Sleep Quality Among Patients With Venous Ulcers: A Cross-sectional Study in a Health Care Setting in São Paulo, Brazil
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Index: WOUNDS. 2012;24(5):124–131.
Abstract: This was an exploratory, descriptive, cross-sectional study to assess sleep quality in 100 patients with venous ulcers using the Pittsburgh Sleep Quality Index (PSQI). Thirty-six (36%) patients had a global PSQI score < 5, indicating that they were good sleepers, while 64 (64%) patients were considered poor sleepers. Fifty-three (53%) patients reported going to bed between 9:00 pm and 11:00 pm, 63 (63%) taking from 16 to 30 minutes to fall asleep, and 41 (41%) waking up after 4 to 5 hours of sleep. Sixty (60%) patients regarded sleeping as a necessity. Most patients with venous ulcers experienced poor sleep quality.
Changes in the demographic transition process have increased life expectancy, leaving the population susceptible to chronic degenerative diseases.1 Leg ulcers have become more common in patients with chronic diseases, particularly those of the circulatory system. These ulcers may be caused by factors, such as vascular, metabolic, and hematologic changes, with venous insufficiency being the main cause of leg ulcers in many developed countries.2,3 Chronic venous insufficiency can be defined as changes in the functioning of the venous system caused by venous valvular incompetence. Its prevalence ranges from 2% to 7% in the adult population. Nearly 47% of cases affect the superficial venous system, and 53% affect the deep venous system.3–6 Venous ulcers cause pain, depression, social isolation, loss of self-esteem, degraded self-image, lifestyle changes, reduced sleep quality and quality of life, and limits the ability of patients to perform normal daily activities. The prevalence of venous ulcers ranges from 0.5% to 1.5% in the adult population.3,4,7,8
Since sleep is a physiological and behavioral process that is essential for the proper functioning of the human body, sleep quality, as experienced by the patient and its impact on the daily life of healthy persons or persons with diseases, has been the focus of many studies.9,10 The measurement of sleep quality has become an important clinical tool to identify health problems.9 Sleep disturbances may be associated with fatigue, mood changes, and decreased pain tolerance.11 Moreover, impaired sleep may lead to metabolic dysfunctions because hormones, which play a vital role in the functioning of the body, are produced and released during the sleep cycle. Aside from hormonal changes, irregular sleep patterns may result in reduced ability to plan and perform tasks, irritability, mood changes, and difficulty concentrating in the short-term, and may cause early aging and cardiovascular diseases over the long-term. All of these factors acting together in patients with venous ulcers may impair wound healing.12–14
Patients with chronic or acute ulcers have an increased risk for sleep disorders, particularly if hospitalization is required.15 It is believed that patients with venous ulcers tend to have more trouble falling asleep and staying asleep compared with other clinical patients, because this condition is usually associated with other comorbidities, such as vascular diseases, diabetes, and hypertension. Hospitalization and other changes in the sleep routine may result in sleep disorders in these patients and exacerbate problems caused by chronic diseases.15–17
Questionnaires may be used to assess and measure sleep quality in patients with venous ulcers.