Sleep Quality Among Patients With Venous Ulcers: A Cross-sectional Study in a Health Care Setting in São Paulo, Brazil
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The Pittsburgh Sleep Quality Index (PSQI) was chosen for this study because it is an instrument designed to measure subjective sleep quality and sleep disturbances.9 The PSQI had been translated into Brazilian Portuguese and was culturally validated, while maintaining its high sensitivity (80%) and specificity (69.8%).15
Patients with venous ulcers require care from a multidisciplinary team working in unison with the purpose of improving treatment approaches and cost-effectiveness, which can lead to better sleep quality. DaVanzo et al18 reported statistical improvement outcomes and lower Medicare costs ($229.07 versus $354.26 per resident episode day; P < 0.01) in skilled nursing facility residents with chronic wounds treated by a wound management team compared with those who did not receive care from the wound management team.
The aim of this study was to assess the sleep quality in patients with venous ulcers.
This was an exploratory, descriptive, cross-sectional study. The Research Ethics Committee of the Universidade Federal de São Paulo (UNIFESP), Brazil, approved the study. Written informed consent was obtained from all patients prior to their inclusion in the study, and steps were taken to ensure patient anonymity. Data were collected between December 2008 and December 2010. One hundred patients with venous ulcers who attended the outpatient wound care clinic of a hospital center in the state of São Paulo, Brazil, participated in this study. Eligibility criteria included patients with venous ulcers who were 18 years or older and were attending the outpatient wound care clinic.
Patients who were not physically or mentally able to complete the questionnaire, and those with mixed ulcers, arterial ulcers, foot ulcers, and wounds other than venous ulcers, were excluded from the study.
Sleep quality was assessed using the PSQI, which is a questionnaire designed to measure subjective sleep quality and sleep disturbances.9 The Brazilian Portuguese version of the PSQI15 was administered to all patients in a private room to ensure comfort and tranquility. The questionnaire consists of 10 items (some containing multiple subitems), of which 4 (items 1 to 4) are presented as open-ended questions, and 6 (items 5 to 10) as semi-open questions. The items are grouped into 7 components: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medications, and daytime dysfunction. Each component is scored from 0 to 3. The global PSQI score is calculated as the sum of ratings for the 7 components for a possible range of 0 to 21, with a cut-off score of 5 (a higher score indicates poorer sleep quality). A global PSQI score > 5 indicates that a person is a “poor sleeper.”9,15
Statistical analysis was carried out using the Statistical Package for the Social Sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL). The chi-square test, Student’s t test, nonparametric Mann-Whitney U test, and Kruskal-Wallis test, followed by the post-hoc Dunn’s multiple comparison test, were used. Statistical significance was set at P < 0.05 for all tests.
Thirty-six (36%) patients with venous ulcers had global PSQI scores ≤ 5, indicating good sleep quality, while 64 (64%) patients had poor sleep quality (Table 1).