Perception of night-time sleep by the surgical patients in an intensive care unit

Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.     

Sleep quality and responses to insufficient sleep in women on different work shifts

1. The aim of this study was to examine degrees of cognitive behavioural effects of fatigue, mood changes and somatic responses to sleep loss in women with and without sufficient sleep, and to explore possible links between effects of sleep loss and specific sleep disturbances in selected groups. 2. A total 156 women working in a casualty department on different work shifts responded to a questionnaire which measured sleep quality, strain and symptoms related to working conditions, as well as effects of sleep loss. 3. About 40% of the women had perceived insufficient sleep during the last 6 months. They perceived significantly worse sleep quality and a higher degree of strain according to working conditions than the others. Palpitation and dysphoria as effects of sleep loss were independently predicted by sleep quality. Dysphoria was also predicted by difficulty in falling asleep. Cognitive behavioural effects of fatigue was predicted by disturbed sleep. Palpitation effects led to a 10-fold increase in the probability of cognitive behavioural effects of fatigue. The effects were most prominent among women suffering from gastrointestinal problems of long duration and chronic pain. 4. Responses to reduced sleep quality in women constitute a form of stress, with sympathetic activation, increased susceptibility to infection, moderate cognitive impairment, mood changes and somatic distress.     

Sleep disturbances and depressive symptoms in healthy postpartum women: a pilot study

In this pilot study we examined the relationship between objective and subjective sleep disturbances and depressive symptoms in 22 healthy primiparous postpartum women within 3 months after delivery. We found that none of the women in our study had clinically significant depression scores on the Edinburgh Postnatal Depression Scale; nonetheless, a variable duration of night-time sleep from night to night during the 7-day monitoring period and reported awakening too early were significantly correlated with increased depressive symptoms. Results suggest that first-time mothers who complain of irregular night-time sleep duration and waking up too early should be screened and evaluated for potential postpartum depressive symptoms.     

慢性阻塞性肺疾病病人睡眠质量及疲劳症状与生活质量的相关性研究

[目的]探讨慢性阻塞性肺疾病(COPD)病人睡眠质量及疲劳症状对生活质量的影响.[方法]选择出院后1个月稳定期COPD病人91例,采用匹兹堡睡眠质量指数(PSQI)、疲劳量表(FS-14)、生活质量评定 St.George's 呼吸问卷(SGRQ)进行测量.[结果]COPD稳定期病人的睡眠质量与国内常模比较具有统计学意义(P<0.01).多元回归分析表明,病人的睡眠质量总分、躯体疲劳症状对生活质量均有影响.[结论]COPD病人睡眠质量差,躯体疲劳现象严重,会降低病人的生活质量.     

Effects of work organization on the mental health of nursing staff

A survey was carried out among a sample of 973 nurses in hospitals in the Valencian Community (Spain). The aim was to study the relation between work organization, sociodemographic and professional factors and the mental health of nursing staff. The information was collected by means of a questionnaire. Three indicators were used to study mental health: fatigue, sleep disturbance and psychological or psychosomatic indicators of mental suffering. Work organization affected the mental health of workers with varying impact according to the mental health indicator under consideration. Dissatisfaction due to work schedule, psychological and mental load increased the risk of showing signs of fatigue, with a prevalence odds ratio (POR) of 2.15, 2.00, 1.86, respectively, along with the risk of psychological symptoms with a POR of 2.36, 1.80, 2.10, respectively. Permanent night shifts or rotating night shifts increased the risk of sleep disturbance with a POR of 2.00 and 1.34 respectively.     

Do sleep problems or urinary incontinence predict falls in elderly women?

The objectives of this cross-sectional study were: (1) To determine if night-time sleep disturbance, daytime sleepiness, or urinary incontinence were associated with an increased risk of falling in older Australian women and (2) to explore the interrelationships between daytime sleepiness, night-time sleep problems, and urge incontinence. Participants were 782 ambulatory, community-dwelling women aged 75 to 86 recruited from within the existing Calcium Intake Fracture Outcome Study, in which women above 70 years were selected at random from the electoral roll. Daytime sleepiness, night-time sleep problems, urinary incontinence and falls data were collected via self-complete questionnaires. Thirty-five per cent of participants had fallen at least once in the past 12 months and 37.7% reported at least one night-time sleep problem. However, only 8.1% of the study sample experienced abnormal daytime sleepiness (Epworth Sleepiness Scale score > 10). Pure stress, pure urge, and mixed incontinence occurred in 36.8%, 3.7%, and 32.6% of participants respectively. In forward stepwise multiple logistic regression analysis, urge incontinence (OR 1.76; 95% CI 1.29 to 2.41) and abnormal daytime sleepiness (OR 2.05; 95% CI 1.21 to 3.49) were significant independent risk factors for falling after controlling for other falls risk factors (age, central nervous system drugs, cardiovascular drugs). As urge incontinence and abnormal daytime sleepiness were independently associated with an increased falls risk, effective management of these problems may reduce the risk of falling in older women.     

A medical definition of fatigue in multiple sclerosis

BACKGROUND: The symptom of fatigue has been described in a variety of ways but absence of a single taxonomy may be hindering research into this prevalent symptom. OBJECTIVE: To define the symptom of fatigue, as experienced by patients with multiple sclerosis (MS), in terms of a common framework, typical of a medical history. DESIGN: Qualitative phase followed by cross-sectional questionnaire survey. METHOD: Forty patients, with clinically definite MS, underwent semi-structured interviews which were analysed within a common framework of: experience (with derived themes of motor, cognitive, somatic/energy, sleep, other features) cadence (i.e. short-term variability), chronicity, precipitating and aggravating factors, relieving factors, severity and associated features. The prevalence of each feature of fatigue, emergent from the interviews, was subsequently determined by questionnaire survey of a further 635 MS patients. RESULTS: Despite variance across patients, fatigue could be described within the derived themes and framework. Nearly all themes were endorsed by the majority of questionnaire respondents. In summary, fatigue could be defined as reversible motor and cognitive impairment, with reduced motivation and desire to rest. It could appear spontaneously or may be brought on by mental or physical activity, humidity, acute infection and food ingestion. It was relieved by daytime sleep or rest without sleep. It could occur at any time but was usually worse in the afternoon. CONCLUSION: A framework, not only derived from patient experience but also meaningful in a medical context, was shown to be capable of describing fatigue in a large cross-section of MS patients. The definition may facilitate inter-disease comparison of fatigue as well as physiological enquiry.     

The impact of sleep interruptions on vital measurements and chronic fatigue of female caregivers providing home care in Japan

The purposes of this study were to examine the impact of sleep interruptions on diurnal changes in blood pressure and chronic fatigue in middle-aged and elderly caregivers by using a cross-sectional quantitative method. Thirty-five female caregivers who were not taking antihypertensive and/or sleeping drugs were recruited for this study. Blood pressure was monitored over a 24 h period. Sleeping or waking periods were monitored with an actigraph. Fatigue was determined from a self-administered questionnaire. Participants were classified into four groups by cause of sleep interruption. One-way analysis of variance showed no differences in blood pressure, but hypertension was prevalent (40%). Sleep duration differed significantly, with the longest duration for those scheduled to wake up for care. Substantial variations were identified in the eight subcategories of chronic fatigue, with those without sleep interruption having the worst profile. This suggests that multiple factors in addition to sleep interruption affect the care burden.     

多发性骨髓瘤患者疲劳现况及其影响因素分析

目的 调查多发性骨髓瘤患者疲劳现况并分析其影响因素,为制订和实施针对性干预护理措施或科研人员开展高证据等级的护理研究提供科学依据.方法 采用一般资料问卷、多维疲劳量表、匹兹堡睡眠质量指数量表、Zung焦虑自评量表、Zung抑郁自评量表及自我感受负担量表对126例多发性骨髓瘤患者进行调查.结果 多发性骨髓瘤患者总体疲劳得...     

Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia

We examined between and within-person variability, affective correlates, and diagnostic differences in daily fatigue in women with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia syndrome (FMS). Two hundred and fifty-five female patients recruited from the community served as participants for this project. The patients had a physician-confirmed diagnosis of RA (n=89), OA (n=76), or FMS (n=90). Individuals completed an initial questionnaire and up to 32 daily diaries assessing illness symptoms and psychosocial variables (i.e., fatigue, pain, sleep problems, depression, and affect). The primary outcome for the current project was variability in fatigue. We examined affective, pain, and sleep correlates of fatigue, and tested whether these relations varied by diagnosis. Results indicated that FMS patients had higher overall levels of and greater daily variability in fatigue compared with the other pain groups. For all patients, fatigue correlated highly with lower positive affect (PA). Moreover, day-to-day increases in fatigue were associated with decreases in PA, particularly among FMS patients, and with increases in negative affect (NA). Daily pain was associated with increased fatigue in all groups, although OA patients showed less pain reactivity than either FMS or RA patients. These findings indicate that fatigue is a common feature of rheumatologic conditions. Nonetheless, there are important differences between RA, OA, and FM patients in both the everyday manifestations and the biopsychosocial correlates of fatigue.     

脑卒中患者疲劳状况及其相关因素的研究

目的 调查脑卒中患者的疲劳状况,并分析影响因素.方法 采用一般资料调查问卷、个人疲劳强度量表、国际通用SPIEGEL睡眠量表对207例住院治疗的脑卒中患者进行调查.结果 患者个人疲劳强度量表总分为（90.19±22.19）分,有疲劳症状者136例,占65.70％.患者年龄、锻炼情况和睡眠情况是患者疲劳状况的主要影响因素.结论 应密切关注脑卒中患者的疲劳状况,并指导患者进行锻炼,改善患者睡眠质量,以缓解其疲劳症状,提高脑卒中患者的生活质量.     

Sleep,anxiety and fatigue in family members of patients admitted to the intensive care unit: a questionnaire study

Introduction

Family members of critically ill patients often experience increased incidence of physical and mental health issues. One of the first ways family members suffer is by losing sleep. The purpose of this study is to understand sleep quality, levels of fatigue and anxiety, and factors contributing to poor sleep in adult family members of critically ill patients.

Methods

A questionnaire was designed to evaluate sleep, fatigue and anxiety during the intensive care unit (ICU) admission. We incorporated three validated instruments: General Sleep Disturbance Scale (GSDS), Beck Anxiety Index (BAI) and Lee Fatigue Scale (NRS-F). Adult family members of patients in ICU for more than 24 hours were approached for questionnaire completion. Patient demographics were recorded.

Results

The study population consisted of 94 respondents, (49.1 ± 12.9 years, 52.7% male); 43.6% were children and 21.3% were spouses of ICU patients. Sleep quality was rated as poor/very poor by 43.5% of respondents, and good/very good by 15.2%. The most common factors contributing to poor sleep were anxiety (43.6%), tension (28.7%) and fear (24.5%). Respondents'' most common suggestions to improve sleep were more information regarding the patient''s health (24.5%) and relaxation techniques (21.3%). Mean GSDS score was 38.2 ± 19.3, with 58.1% of respondents experiencing moderate to severe sleep disturbance. Mean BAI was 12.3 ± 10.2, with 20.7% of respondents experiencing moderate to severe anxiety. Mean NRS-F was 3.8 ± 2.5, with 57.6% of respondents experiencing moderate to high fatigue. Family members who spent one or more nights in the hospital had significantly higher GSDS, BAI and NRS-F scores. The patient''s Acute Physiology and Chronic Health Evaluation (APACHE) II score at survey completion correlated significantly with family members'' GSDS, BAI and NRS-F.

Conclusion

The majority of family members of ICU patients experience moderate to severe sleep disturbance and fatigue, and mild anxiety.     

Self-reported sleep and health among Norwegian hospital nurses in intensive care units

Aim and background: Shift work, and especially night work, is associated with poor health. Nurses, work a variety of work schedules including night work. So far, few studies have specifically investigated sleep and health among intensive care nurses. Design and methods: We investigated sleep, sleepiness, fatigue, subjective health complaints, anxiety and depression in 150 intensive care nurses (convenience sample representing a response rate of 56·2%). The nurses worked at two major University hospitals in Norway and answered a questionnaire survey. Results: The intensive care nurses reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to normative data. Poor sleep was reported by 70% and excessive sleepiness by 25% of the nurses; however, the design of the study did not allow us to determine the causes underlying these findings. Multiple linear regression analyses showed that age was positively associated with sleep problems, fatigue, subjective health complaints and anxiety and depression. In contrast, shift work experience was negatively associated with sleep problems, suggesting better coping with shift work over time. Conclusions: Nurses working in intensive care units reported poorer sleep, more sleepiness, more fatigue, more anxiety and more depression compared to Norwegian norm groups. Age was positively related to these complaints, whereas shift work experience was negatively related to poor sleep. More studies are needed on strategies to improve sleep and health in nurses.     

Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery

The aim of this study was to examine the prevalence of depression and anxiety following coronary artery bypass surgery (CABG) and to see how those patients with depression and anxiety differ in sleeping pattern. The individual reaction to sleep loss was tested as a predictor of certain emotional symptoms in the follow-up period. Thirty-eight males, between 45 and 68 years, were interviewed prior to, and 1 month after, surgery, and received a questionnaire at the 6-month follow-up. Eighty per cent scored moderate anxiety prior to surgery and six patients were depressed. An anxiety-prone individual reactivity persisted in the same patients in 38.9% (n = 14) following CABG, with significantly more sleep disturbances, firedness, energy deficits, immobility, and lower degree of quality of life (QoL). Sad/depressed mood or cognitive/behavioural fatigue symptoms as reactions to sleep loss were predictors of sleep problems and daytime sequelae, whereas a higher postoperative NYHA class was predicted by cognitive/behavioural fatigue and dysphoria reactions. Being less refreshed by sleep on final awakening prior to surgery related to 44.5% of the variance in QoL outcome 6 months following surgery. In conclusion, an anxiety-prone individual reactivity is significantly associated with sleep disturbances. Reactions to sleep loss prior to surgery are associated with emotional distress after surgery.     

孕妇妊娠晚期疲乏特征的潜在类别分析

目的 探讨孕妇妊娠晚期疲乏特征的潜在类别,比较不同类别孕妇在人口学特征及睡眠质量、心理韧性上的差异。方法 于2022年4—7月便利选取郑州市某三级甲等医院产科门诊就诊的251例孕妇为研究对象,采用一般资料调查表、疲劳自评量表、匹兹堡睡眠质量指数量表及心理韧性量表进行调查。结果 孕妇妊娠晚期疲乏特征可分为2个潜在类别,即高情境性-广泛疲乏型（29.08%）和积极情境性-疲乏低发型（70.92%）;Logistic回归分析结果显示：孕周、不良妊娠史、睡眠质量及心理韧性是孕妇妊娠晚期疲乏特征的潜在类别的影响因素（P<0.05）。结论 孕妇妊娠晚期疲乏特征存在群体异质性,可分为2个潜在类别,妊娠周数较大、既往有不良妊娠史、睡眠质量差的孕妇妊娠晚期疲乏症状较重,应对该类别孕妇给予更多关注。     

普外科术后患者口渴及口渴痛苦程度的现况研究

目的 调查普外科术后患者的口渴程度(thirst intensity,TI),口渴不适及口渴痛苦程度(thirst distress, TD)的现况及其影响因素,为改善普外科术后患者因口干、口渴引起的不适感提供支持。方法 对224例普外科术后患者采用一般资料调查表、口渴程度量表、围手术期口渴不适量表和口渴痛苦程度量表进行调查。结果 普外科术后患者口渴程度、口渴不适及口渴痛苦程度均偏高,其中不同年龄段的患者口渴程度不同；开腹手术的患者口渴程度大于未开腹的手术患者；年龄、工作状况及是否开腹是影响患者术后口渴不适的相关因素。是否开腹是普外科术后患者口渴程度、口渴不适及口渴痛苦程度的独立危险因素(均P<0.05)。结论 普外科术后患者口渴程度、口渴不适及口渴痛苦程度普遍较高,临床护理人员应根据不同年龄段的特点采取不同的护理干预措施,注意倾听患者的主诉；对开腹患者应提前做好健康宣教,尽量缩短术前禁食禁水时间,加强患者对手术计划的了解,同时医护应一起探讨患者术后的补液及进食饮水计划,尽量缓解普外科术后患者的口渴症状。     

Fatigue and Sleep in Chronic Headache Sufferers: An Age- and Sex-Controlled Questionnaire Study

We studied fatigue and sleep in chronic headache sufferers in comparison to age- and sex-matched controls. We determined the prevalence and intensity of fatigue as well as several sleep features. The study was conducted in a headache center through the use of a questionnaire. One hundred thirteen headache sufferers (59 men and 54 women) and 110 controls (56 men and 54 women) were included in the analysis. Fatigue was found to be equally common in the headache sufferers (70.3%) and in the controls (60.0%). However, the headache sufferers rated the intensity of their fatigue significantly higher (4.1 versus 2.8 cm on a 10-cm visual analog scale). When the sexes were considered separately, the difference in intensity of the fatigue between the two groups was significant only for the women (5.1 versus 3.0 cm). With regard to sleep, the headache sufferers slept significantly shorter (6.7 hours) than the controls (7.0 hours). It also took them longer to fall asleep (31.4 versus 21.1 minutes) and longer to fall back asleep after waking up at night (28.5 versus 14.6 minutes). When the sexes were considered separately, the differences in sleep features between the two groups were significant only for the men.
On the basis of these results, we conclude that chronic headache sufferers feel more tired, especially the women, and do not sleep as well at night, especially the men. Further study is necessary to determine the significance of these findings in relation to chronic headache suffering.     

The biologic effects of grounding the human body during sleep as measured by cortisol levels and subjective reporting of sleep, pain, and stress

OBJECTIVES: Diurnal cortisol secretion levels were measured and circadian cortisol profiles were evaluated in a pilot study conducted to test the hypothesis that grounding the human body to earth during sleep will result in quantifiable changes in cortisol. It was also hypothesized that grounding the human body would result in changes in sleep, pain, and stress (anxiety, depression, irritability), as measured by subjective reporting. SUBJECTS AND INTERVENTIONS: Twelve (12) subjects with complaints of sleep dysfunction, pain, and stress were grounded to earth during sleep for 8 weeks in their own beds using a conductive mattress pad. Saliva tests were administered to establish pregrounding baseline cortisol levels. Levels were obtained at 4-hour intervals for a 24-hour period to determine the circadian cortisol profile. Cortisol testing was repeated at week 6. Subjective symptoms of sleep dysfunction, pain, and stress were reported daily throughout the 8-week test period. RESULTS: Measurable improvements in diurnal cortisol profiles were observed, with cortisol levels significantly reduced during night-time sleep. Subjects' 24-hour circadian cortisol profiles showed a trend toward normalization. Subjectively reported symptoms, including sleep dysfunction, pain, and stress, were reduced or eliminated in nearly all subjects. CONCLUSIONS: Results indicate that grounding the human body to earth ("earthing") during sleep reduces night-time levels of cortisol and resynchronizes cortisol hormone secretion more in alignment with the natural 24-hour circadian rhythm profile. Changes were most apparent in females. Furthermore, subjective reporting indicates that grounding the human body to earth during sleep improves sleep and reduces pain and stress.