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Acharya R, Blackwell S, Simoes J, Harris B, Booth L, Bhangu A, Glasbey J. Non-pharmacological interventions to improve sleep quality and quantity for hospitalized adult patients-co-produced study with surgical patient partners: systematic review. BJS Open 2024; 8:zrae018. [PMID: 38597159 PMCID: PMC11004792 DOI: 10.1093/bjsopen/zrae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Hospitalized patients experience sleep disruption with consequential physiological and psychological effects. Surgical patients are particularly at risk due to surgical stress and postoperative pain. This systematic review aimed to identify non-pharmacological interventions for improving sleep and exploring their effects on sleep-related and clinical outcomes. METHODS A systematic literature search was performed in accordance with PRISMA guidelines and was preregistered on the Open Science Framework (doi: 10.17605/OSF.IO/EA6BN) and last updated in November 2023. Studies that evaluated non-pharmacological interventions for hospitalized, adult patients were included. Thematic content analysis was performed to identify hypothesized mechanisms of action and modes of administration, in collaboration with a patient partner. Risk of bias assessment was performed using the Cochrane Risk Of Bias (ROB) or Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools. RESULTS A total of 59 eligible studies and data from 14 035 patients were included; 28 (47.5%) were randomized trials and 26 included surgical patients (10 trials). Thirteen unique non-pharmacological interventions were identified, 17 sleep measures and 7 linked health-related outcomes. Thematic analysis revealed two major themes for improving sleep in hospital inpatients: enhancing the sleep environment and utilizing relaxation and mindfulness techniques. Two methods of administration, self-administered and carer-administered, were identified. Environmental interventions, such as physical aids, and relaxation interventions, including aromatherapy, showed benefits to sleep measures. There was a lack of standardized sleep measurement and an overall moderate to high risk of bias across all studies. CONCLUSIONS This systematic review has identified several sleep interventions that are likely to benefit adult surgical patients, but there remains a lack of high-quality evidence to support their routine implementation.
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Affiliation(s)
- Radhika Acharya
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - Sue Blackwell
- Patient Liaison Group (PLG), Association of Coloproctology of Great Britain and Ireland, London, UK
| | - Joana Simoes
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - Benjamin Harris
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - Lesley Booth
- Patients and Researchers Together (PART), Bowel Research UK, London, UK
| | - Aneel Bhangu
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
| | - James Glasbey
- National Institute of Health and Care Research (NIHR) Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translation Medicine, Birmingham, UK
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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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Ritmala-Castren M, Salanterä S, Holm A, Heino M, Lundgrén-Laine H, Koivunen M. Sleep improvement intervention and its effect on patients' sleep on the ward. J Clin Nurs 2021; 31:275-282. [PMID: 34114280 DOI: 10.1111/jocn.15906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022]
Abstract
AIM AND OBJECTIVE The aim of the study was to investigate how the sleep improvement interventions developed for the wards were associated with patients' sleep. The objective was to promote patients' sleep. BACKGROUND The quality of sleep is vital for patients' health and recovery from illness. However, patients generally sleep poorly during hospitalisation. Sleep-disturbing factors are connected to the hospital environment, patients' physical illness, emotional state and the activities of the staff. Many sleep-disturbing factors can be influenced by appropriate nursing interventions. DESIGN A two-group intervention study including the development of nursing interventions aimed at supporting patients' sleep. One group received a sleep promotion intervention and the other received standard care. Both groups evaluated their sleep in the morning. METHODS A survey of participants' sleep evaluations was collected with the five-item Richards-Campbell Sleep Questionnaire. The data were analysed statistically. The STROBE checklist was used to report the study. RESULTS From the participants' perspective, sleep was better in the intervention group, even though statistically significantly only among men. The pain intensity correlated with sleep quality. The number of patients in the room or whether participants had had an operation had no effect on their sleep evaluations. CONCLUSIONS Interventions targeted at supporting and promoting the sleep quality of hospital inpatients may be effective. They should be developed in collaboration with patients and nurses. Several nursing interventions can be proposed to promote better sleep among patients; however, more research is needed to confirm the results. Sleep promotion should include both standardised protocols and individualised sleep support. RELEVANCE TO CLINICAL PRACTICE Investing in nursing interventions to promote patients' sleep is important. Patients' individual sleep-related needs should be part of their care plan. Training programmes that support nurses' knowledge and skills of patients' sleep promotion should be part of nursing education in healthcare organisations.
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Affiliation(s)
- Marita Ritmala-Castren
- Department of Nursing Science, University of Turku, Turku, Finland.,Helsinki University Hospital, Nursing Administration, Helsinki, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | | | - Heljä Lundgrén-Laine
- Department of Nursing Science, University of Turku, Turku, Finland.,Central Finland Hospital Nova, Central Finland Health Care District, Jyvaskyla, Finland
| | - Marita Koivunen
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
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Effect of Foot Reflexology on Pain, Fatigue, and Quality of Sleep after Kidney Transplantation Surgery: A Parallel Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5095071. [PMID: 32831868 PMCID: PMC7421603 DOI: 10.1155/2020/5095071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/12/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
Materials and Methods The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep. Results In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05). Conclusion Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation.
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SAZA S, ÇEVİK K. KOAH tanısı almış hastalara uygulanan progresif gevşeme egzersizlerinin yorgunluk ve yaşam kalitesine etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.681311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yang SY, Lan SJ, Yen YY, Hsieh YP, Kung PT, Lan SH. Effects of Exercise on Sleep Quality in Pregnant Women: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:1-10. [PMID: 32006719 DOI: 10.1016/j.anr.2020.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Sleep quality was considered a priority concern facing pregnant women. Conventional wisdom argues that good sleep quality benefits pregnant women and their fetuses. The aim of this study is to assess the effects of a specific exercise program on the sleep quality in pregnant women. METHODS Searches were executed in seven databases since their inceptions until February 28, 2019, for randomized controlled trials evaluating the effects of an exercise program on the sleep quality and insomnia in pregnant women. A random-effects model was applied for meta-analysis, and odds ratio, mean differences (MDs), and 95% confidence intervals (CIs) are shown as parts of outcomes. RESULTS Seven studies were included for meta-analysis. Compared with their not-exercising counterparts, analyses showed that regularly exercising women had significantly enhanced sleep quality, with an odds ratio of 6.21 (95% CI, 2.02-19.11;p = .001; I2 = 80.2%), with a standardized MD of -0.93 (95% CI, -1.19 to -0.67; p < .001; I2 = 30.0%). However, exercising women showed no significant insomnia improvement, with an standardized MD of -2.85 (95% CI, -7.67 to 1.98; p = .250; I2 = 97.0%), relative to their not-exercising counterparts. CONCLUSION This research indicated that exercise has a positive impact on the sleep quality of pregnant women. Despite the aforementioned positive impact on sleep quality, the present study did not find evidence to support that exercise may also improve insomnia for pregnant women.
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Affiliation(s)
- Shu-Ya Yang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Yea-Yin Yen
- Department of Oral Hygiene, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Ping Hsieh
- Department of Long Term Care, National Quemoy University, Jinning, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Huan Lan
- School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian, China.
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Sleep Quality of Hospitalized Patients, Contributing Factors, and Prevalence of Associated Disorders. SLEEP DISORDERS 2020; 2020:8518396. [PMID: 32308998 PMCID: PMC7157800 DOI: 10.1155/2020/8518396] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/04/2020] [Indexed: 11/18/2022]
Abstract
Background Data in the literature has shown poor sleep quality to be frequently observed in hospitalized patients and known to be associated with poor treatment outcome. Many factors may impact poor sleep quality, and there is currently limited available data. We aim to determine the prevalence of poor sleep quality and associated factors in patients admitted to internal medicine wards as well as the change of sleep quality over time after admission. Methods An analytic observational study was conducted at the internal medicine wards at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Patients were personally interviewed to evaluate the history of sleep quality at home, sleep quality after the first and the third days of admission, and potential associated factors. The Pittsburgh Sleep Quality Index and screening questionnaires for the common diseases associated with poor sleep quality were also utilized. The logistic regression analysis was used to determine the independent factors which led to poor sleep quality. Results Data were collected from 96 patients during the period of June 2015 to February 2016. The mean age of the patients was 50.8 ± 16.7 years, and 51% were male. Infectious disease was the most common principal diagnosis accounted for 29.2%. The results show high prevalence of poor sleep quality after the first night of admission compared to baseline sleep quality at home (50% vs. 18.8%; p < 0.001). After 3 days of admission, the prevalence of poor sleep quality was reduced to the level close to baseline sleep quality at home (28.1% vs. 18.8%; p = 0.13). Multivariate analysis demonstrated that light exposure and pain were the main independent factors for poor sleep quality on the first day (odds ratio 6.68; 95% CI 2.25-19.84) and on the third day (odds ratio 3.47; 95% CI 1.24-9.71), respectively. Conclusions This is the first study conducted on the sleep quality of hospitalized patients that included the follow-up period during hospital admission. Our study demonstrated high prevalence of poor sleep quality in hospitalized patients on the first day. Interestingly, the sleep quality was partly improved during hospitalization. Light exposure and pain were demonstrated to be the factors associated with poor sleep quality.
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Miller MA, Renn BN, Chu F, Torrence N. Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions. Gen Hosp Psychiatry 2019; 59:58-66. [PMID: 31170567 PMCID: PMC6620136 DOI: 10.1016/j.genhosppsych.2019.05.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings. METHOD A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines. RESULTS Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia. CONCLUSIONS Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.
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Affiliation(s)
- Megan A Miller
- Rehabilitation Care Service, VA Puget Sound -Seattle Division, Seattle, WA, United States of America.
| | - Brenna N Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Frances Chu
- University of Washington Health Sciences Library, Seattle, WA, United States of America
| | - Nicole Torrence
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States of America; Geriatrics and Extended Care Service, VA Puget Sound - Seattle Division, Seattle, WA, United States of America
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Chen Y, Yu E, Liao Z, Tan Y, Qiu Y, Zhu J, Lin S, Wu M. Psychiatric diagnoses and their influencing factors in patients complaining of sleep problems: A study of a psychiatric consultation-liaison service. Int J Psychiatry Med 2018; 53:197-206. [PMID: 29320908 DOI: 10.1177/0091217417749793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective This study aimed to identify misdiagnosed or undiagnosed psychiatric disorders and the factors associated with these disorders in patients with sleep problems who are referred to a consultation-liaison service. Method Records of all inpatients receiving a consultation from the Psychiatry Department between January and December 2016 were retrospectively reviewed. Psychiatric diagnoses were analyzed using descriptive statistics, and the factors associated with the risk of these disorders in patients with sleep problems were determined by multiple logistic regression analysis. Results Of the 331 referral patients whose referral reason was simply having trouble in sleeping, only 97 patients were diagnosed with primary sleep disorder after consultation. The recognition rate of psychiatric disorders in inpatients with sleep problems among nonpsychiatric physicians was 29.3%. Anxiety (107, 45.7%) was the most common psychiatric diagnosis in patients with sleep problems followed by organic mental disorder (83, 35.5%), depression (37, 15.8%), and other mental disorders (8, 3.4%). Multiple logistic regression analysis revealed that a course >1 month (OR = 3.656, 95% CI = 2.171-6.156, p = 0.000) and sleep-wake rhythm disturbances (OR = 25.008, 95% CI = 5.826-107.341, p = 0.000) were associated with increased risks of psychiatric disorders. Conclusions The study showed that recognition rate of psychiatric disorders in inpatients with sleep problems was very low. A course >1 month and sleep-wake rhythm disturbances were associated with increased risks of disorders and could be used as indicators by nonpsychiatric physicians to improve diagnoses.
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Affiliation(s)
- Yan Chen
- 1 Department of Psychiatry, 70571 Zhejiang Chinese Medical University , China
| | - Enyan Yu
- 2 Department of Psychiatry, 74678 Zhejiang Provincial People's Hospital of Hangzhou Medical College, China
| | - Zhengluan Liao
- 2 Department of Psychiatry, 74678 Zhejiang Provincial People's Hospital of Hangzhou Medical College, China
| | - Yunfei Tan
- 2 Department of Psychiatry, 74678 Zhejiang Provincial People's Hospital of Hangzhou Medical College, China
| | - Yaju Qiu
- 2 Department of Psychiatry, 74678 Zhejiang Provincial People's Hospital of Hangzhou Medical College, China
| | - Junpeng Zhu
- 2 Department of Psychiatry, 74678 Zhejiang Provincial People's Hospital of Hangzhou Medical College, China
| | - Sisi Lin
- 1 Department of Psychiatry, 70571 Zhejiang Chinese Medical University , China
| | - Minghao Wu
- 3 Department of Psychiatry, Bengbu Medical College, China
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Duman M, Timur Taşhan S. The effect of sleep hygiene education and relaxation exercises on insomnia among postmenopausal women: A randomized clinical trial. Int J Nurs Pract 2018; 24:e12650. [DOI: 10.1111/ijn.12650] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Mesude Duman
- Diyarbakir Ataturk School of Health; Dicle University; Diyarbakir Turkey
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