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Research Article Sleep Quality Among Female Hospital Staff Nurses Hindawi Publishing Corporation Sleep Disorders Volume 2013, Article ID 283490, 6 pages http://dx.doi.org/10.1155/2013/283490 Research Article Sleep Quality among Female Hospital Staff Nurses Pei-Li Chien,1 Hui-Fang Su,2 Pi-Ching Hsieh,2 Ruo-Yan Siao,1 Pei-Ying Ling,3 and Hei-Jen Jou3,4 1 Department of Preventive Medicine, Taiwan Adventist Hospital, No. 424, Section 2, Bade Road, Songshan District, Taipei 105, Taiwan 2 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No. 89, Nei-Chiang Street, Wanhua District, Taipei 10845, Taiwan 3 Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, No. 424, Section 2, Bade Road, Songshan District, Taipei 105, Taiwan 4 Department of Obstetrics and Gynecology, National Taiwan University Hospital, No. 7, Zhongshan S. Road, Zhongzheng District, Taipei 100, Taiwan Correspondence should be addressed to Hei-Jen Jou; [email protected] Received 13 January 2013; Accepted 22 April 2013 Academic Editor: Michel M. Billiard Copyright © 2013 Pei-Li Chien et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures. Methods. Female staff nurses at a regional teaching hospital in Northern Taiwan were recruited. The Chinese version of the pittsburgh sleep quality index (C-PSQI) was used to assess subjective sleep quality, and an electrocardiogram-based cardiopulmonary coupling (CPC) technique was used to analyze objective sleep stability. Work stress was assessed using questionnaire on medical worker’s stress. Results. A total of 156 staff nurses completed the study. Among the staff nurses, 75.8% (117) had a PSQI scoreof ≥5 and 39.8% had an inadequate stable sleep ratio on subjective measures. Nurses with a high school or lower educational degree had a much higher risk of sleep disturbance when compared to nurses with a college or higher level degree. Conclusions. Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses. More studies are warranted on this important issue to discover possible factors and therefore to develop a systemic strategy to cope with the problem. 1. Introduction other emotional factors in addition to objective sleep quality. However,limitedstudyofobjectivesleepqualityofhospital Poor sleep quality among hospital stuff nurses is a critical nurses provides little information for better understanding of issue for healthcare system. It not only leads to health prob- sleep disturbance among this population. lemsofthenurses,butitisalsoassociatedwithalowerwork The current methods used to assess objective sleep phys- performance and a higher risk of medical errors which may jeopardize patient’s safety [1]. The incidence of sleep distur- iology primarily rely on polysomnography (PSG) which is bance among general Asian population ranged from 26.4% based on the analysis of signals of electroencephalography to 39.4% [2, 3]. Most previous studies on sleep quality of (EEG), electrooculography, electromyography, and electro- nurses focused on the effect of shift work on subjective sleep cardiography (ECG). Although PSG is the gold standard for perception using self-report questionnaire and revealed that objective sleep quality assessment, the cost and technical up to 57% of shift-working nurses had sleep disturbance [4]. complexity of PSG limit its use as a routine screening tool. In It is therefore warranted to find out possible factors associated addition, it has been noted that PSG measurement may have with sleep disturbance of working nurses. been largely affected by “first-night effect” from an unfamiliar The perception of sleep quality is complex and associated laboratory environment and discomfort from PSG sensors with various subjective factors such as fatigue, work stress, or and equipment [5]. In addition, sleep pattern of subjects at 2 Sleep Disorders home may be quite different when compared with that in two groups: the higher stress group (HSG) with a score of >32 the laboratory room. Previous studies have also demonstrated and the lower stress group (LSG) with a stress score of ≤32. inconsistency between subjective sleep perception and PSG staging [6–8]. 2.3. Assessment of Subjective Sleep Quality. The Chinese Recently, an alternative method term cardiopulmonary edition Pittsburgh sleep quality index (C-PSQI) was used coupling (CPC) analysis has been developed to quantify sleep to assess subjective sleep quality [11]. Subjects were asked stability. The technique is based on analysis of continuous to assess their sleep condition in the previous month. The ECG signals using take-home ECG devices [9]. This novel PSQI is a self-rated questionnaire and comprises 18 questions technology is less expensive and is more convenient since to assess seven domains of sleep, including subjective sleep the measures do not require subjects to sleep in a laboratory quality, sleep latency, sleep duration, habitual sleep efficiency, room. Therefore the study does not interrupt the daily work sleep disturbances, use of sleeping medication, and daytime of the nurses. dysfunction. Each domain is rated on a 4-point scale (0–3), Thepurposeofthisstudywastoassessthesleepquality which generates a total score ranging between 0 and 21. Poor of hospital stuff nurses, including subjective sleep perception sleepers had a total score of 5 or above, while good sleepers by self-report questionnaire and objective sleep stability by hadascoreoflessthan5.TheCronbach’s values were 0.83 CPC method. We also tried to identify possible demographic, for the original PSQI instrument [12] and 0.77 for C-PSQI lifestyle, and work factors for poor sleep quality among [11], respectively. hospital working nurses. 2.4. Assessment of Objective Sleep Quality. Atake-home Holter ECG SD-100 portable recorder (Microstar Inc., Taipei, 2. Methods Taiwan) was used to obtain continuous ECG signals of the subjects during their time in bed with only 4 leads 2.1. Subjects. A cross-sectional study was conducted from attached to the trunk of the subjects. All subjects received March 1, 2009 to September 30, 2009 to investigate the subjec- ECG recording at home after a detailed demonstration of tive sleep perception, objective sleep stability, and the possible the recording process by the researcher. The ECG recording factors associated with poor sleep quality among staff nurses wascollectedontheseconddayandthenuploadedtoa at a regional teaching hospital with 389 nurses. One hundred central laboratory. The signals were automatically processed and seventy-five subjects from the hospital, including nurses andanalysedtogenerateasleeppictogramusinganECG- and nurse managers, were randomly selected by computer based CPC (cardiopulmonary coupling analysis) technique chaos generator with an approximate nurse/nurse manager [9]. Three physiological sleep states were classified based on ratio of 3 : 1 and study subjects comprising about half of CPC analysis: stable sleep, unstable sleep, and REM/wakeful the total hospital nursing staff and nursing managers. Male (awake/dream) states [9], as expressed by both absolute time nurses were excluded from the study because of their small duration and ratio of time in bed. A stable sleep ratio ≥41% proportion among the nursing staff. Written informed con- was regarded as adequate sleep “stability”, while inadequate sent from each subject was obtained after the study’s approval sleep stability indicated a stable sleep ratio of <41%. Recorded by the Institutional Review Board of the study hospital. data also included total sleep time, sleep latency duration, and The authors developed a detailed questionnaire according apnea/hypopnea index (AHI). to the literature, which included demographic information In addition to the three physiological sleep patterns, the (age, gender, education level, marital status, etc.) and associ- machine also records sleep apnea/hypopnea of the subjects. ated factors such as regular exercise, managerial position, and The AHI represents an index of apnea/hypopnea per hour work shift. Regular exercise was defined as a regular exercise of time in bed. An AHI of 5 to 15 was defined as mild habit of ≥3 exercise per week with duration of ≥30 minutes apnea/hypopnea, an AHI between 16 and 30 meant moderate every time. Work shift was defined as >1workshiftperweek apnea/hypopnea, and an AHI of greater than 30 signified during last month. severe apnea/hypopnea. 2.5. Statistic Analysis. Descriptive analysis was used to ana- 2.2. Assessment of Work Stress. Questionnaire on medical lyze basic characteristics of the subjects with mean values ± worker’s stress (QMWS) (Cronbach alpha coefficient 0.84) standard deviation (SD). Comparison between groups was 2 was used to assess the subjects’ work stress [10]. There are done with Student’s -test for continuous variables and eight questions in the QMWS, including stress from (1) run- test for discrete variables. Multiple variable logistic regression ning the hospital, (2) preparing the accreditation of the hospi- was used to calculate the odds ratios of variant demographic tal, (3) the stability of the patients’ condition, (4) the relation- factors on subjective perception and objective sleep stabil- ship with patients, (5) medical dispute or lawsuits,
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