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Fang CS, Tu YK, Chang SL, Kuo CC, Fang CJ, Chou FH. Effectiveness of sound and darkness interventions for critically ill patients' sleep quality: A systematic review and component network meta-analysis. Nurs Crit Care 2024; 29:134-143. [PMID: 37017370 DOI: 10.1111/nicc.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Noise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications. AIM To identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients. STUDY DESIGN This systematic review and component network meta-analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta-Analyses (PRISMA-NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk-of-bias tool (V.2.0) and the online Confidence in Network Meta-Analysis (CINeMA) application. RESULTS Twenty-four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs. CONCLUSIONS This study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality. RELEVANCE TO CLINICAL PRACTICE This study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.
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Affiliation(s)
- Chiu-Shu Fang
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Kang Tu
- College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Lun Chang
- Department of Otorhinolaryngology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Pet Care and Groomimg, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chia-Chi Kuo
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Ching-Ju Fang
- Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Medical Library, National Cheng Kung University, Tainan, Taiwan
| | - Fan-Hao Chou
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Ismail A, Imam A, Raguini M, Hassan D, Ali A, Alkhotani A. Impact of Quiet Time on Psychological Outcomes of Neonatal Intensive Care Unit Nurses in Jeddah, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e50307. [PMID: 38205456 PMCID: PMC10777254 DOI: 10.7759/cureus.50307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Although quiet time is implemented in neonatal intensive care units (NICUs) for the benefit of infants, it may also positively impact the psychological outcomes of healthcare professionals. Several studies have examined the impact of quiet-time implementation on patients; however, there is a paucity of research assessing its impact on the psychological outcomes of NICU nurses, particularly in Saudi Arabia. OBJECTIVE AND METHODS This study aimed to assess the impact of quiet time on the psychological outcomes (stress, anxiety, and depression) of NICU nurses in Jeddah, Saudi Arabia. A cross-sectional design was used for this study. A total of 87 NICU nurses from two hospitals participated in this study. One group did not practice quiet time, while the second group did. A questionnaire survey assessed participants' demographic characteristics, and their depression, anxiety, and stress were assessed using the depression, anxiety, and stress scale-21 (DASS-21). The data were analyzed for frequency, percentage, mean, and standard deviation (SD). Bivariate analysis, independent t-tests, and one-way analysis of variance were used to test the differences between variables and groups. Pearson's correlation coefficient (r) was used to analyze the relationships between continuous variables and perceived stress, anxiety, and depression. RESULTS A substantial number of NICU nurses perceived stress, anxiety, and depression; however, there were no significant differences in perceived stress, anxiety, and depression between the nurses who worked in NICUs that applied quiet time and NICUs that did not (P ≤ 0.05). CONCLUSION This study found no statistically significant relationship between quiet-time implementation and perceived stress, anxiety, or depression among NICU nurses. Further research with a larger sample size or increased quiet-time implementation may be required.
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Affiliation(s)
- Ahmad Ismail
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Ashwag Imam
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Minerva Raguini
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Dina Hassan
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Aziza Ali
- Neonatal Intensive Care, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Abdulaziz Alkhotani
- Pediatrics, Umm Al-Qura University, Makkah, SAU
- Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
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3
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Grigg-Damberger MM, Hussein O, Kulik T. Sleep Spindles and K-Complexes Are Favorable Prognostic Biomarkers in Critically Ill Patients. J Clin Neurophysiol 2022; 39:372-382. [PMID: 35239561 DOI: 10.1097/wnp.0000000000000830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY In this narrative review, we summarize recent research on the prognostic significance of biomarkers of sleep in continuous EEG and polysomnographic recordings in intensive care unit patients. Recent studies show the EEG biosignatures of non-rapid eye movement 2 sleep (sleep spindles and K-complexes) on continuous EEG in critically ill patients better predict functional outcomes and mortality than the ictal-interictal continuum patterns. Emergence of more complex and better organized sleep architecture has been shown to parallel neurocognitive recovery and correlate with functional outcomes in traumatic brain injury and strokes. Particularly interesting are studies which suggest intravenous dexmedetomidine may induce a more biomimetic non-rapid eye movement sleep state than intravenous propofol, potentially providing more restorative sleep and lessening delirium. Protocols to improve intensive care unit sleep and neurophysiological studies evaluating the effect of these on sleep and sleep architecture are here reviewed.
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4
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Bellon F, Beti-Abad A, Pastells-Peiró R, Casado-Ramirez E, Moreno-Casbas T, Gea-Sánchez M, Abad-Corpa E. Effects of nursing interventions to improve inpatients' sleep in intensive and non-intensive care units: Findings from an umbrella review. J Clin Nurs 2022; 32:1963-1978. [PMID: 35170142 DOI: 10.1111/jocn.16251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/24/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
AIM This review aimed to synthesise the available reviews on the effects of nursing interventions on sleep quality among patients hospitalised in intensive care and non-intensive care units. BACKGROUND Poor sleep quality is a common fact in hospitalised patients. Nurses can contribute to the improvement of patients' sleep quality and duration. DESIGN A review of intervention reviews was carried out and reported following the PRISMA guidelines and checklist. METHODS We systematically searched for reviews published from January 2009 to December 2019 in PubMed, CINAHL Plus, Scopus, Institute for Scientific Information Web of Science, Joanna Briggs Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Searches were repeated at 24 November 2020 to include the most recent evidence. A narrative synthesis of the results was conducted. RESULTS Nine reviews (representing 109 original papers) met the selection criteria and were included for critical appraisal. Overall, nursing interventions and sleep quality were poorly defined. We grouped the interventions into 3 categories (environmental, barrier and internal interventions) to provide a more comprehensive overview and examine effects of nursing interventions on inpatients sleep quality. Inconsistent results were obtained and low quality of the original articles was reported, making it difficult to establish absolute conclusions. CONCLUSION The impact of environmental changes on patients' sleep was positive but inconclusive, while use of earplugs and eye masks, music and acupuncture generally showed positive results with moderate quality of evidence, and no harmful effects were reported.
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Affiliation(s)
- Filip Bellon
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, GESEC Group, University of Lleida, Lleida, Spain.,Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
| | - Aintzane Beti-Abad
- Department of Infectious Diseases, Basurto University Hospital, Bilbao, Spain
| | - Roland Pastells-Peiró
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, GESEC Group, University of Lleida, Lleida, Spain.,Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
| | | | - Teresa Moreno-Casbas
- Nursing and Healthcare Research Unit (Investén-isciii), Madrid, Spain.,Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Madrid, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, GESEC Group, University of Lleida, Lleida, Spain.,Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain.,Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Madrid, Spain
| | - Eva Abad-Corpa
- Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Madrid, Spain.,University of Murcia-Murcia Health Service (IMIB-Arrixaca), Murcia, Spain
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2021; 45:470-476. [PMID: 34456175 DOI: 10.1016/j.medine.2021.08.011] [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: 01/14/2020] [Accepted: 03/24/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3 periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3 periods, with significant differences between these periods in nursing care (P = 0.005) and nursing activities (P = 0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P = 0.012), daily alcohol intake (P = 0.023), benzodiazepine use during admission to the ICU (P = 0.01) and comorbidities (P = 0.005). There were significant differences in sleepiness between discharge and the first day (P ≤ 0.029) and between discharge and half stay (P = 0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, Spain
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, Spain
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Locihová H, Axmann K, Žiaková K. Sleep-disrupting effects of nocturnal nursing interventions in intensive care unit patients: A systematic review. J Sleep Res 2020; 30:e13223. [PMID: 33128479 DOI: 10.1111/jsr.13223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Patients staying in the intensive care unit (ICU) require constant monitoring and numerous nursing interventions performed as needed, irrespective of daytime or night-time. The disturbing effect of nocturnal nursing interventions and their contribution to sleep disruptions are unclear. The review analysed nocturnal nursing interventions, and their character, frequency and effects on sleep quality. The databases CINAHL, PubMed and Scopus were searched to identify and subsequently evaluate 19 studies (1,531 patients) meeting the algorithm used. Although nocturnal nursing interventions provided to ICU patients were frequent and varied, they were responsible for only a minority of observed sleep disruptions. The most frequent nocturnal intervention was Vital signs monitoring (Nursing Interventions Classification, 6,680). Implementation of sleep protocols, of which an integral part is clustering and planning of nocturnal interventions, appears to be effective. The review suggests that nursing interventions are not the main cause of sleep disruptions in the ICU. In an effort to improve the quality of sleep in ICU patients, other factors causing disturbance need to be addressed as well. The current trend is more careful planning of nursing care, clustering of interventions and minimizing nocturnal disruptions to allow patients at least one uninterrupted sleep cycle (90 min).
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Affiliation(s)
- Hana Locihová
- AGEL Research and Training Institute, Prostějov, AGEL Nemocnice Valašské Meziříčí, AGEL Střední zdravotnická škola, Ostrava, Czech Republic
| | - Karel Axmann
- Fakultní nemocnice Olomouc, Palacky University in Olomouc, Faculty of Medicine and Dentistry, Olomouc, Czech Republic
| | - Katarína Žiaková
- Comenius University in Bratislava Jessenius Faculty of Nursing in Martin, Martin, Slovakia
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7
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Palimaru AI, Brown RA, Troxel WM, Dickerson DL, Johnson CL, D'Amico EJ. Understanding sleep facilitators, barriers, and cultural dimensions in Native American urban youth. Sleep Health 2020; 6:478-488. [PMID: 32527661 PMCID: PMC7529658 DOI: 10.1016/j.sleh.2020.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES American Indian/Alaska Native (AI/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban AI/AN youth may face certain challenges, including specific psychosocial stressors (e.g., discrimination) and environmental factors (e.g., noise, light) that render them particularly vulnerable to poor sleep health. However, few studies have explored AI/AN adolescent sleep. To our knowledge, this is the first study to use systematic qualitative methods with AI/AN youth to explore their sleep environment and sleep behaviors. DESIGN In-depth interviews with 26 youth. SETTING Two urban areas in Central and Southern California. PARTICIPANTS Urban-dwelling AI/AN youth, age 12-16 years. INTERVENTION N/A. MEASUREMENT N/A. RESULTS We identified five main themes, each with subthemes: sleep patterns and desired sleep, sleep barriers inside the home, environmental factors, sleep facilitators, and cultural dimensions. Key concerns discussed were poor sleep hygiene, excessive use of electronics prior to bedtime, issues with temperature regulation, and noise both within and outside the home. Parents can be an important vehicle for messaging around sleep health and for behavior management. Participating adolescents also indicated differing levels of attachment to Native identity, suggesting that culturally-targeted sleep interventions should build in openness and flexibility to a range of identity starting points. Further, we identified cultural practices, such as sweat lodges and dreamcatchers, that could be incorporated in future sleep interventions for this population. CONCLUSION Findings increase our understanding of urban AI/AN youth's sleep environments and behaviors, thus potentially informing program development around sleep health for this vulnerable population.
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Affiliation(s)
| | | | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA
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Bernat Adell MD, Galarza Barrachina L, Bisbal Andrés E, Cebrián Graullera G, Pagés Aznar G, Morán Marmaneu MÁ, Ferrandiz Selles MD, Melgarejo Urendez A. Factors affecting sleep quality in Intensive Care Units. Med Intensiva 2020; 45:S0210-5691(20)30114-5. [PMID: 32482371 DOI: 10.1016/j.medin.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report sleep quality and identify related factors. DESIGN A descriptive cross-sectional study was made with a convenience sample of 129 patients. The differences between 3periods were evaluated using the Wilcoxon test and Spearman correlation r. Multiple regression analyses were performed to relate independent variables to sleep quality. SETTING The Department of Intensive Care Medicine of a tertiary hospital. PARTICIPANTS Patients admitted between February 2016 and December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire, and demographic and clinical variables. RESULTS External factors interfering with sleep quality were noise and constant light exposure in the 3periods, with significant differences between these periods in nursing care (P=0.005) and nursing activities (P=0.019). The other factors affecting sleep quality and identified by the multivariate regression model were age (P=0.012), daily alcohol intake (P=0.023), benzodiazepine use during admission to the ICU (P=0.01) and comorbidities (P=0.005). There were significant differences in sleepiness between discharge and the first day (P≤0.029) and between discharge and half stay (P=0.001). CONCLUSIONS Noise and light were the most annoying factors, but statistical significance was only reached for nursing activities and care. Age, alcohol intake, benzodiazepine use in the ICU and a higher comorbidity index had a negative impact upon sleep. Sleepiness was reduced at the end of stay.
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Affiliation(s)
- M D Bernat Adell
- Unidad Predepartamental de Enfermería, Universitat Jaume I, Castellón, España
| | - L Galarza Barrachina
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España.
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Cebrián Graullera
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - G Pagés Aznar
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M Á Morán Marmaneu
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - M D Ferrandiz Selles
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
| | - A Melgarejo Urendez
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón, España
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Psychometric evaluation of the Freedman questionnaire to assess sleep in critical patients. Med Intensiva 2019; 44:344-350. [PMID: 31178271 DOI: 10.1016/j.medin.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 12/27/2022]
Abstract
AIM A study was made of the psychometric characteristics of the modified Freedman questionnaire to assess sleep in critical patients. DESIGN A psychometric study was carried out, with content validity being explored by a group of experts, and internal consistency based on Cronbach's alpha coefficient. Factor analysis was performed to explore construct validity, and stability was assessed by test-retest analysis. SETTING The Department of Intensive Care Medicine of a reference hospital. PARTICIPANTS Patients admitted between 23 February 2016 and 20 December 2017. INTERVENTIONS Questionnaire administration. VARIABLES Items of the modified Freedman questionnaire. RESULTS Item relevance and definition yielded scores >3 (Likert scale maximum=4). Cronbach's alpha showed a global value of 0.933. The intraclass correlation index was >0.75 for most of the items of the questionnaire. Factor analysis allowed the detection of specific associations between the studied variables and the four factors. CONCLUSIONS The modified Freedman questionnaire showed good psychometric characteristics. It may be a reliable instrument for assessing the quality of sleep in critically ill patients, as well as the environmental factors.
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