title: 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
Creators: name: AL-Sulami, Ghaida
Publisher: name: University of Glasgow
Year: 2020
Subjects: subject: Sleep quality, RCSQ, sleep assessment, self-report.

description: 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 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&lt;0.0005] and Propofol sedation [-3.600, p&lt;0.05], noise [-1.033, p&lt;0.05], daytime sleepiness [0.856 p&lt;0.05], the presence of mechanical-ventilation [-1.218, p&lt;0.05], and sex differences [1.836, p&lt;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. This thesis can thus be viewed as a solid foundation for further research, which is required to strengthen, expand on, and confirm the findings contained herein.