Search

Delirium and sleep deprivation are experienced by patients in intensive care units (ICUs) and have been associated with negative patient outcomes. Benzodiazepine, often used for sedation in critically ill patients, contributes to an imbalance of neurotransmitters that can influence the wake-sleep-regulatory system and the occurrence of delirium. This dissertation evaluated the effect of a sedation wake-up trial (SWT) and spontaneous breathing trial (SBT) on the occurrence of delirium, perception of sleep and other outcomes in trauma ICU (TICU) patients. The first study was a prospective interventional trial that implemented the SWT plus SBT in TICU patients. The intervention group (IG, n = 20) experienced less delirium (OR 0.107; 95% CI: 0.025-0.459), recovered from drug-induced coma faster (RH 2.25; 95% CI: 1.08-4.65), and was liberated from the mechanical ventilator (RH 3.09; 95% CI: 1.45-6.60) and discharged from the TICU sooner (RH 4.20; 95% CI: 1.82-9.69) than the control group (CG, n = 20). Sleep perception was rated as bad and did not differ between groups. A second report addressed the feasibility of conducting the SWT plus SBT based on the ability to implement the combined intervention, measure patients' physiological responses, and maintain patient safety. IG patients passed 67% of the 39 SWTs performed. Those who did not pass presented RASS scores of +1 and +2, tachycardia, or showed ventilator asynchrony. Eighteen patients tolerated their first SBT and after the second SBT more than half of patients were discontinued from the mechanical ventilator. Physiological responses (i.e., heart rate, respiratory rate, and systolic blood pressure) increased significantly from the beginning to the end of the SWT. However, their overall means did not increase by 20%. Opioids were not interrupted during the SWT; however, at the end of six SWTs patients reported having pain. The findings demonstrated that those TICU patients who received the combined intervention decreased in the occurrence of delirium and improved in several outcomes. However, this conclusion is limited by the non randomized design, the small sample, and the lack of control in the type of sedative given to both groups. The combined intervention was well tolerated, safe, and clinically feasible.

ABSTRACTPURPOSE: This study compared the occurrence rates for and severity of sleep disturbance in cancer patient-family caregiver (FC) dyads.PATIENTS AND METHODS: One hundred and two dyads were recruited from two radiation therapy (RT) departments. Patients and their FCs completed the Pittsburgh Sleep Quality Index (PSQI) and the General Sleep Disturbance Scale (GSDS) and wore wrist actigraphs to obtain subjective and objective measures of the occurrence and severity of sleep disturbance at the initiation of RT.RESULTS: While the occurrence rates of clinically significant levels of sleep disturbance were high for both patients and their FCs, no differences were found between the dyads in these occurrence rates. Very few between group differences were found in the severity of any of the sleep-wake parameters using both the subjective and objective measures of sleep disturbance.CONCLUSIONS: The findings from this study suggest that cancer patients and their FCs experience similar levels of sleep disturbance and that both groups could benefit from interventions that aim to promote restful sleep. In addition to routine and systematic assessment of sleep disturbance by oncology clinicians, interventions are needed that take into account the specific needs of the patient and the FC as well as the potential for partners' sleep patterns to influence one another.

Most of the knowledge on sleep in older adults with dementia is based on studies conducted in the United States and other Western countries. Sleep research worldwide of other populations with dementia is meager by comparison. The aim of this dissertation is to increase knowledge on sleep in older persons with dementia by studying a Korean population and to suggest effective interventions. Literature on sleep in older adults with dementia was reviewed to identify their sleep characteristics and sleep-related factors and to discuss nursing interventions. Two data-based studies were conducted on a pilot study. A prospective observational study was performed with a convenience sample of 12 older Korean adults with dementia who reside in institutions. The first study examined environmental factors for the effective management of sleep problems in four cases. The second study investigated sleep characteristics, including rest-activity rhythms in institutionalized older Korean adults with dementia, and explored associated factors. Older Korean adults with dementia who reside in institutions experienced fragmented sleep due to frequent nocturnal awakenings and spent extended time napping. The type of institution was a significant factor in rest-activity patterns. Further study with large sample sizes is clearly needed to determine which institutional factors affect sleep and rest-activity patterns in various settings.

Breastfeeding (BF) is a health-promoting behavior and exclusive BF has proven economic and ecologic benefits to individuals and societies. Yet Healthy People 2010 BF objectives for exclusive BF remain unmet and prevalence is lowest for low-income populations. The purpose of this descriptive longitudinal study of 126 predominantly low income and ethnically diverse mother-infant dyads was to compare maternal and infant factors associated with nighttime BF behavior between exclusive BF dyads and supplemented dyads. Descriptive statistics, repeated measures ANOVA, independent t-tests, and Chi-square tests were used for analysis.BF behavior was categorized as either 1) exclusive BF, defined as 100% BF or breastmilk feeding on all three nights, or 2) supplementation, defined as any formula during any of the three nights.Compared to women in supplementation (n=59), women in exclusive BF (n=67) were older, more likely Caucasian, working at 36 weeks pregnant but not working at 1 month postpartum, in a relationship, and getting less help with baby at night. There was no group difference in objective sleep at the last month of pregnancy assessment. At one month postpartum, women in the supplementation group averaged 30 minutes less night sleep compared to women in the exclusive BF group.Compared to infants who were supplemented (n=54), infants who were exclusively breastfed (n=66) were significantly more likely to room-in with mothers in hospital and receive a home visit. They were statistically larger at birth, although the difference in size may not be clinically relevant.Assessment of sleep in new mothers is important for BF maintenance and more effort is needed to promote exclusive BF among younger women, African Americans and women of Asian descent. Rooming-in practice in the hospital after birth should be encouraged, as it was significantly associated with exclusive BF behavior at one month postpartum in this diverse sample of new families. Future research using a qualitative approach would be ideal to discover how nighttime feeding for new mothers evolves over time, their motivation for BF, and their network of influence in support of BF behavior. Findings from qualitative research will be useful in developing an effective intervention for BF maintenance.

Depressive symptoms, sleep disturbance and chronic illness are seldom studied together. Depression is higher in women and insomnia is a common sleep problem for women. Both are nurse-managed symptoms. This dissertation first proposes a theoretical nursing perspective of insomnia guided by four theoretical perspectives. The concepts from these perspectives were incorporated into a proposed model focused on mechanisms of insomnia and insomnia symptom experience.The research involved a community-based sample of 347 healthy, ethnically diverse, premenopausal women between 40-50 years of age. The purpose was to describe patterns of depressive symptoms across time as a function of fixed demographic factors and time-varying biological and social factors, and describe the relationship between depressive symptoms and physical illness. The women with hypertension provided a group with a chronic physical illness.Longitudinal data included the Center for Epidemiologic Studies - Depression (CES-D) scale, investigator-designed questionnaires about sociodemographics, medical history, and health problems, Pittsburgh Sleep Quality Index, social support subscale of the Interpersonal Relationships Inventory, and the health perception item from the Medical Outcomes Study Short Form. Biometric measures included: follicle stimulating hormone assays, blood pressure, and height and weight for calculating body mass index (BMI). Group comparisons used t-tests, ANOVA, chi square, and Mann-Whitney U.Negative binomial regression was used for analysis of CES-D due to its skewed distribution in this sample. A significant model of predictors of CES-D scores was identified. Prevalence of depressive symptoms was 30% at study initiation and 26% at 30 months. Predictors of high CES-D scores were poor sleep quality, presence of chronic illness at 30 months, high BMI, and the interaction of time and poor sleep quality. Time, having a partner, positive social support and the interaction of time with low BMI predicted low CES-D scores. A higher proportion of African American women scored > 16 on the CES-D. Number of health conditions, presence of chronic illness, and hypertension were significantly higher for women scoring >16 on CES-D compared to women scoring

The purpose of this study was to investigate the feasibility and effectiveness of a "mindful-yoga" intervention for healthy pregnant women that blended elements of Mindfulness-Based Stress Reduction and Iyengar style prenatal yoga, on stress, anxiety, sleep, and pain; to estimate statistical power and sample size for a larger study; and to establish whether the treatment is effective for second or third trimester women. The effects of variables on mindful-yoga were studied over time, comparing baseline (Time1) and post-intervention (Time2) data in a single treatment group of 19 English-speaking nulliparous women with healthy pregnancies, 17 of whom adhered to the intervention that met for seven weekly sessions.Data were analyzed with descriptive statistics, correlations, parametric and nonparametric paired comparisons, and effect sizes. Participants were well-educated, middleclass, and planning vaginal birth. Although no one was currently being treated for psychiatric disorders, nearly 30% had a history of depression or anxiety.The intervention resulted in higher scores for two facets of mindfulness (Observing and Nonreacting). From Time1 to Time2, third trimester participants demonstrated significant reductions in perceived stress and trait anxiety. Second trimester women demonstrated improvements in pain and sleep. In contrast, the third trimester group experienced worse pain and sleep as pregnancy progressed. To control for gestation, Time1 data for the 8 women who began mindful-yoga in the third trimester (26.5 weeks ±2.3) were compared with Time2 data for the 9 women who began mindful-yoga in the second trimester (27.1 weeks ±4.1). Second trimester women at Time2 experienced improved sleep (fewer night awakenings and less wake time during the night) as measured by wrist actigraphy compared to third trimester group baseline data.This study demonstrated important clinical improvements in sleep and pain for women who began mindful-yoga in their second trimester. Mindful-yoga intervention merits further research for reducing perceived stress and anxiety and second trimester sleep enhancement and pain reduction. The mechanisms of mindful-yoga on stress appraisal, anxiety, sleep, and pain were not clearly linked to mindfulness, and further studies are required to develop theoretical linkages between mindful-yoga and symptom reduction during pregnancy.

The purpose of this study was to describe depressive symptoms and sleep in first-time mothers. Predictors of postpartum depressive symptoms, including perceived stress, social support, and maternal adjustment were also examined. Another purpose was to compare objective and subjective sleep in mothers with and without depressive symptoms in the third trimester (Time 1) and at 12 weeks postpartum (Time 2).This descriptive, correlational, longitudinal, secondary analysis utilized data from two randomized clinical trials. Depressive symptoms, psychosocial measures, and subjective and objective sleep measures were collected on a sample of 161 first-time mothers between the ages of 18 and 43 years.The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms. Mean CES-D scores at Time 1 (12.2 ± 7.0) significantly improved at Time 2 (8.8 ± 6.7). However, of the 46 women scoring in the depressed range at Time 1, 32.6 % (n = 15) continued to experience depressive symptoms at 12 weeks postpartum. Of the 115 women with minimal symptoms at Time 1, 7% (n = 8) experienced depressive symptoms at 12 weeks postpartum. Depressive symptoms and sleep disturbance were significantly associated at Time 1 and Time 2. Overall sleep disturbance, minutes to fall asleep, ability to stay asleep, and daytime sleepiness significantly improved from late pregnancy to 12 weeks postpartum. Women with depressive symptoms in the late third trimester and 12 weeks postpartum reported significantly more sleep disturbance, trouble falling asleep and more daytime sleepiness than women without depressive symptoms. Fifty-seven percent of the variance in mothers' depressive symptoms at 12 weeks postpartum was explained by six independent variables. However, antenatal CES-D score alone was a significant predictor of postpartum depression scores, accounting for 16.7% of the variance in depression scores at 12 weeks postpartum. The results of this study underscore the need for health care providers to assess depressive symptoms and sleep during pregnancy and during the first few postpartum months. Furthermore, results suggest that complaints of sleep disturbance, especially prolonged sleep onset latency and increased daytime sleepiness, may be relevant screening questions in relation to risk for postpartum depression.