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 sociodemographic data show that 51 (51%) were men, 59 (59%) were 60 years and older, 78 (78%) were white, and 45 (45%) were married (Table 2). It was also observed that 29 (29%) patients had diabetes mellitus, and 61 (61%) had high blood pressure (Table 3).
Sleep patterns. Fifty-three (53%) patients went to sleep between 9:00 pm and 11:00 pm, 63 (63%) took between 31 and 60 minutes to fall asleep, 53 (53%) woke up between 4:00 am and 5:00 am, and 41 (41%) slept 4 to 5 hours per night. There were significant differences (P < 0.001) in the distribution of responses across categories in all open-ended questions (Table 4). The results also revealed that 34 (34%) patients took more than 30 minutes to fall asleep, 92 (92%) woke up in the middle of the night or early in the morning, 90 (90%) woke up to use the bathroom, 88 (88%) had bad dreams or nightmares, 12 (12%) took medication to sleep, and 87 (87%) had trouble staying awake while driving (Table 5). There were significant differences (P < 0.001) in the distribution of responses across different response categories in all semi-open questions (Table 5). Forty (40%) patients considered sleep a necessity, 60 (60%) took intentional daytime naps, and 40 (40%) reported a need for daytime naps (Table 6).
Chronic ulcers are painful, difficult to heal, and may present odor and exudate. The presence of ulcers may reduce the mobility and autonomy of patients, interfere with their professional life, and result in social isolation and low self-esteem. All of these factors combined may contribute to poor sleep quality and reduced quality of life.8 Therefore, it is important to assess sleep quality in patients with venous ulcers. Some studies have reported on the negative impact of chronic diseases on sleep quality,19–22 reduced sleep duration, prolonged time to fall asleep,16,23 and a strong association between chronic diseases and sleep disorders.24 Disturbed subjective sleep quality was reported by van Dijk et al17 in adult patients with longstanding type 1 diabetes mellitus, and by Luyster et al16 in patients with rheumatoid arthritis.
The present study showed that most patients with venous ulcers (64%) experienced poor sleep quality; however, the venous ulcer—with associated pain, odor, fear of complications or amputation, and financial concerns—may not be the sole cause. Other factors that cause poor sleep in this population include age-related illnesses, nocturia, issues related to marital status, a morning-type orientation, irregularity in bed times and rise times, functional disability, and cognitive impairment.