Qualitative Interviewing: The Art of Hearing Data

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure

Background: Actigraphy is increasingly used in sleep research and the clinical care of patients with sleep and circadian rhythm abnormalities. The following practice parameters update the previous practice parameters published in 2003 for the use of actigraphy in the study of sleep and circadian rhythms. Methods: Based upon a systematic grading of evidence, members of the Standards of Practice Committee, including those with expertise in the use of actigraphy, developed these practice parameters as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations. Recommendations: Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders. More specifically, actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work disorder. Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24hr sleep/wake syndrome (including that associated with blindness). When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea. In patients with insomnia and hypersomnia, there is evidence to support the use of actigraphy in the characterization of circadian rhythms and sleep patterns/ disturbances. In assessing response to therapy, actigraphy has proven useful as an outcome measure in patients with circadian rhythm disorders and insomnia. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses. Similarly, in normal infants and children, as well as special pediatric populations, actigraphy has proven useful for delineating sleep patterns and documenting treatment responses. Conclusions: Recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations for the use of actigraphy in the clinical setting. Additional research is warranted to further refine and broaden its

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Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007.

Objective:To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.Methods:We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We a

/pdf/guidelines-for-family-centered-care-in-the-neonatal-3kja37jlgs.pdf

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

HANDBOOK OF MIXED METHODS IN SOCIAL & BEHAVIORAL RESEARCH (Book)

The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents' work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.

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Sleep patterns and fatigue in new mothers and fathers.

Objective: To describe the sleep characteristics and examine the associations among perceived stress, sleep disturbances, depressive symptoms, and physical symptoms among female college students. Methods: A total of 103 students completed a battery of questionnaires. Results: The students experienced high stress during the school year. The majority of them slept less than 6 hours during weekdays and experienced moderate fatigue. High stress levels are associated with sleep disturbances, less nocturnal total sleep time, higher fatigue severity, and more depressive symptoms. Perceived stress and sleep disturbances are significant predictors for depressive symptoms and physical symptoms. Compared to the good sleepers, the poor sleepers reported more daytime sleepiness, depressive symptoms, and physical symptoms. Conclusions: Interventions to reduce stress and improve sleep are critically needed in college education.

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Stress and Sleep Disturbances in Female College Students

Objective The purpose of this study was to describe sleep and fatigue during the first week of postpartum recovery, and compare women after cesarean delivery with women after vaginal delivery while their infants were hospitalized in the intensive care unit (ICU). Methods This cross-sectional descriptive exploratory study involved 21 postpartum Chinese American mothers (6 after cesarean delivery and 15 after vaginal delivery). Three types of data were collected: (1) mothers' demographic data; (2) objective sleep that included total sleep time (TST) and wake after sleep onset (WASO) measured using wrist actigraphy, and (3) subjective sleep quality (General Sleep Disturbance Scale) and fatigue severity (Numerical Rating Scale-Fatigue). Results All of the mothers experienced poor sleep while their 3- to 5-day-old infants were in the ICU. After cesarean birth, mothers averaged only about 4 hours TST with 34% WASO while still hospitalized, compared with 6.5 hours TST with 14% WASO for mothers after vaginal birth monitored in their home after hospital discharge. Conclusion Sleep disturbances and fatigue need to be further investigated to better understand the relationship between type of delivery and maternal health outcomes. Despite infant care provided in ICUs, these new mothers could benefit from interventions to promote their own sleep, particularly when also recovering from cesarean delivery.

Early postpartum sleep and fatigue for mothers after cesarean delivery compared with vaginal delivery: an exploratory study.

Objective To explore relationships between impaired sleep and well-being in mothers with low-birth-weight infants in the neonatal intensive care unit. Design Cross-sectional descriptive exploratory design. Setting Neonatal intensive care unit in metropolitan Atlanta, GA. Participants Twenty second-week postpartum, first-time mothers who had a low-birth-weight infant hospitalized in the neonatal intensive care unit. Methods Self-report data were collected for sleep, fatigue, depression, and well-being. Total sleep time, wake after sleep onset, circadian activity rhythms, and light exposure were measured using a wrist actigraph. Results Mothers reported clinically significant sleep disturbance and fatigue severity. Actigraphy showed the average nighttime total sleep time was less than 7 hours with 19%±2.2% wake after sleep onset, and the total daytime sleep was more than an hour. Mothers also experienced moderate depressive symptoms. Maternal well-being as measured by the Medical Outcomes Short Form-36, version 2 was approximately 1  SD below the mean scores of age-matched women in the general U.S. population. Conclusion Mothers of hospitalized low-birth-weight infants are vulnerable. The presence of sleep disturbances and negative physical and mental health indicators warrants further study. Intervention is needed to promote sleep for new mothers during postpartum recovery, especially mothers who are dealing with a medically ill infant.

https://www.jognn.org/article/S0884-2175(15)30237-9/pdf

Impaired Sleep and Well-Being in Mothers With Low-Birth-Weight Infants

PURPOSE/OBJECTIVES To describe the sleep characteristics of family caregivers of individuals with a primary malignant brain tumor (PMBT). DESIGN Cross-sectional, correlational design using baseline data from a longitudinal study. SETTING Neuro-oncology and neurosurgery clinics at an urban tertiary medical center in the United States. SAMPLE 133 family caregivers recruited one to two months following diagnosis of family member's PMBT. METHODS Subjective and objective measures of sleep were obtained via self-report and the use of accelerometers (three nights). MAIN RESEARCH VARIABLES Sleep characteristics including sleep latency, total sleep time, wake after sleep onset, number of naps, number of arousals, sleep-wake cycle, and sleep quality. FINDINGS Sleep latency in caregivers was, on average, 35 minutes (SD = 34.5)-more than twice as long as the norm of 15 minutes (t[113]) = 6.18, p < 0.01). Caregivers averaged a total sleep time of 5 hours and 57 minutes (SD = 84.6), significantly less than the recommended 7 hours (t[113] = -8, p < 0.01), and were awake in the night 15% of the time, significantly more than the norm of 10% (t[111] = 5.84, p < 0.01). Caregivers aroused an average of 8.3 times during nocturnal sleep (SD = 3.5, range = 2-21), with about 32% reporting poor or very poor sleep quality. CONCLUSIONS Caregivers experienced sleep impairments that placed them at risk for poor mental and physical health, and may compromise their ability to continue in the caregiving role. IMPLICATIONS FOR NURSING Nurses need to assess sleep in caregivers of individuals with PMBT and implement interventions to improve sleep. KNOWLEDGE TRANSLATION Sleep deprivation is common in family caregivers during the early stages of care for individuals with a PMBT. A single-item sleep quality question could be an easy but valuable tool in assessing sleep disturbances in family caregivers of individuals with a PMBT. The health trajectory of family caregivers warrants further longitudinal study, in addition to the examination of the bidirectional relationship of health status of care recipients and their family caregiver.

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Shih-Yu Lee

Papers

Sleep patterns and fatigue in new mothers and fathers.

Stress and Sleep Disturbances in Female College Students

Early postpartum sleep and fatigue for mothers after cesarean delivery compared with vaginal delivery: an exploratory study.

Impaired Sleep and Well-Being in Mothers With Low-Birth-Weight Infants

Sleep Characteristics of Family Caregivers of Individuals With a Primary Malignant Brain Tumor