with better sleep quality had less fatigue.

Prevalence of non-specific chronic low-back pain and risk factors among male soldiers in Saudi Arabia

Background

Non-specific chronic low back pain (NSCLBP) is the most common musculoskeletal disorder affecting health and work among the military population. NSCLBP is a complex disorder with several risk factors contributing to its occurrence. Therefore, the objective of our study was to estimate the prevalence and contribution of risk factors towards NSCLBP among male soldiers in Saudi Arabia.

Methods

A cross-sectional study was conducted from March 2020 to January 2021 among the military personnel at Hafar Al-Batin military base, Saudi Arabia. The entire population (n = 62, 000) at the military base were invited to participate in the study. The participants were invited to participate in the study either through direct referral from in-patient and out-patient departments of the military hospital or by invitation through pamphlets, email, and advertisement across the offices and residential areas. Soldiers reporting lower back pain for at least 12 weeks were screened for inclusion criteria at the physical therapy department of the military hospital. Inclusion criteria included pain or discomfort originating from the lower back without any known spinal diseases. Participants with a systemic inflammatory disorder, trauma, neurological symptoms, and recent spinal surgery were excluded. All eligible participants were assessed for demographic variables and risk factors and complete the Rolland Morris Disability Questionnaire and WHO-Five Well-Being Index.

Results

This study identified a 46.3% prevalence of pain originating from the spine with a 2.7% prevalence of NSCLBP. Spearman's rho correlation between the severity of disability due to NSCLBP was strongly associated with age (r_s = 0.834, p < 0.01), quality of sleep (r_s = 0.790, p < 0.01), body mass index (BMI) (r_s = 0.617, p < 0.01), smoking (r_s = 0.520, p < 0.01), co-morbidity (r_s = 0.357, p < 0.01), but not with the level of physical activity (r_s = 0.044, p = 0.07).

Conclusion

There was a high prevalence of pain originating from the spine among male Saudi soldiers with a relatively low prevalence of NSCLBP. However, the prevalence of disability due to NSCLBP was strongly associated with age, sleep quality, BMI, smoking habit, and co-morbidity.

Evaluating the Quality of Life and Sleep Quality in Saudi Women with Breast Cancer-Related Lymphedema: A Cross-Sectional Correlational Study

Background

Among the different cancers found in women, breast cancer is the most common. Breast cancer-related lymphedema is a serious health complication affecting the quality of life and sleep quality. This study evaluates the quality of life and sleep quality among Saudi women with different stages of lymphedema following the treatment of breast cancer.

Methods

This cross-sectional correlational study included 163 Saudi women with breast cancer-related lymphedema (Stages I-III), aged 28 to 56 years. From the patients identified for this study, women who suffered from mental and psychological dysfunctions or other malignant disorders were excluded. Copies of structured questionnaires were given to each participant during their visits to outpatient physiotherapy clinics. Quality of life was assessed using a valid questionnaire (EORTC QLQ-C30), while sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The differences between the different lymphedema stages have been assessed.

Results

Of the total number of participants 27 women had been diagnosed with stage I lymphedema, 84 women had been diagnosed with stage II lymphedema, and 52 women had been diagnosed with stage III lymphedema. All participants have shown low scores on both EORTC QLQ-C30 and PSQI. While analyzing the differences between the 3 stages of lymphedema with the Kruskal–Wallis test, noteworthy statistical differences between the 3 stages of lymphedema (P < .05) have been found. The Stage III lymphedema patients have been shown the lowest quality of life values in all scales when compared with the stage I and stage II lymphedema patients. For PSQI scores, the stage III lymphedema patients worse values than the stage I and stage II lymphedema patients (P < .05).

Conclusion and Recommendations

Both quality of life and quality of sleep have significantly decreased in Saudi women with different stages of breast cancer-related lymphedema. Quality of life and quality of sleep are the worst in stage III lymphedema patients. Future research should consider repeat and enlarge these results as well as assess the risk factors that affect the quality of life and quality of sleep among Saudi women suffering from breast cancer-related lymphedema.

Psychological impact of the coronavirus 2019 (COVID-19) pandemic on nurses

AIM

The new coronavirus disease (COVID-19) pandemic has laid unprecedented stress on healthcare workers and especially nurses. The main objective of this study is to determine the prevalence of stress, anxiety, depression and sleep disturbance among nurses in Oman during the COVID-19 pandemic, and to explore the contributing factors.

METHODS

A cross-sectional and descriptive correlational design using Qualtrics® software was performed. Data were collected using the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale and the Perceived Stress Scale.

RESULTS

Of the 1,130 nurses who participated, 75.6% (n = 854) reported stress, 44.2% (n = 499) reported anxiety, 38.5% (n = 435) reported depression and 73.7% (n = 833) reported poor sleep. Stress, anxiety, depression and sleep disturbance (p < .05) were significantly associated with age, marital status, comorbidity and whether family members or relatives were suspected or confirmed with COVID-19. The stress, anxiety, depression and sleep disturbance were significantly positively corelated with each other. Logistic regression showed nurses in the age group between 18 and 30, who worked at the frontline, were at a higher risk of stress, anxiety, depression and sleep disturbance.

CONCLUSIONS

Stress, anxiety, depression and sleep disturbance are significant problems for nurses working in Oman during the COVID-19 pandemic. Appropriate interventions to monitor and reduce psychological problems and sleep disturbance among nurses are needed, which can help to support nurses' work during contagious disease outbreaks.

Sleep disturbance among Arabic breast cancer survivors

BACKGROUND

Sleep disturbance is the most common and distressing cancer symptom that negatively affects the quality of life (QoL). The main objective of this study is to determine the prevalence of sleep disturbance among Arabic women with breast cancer, post-treatment, and assess their sleep disturbance in relation to health-related QoL, demographics and treatment characteristics.

METHODS

In this study, cross-sectional data were collected using the Pittsburgh Sleep Quality Index (PSQI: 19-items) and the Functional Assessment of Cancer Therapy-General (FACT-G: 27 items). Demographic information and treatment characteristics were also collected.

RESULTS

A total of 133 women who had been diagnosed with breast cancer agreed to participate in the study. Approximately three-quarters (73.7%; n = 98) of the participants was reported as poor sleepers (PSQI ˃ 5). The worse mean score of the PSQI component was the sleep latency with the highest score (M = 1.71, SD = 0.93). There were significant relationships between poor sleep and treatment (patients receiving both chemotherapy and radiotherapy) and with comorbidities (asthma, anaemia, hypertension/heart failure, diabetes/heart diseases) (P < 0.05). Those experiencing poor sleep had the lowest QoL among the cancer patients.

CONCLUSION

Sleep disturbance is a significant problem for Arabic patients diagnosed with breast cancer. The result suggests that sleep disturbance should be routinely assessed in clinical settings. Further research should develop an intervention for management to reduce sleep disturbance and improve sleep quality in cancer patients.

Measuring Subjective Sleep Quality: A Review

Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Mini-Sleep Questionnaire (MSQ), Jenkins Sleep Scale (JSS), Leeds Sleep Evaluation Questionnaire (LSEQ), SLEEP-50 Questionnaire, and Epworth Sleepiness Scale (ESS). As the most frequently used subjective measurement of sleep quality, the PSQI reported good internal reliability and validity; however, different factorial structures were found in a variety of samples, casting doubt on the usefulness of total score in detecting poor and good sleepers. The sleep disorder scales (AIS, ISI, MSQ, JSS, LSEQ and SLEEP-50) reported good psychometric properties; nevertheless, AIS and ISI reported a variety of factorial models whereas LSEQ and SLEEP-50 appeared to be less useful for epidemiological and research settings due to the length of the questionnaires and their scoring. The MSQ and JSS seemed to be inexpensive and easy to administer, complete, and score, but further validation studies are needed. Finally, the ESS had good internal consistency and construct validity, while the main challenges were in its factorial structure, known-group difference and estimation of reliable cut-offs. Overall, the self-report questionnaires assessing sleep quality from different perspectives have good psychometric properties, with high internal consistency and test-retest reliability, as well as convergent/divergent validity with sleep, psychological, and socio-demographic variables. However, a clear definition of the factor model underlying the tools is recommended and reliable cut-off values should be indicated in order for clinicians to discriminate poor and good sleepers.