Sleep quality and sleep disruptive factors in adult patients in the intensive care unit: Feasibility and acceptability of the daily use of self-report for sleep quality assessment in the ICU in Saudi Arabia.
Abstract
Background
Poor sleep quality is common in ICU patients, where various sleep disruptive
factors are associated with poor sleep in ICUs. Sleep assessment on a daily basis
in ICU patients is challenging yet important to enable nurses to recognise poor
sleep and develop appropriate interventions and support to manage this. One
such tool recommended in recent literature for undertaking daily sleep
assessment is the Richards Campbell Sleep Questionnaire (RCSQ). However,
there is little evidence of its feasibility and acceptability in daily use in ICU
clinical practice and no evidence of its use in Arab speaking countries.
Furthermore, data about patients' sleep quality and sleep disruptive factors in
ICUs in Arabic speaking countries, particularly Saudi Arabia is limited.
Aim
The aim of the study reported on in this thesis was to develop and test the
psychometric properties, and feasibility and acceptability of daily self-report
assessment of sleep quality in an ICU setting in Saudi Arabia using an Arabic
version of the RCSQ (the RCSQ-A). The study also aimed to report on sleep
quality and sleep disruptive factors among ICU patients in Saudi Arabia.
Design and methods
The study was carried out in Saudi Arabia in a mixed medical and surgical ICU
using a two-phase design. The first phase involved two steps: in the first step,
the RCSQ was translated into Arabic, while the second step involved testing the
internal consistency and reliability of the RCSQ-A in an initial pilot sample of 57
ICU patients. Content validity was also examined in a subsample of 30 ICU
patients using a cognitive interviewing method.
The second phase was a prospective observational repeated measures study
carried out over a three-month period. In this phase, 120 ICU patients were
asked to rate their previous night's sleep quality on a daily basis using RCSQ-A alongside a self-report of sleep disruptive factors using the modified Sleep in
Intensive Care Questionnaire (SICQ) until their discharge from the ICU. Data
regarding the feasibility and acceptability of repeated measurement using the
RCSQ-A were collected. The correlations between self-reported sleep disruptive
factors, patients' demographic and clinical variables, and patients' self-reported
sleep quality were assessed. Results
The Arabic version of the RCSQ (RCSQ-A) showed evidence of content validity
and internal consistency with a Cronbach’s alpha of 0.89 for self-report sleep
quality assessment in an Arabic ICU patients. The RCSQ-A was shown to be
feasible and acceptable to the ICU patients for daily self-report sleep
assessment with self-completion requires external assistance to complete RCSQA. Sleep quality in the participants was generally poor; their sleep patterns were
characterised by light sleep with frequent awakenings. Factors disrupting sleep
were multiple and highly varied. Nevertheless, noise, talking and fear, were the
highest-rated disruptive factors. In the multiple regression analysis , factors
which significantly associated with patient sleep [exp(b), p-value] were
previously receipt of Midazolam [-6.424, p<0.0005] and Propofol sedation
[-3.600, p<0.05], noise [-1.033, p<0.05], daytime sleepiness [0.856 p<0.05], the
presence of mechanical-ventilation [-1.218, p<0.05], and sex differences [1.836,
p<0.05].
Conclusion
The results from this study highlight that the RCSQ-A is a feasible and acceptable
measure for daily routine use for self-report sleep assessment in Saudi ICU
clinical practice. Further research would be useful to contribute to the growing
body of research addressing its effectiveness in middle eastern populations. The
results highlight the importance of routinely inquiring about ICU patients' sleep
quality and identifying individual sleep disruptive factors to develop
individualised interventions to meet patient needs. T