Sleep Pattern and Factors Causing Sleep Disturbance in Adolescents with Cancer before and after Hospital Admission

Jin Jung; Eun-Hye Lee; You-Jin Yang; Bo-Yoon Jang

doi:10.5388/aon.2017.17.3.143

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Jung, Lee, Yang, and Jang: Sleep Pattern and Factors Causing Sleep Disturbance in Adolescents with Cancer before and after Hospital Admission

Original Article

Asian Oncology Nursing 2017; 17(3): 143-150.

Published online: 30 September 2017

DOI: https://doi.org/10.5388/aon.2017.17.3.143

Sleep Pattern and Factors Causing Sleep Disturbance in Adolescents with Cancer before and after Hospital Admission

Jin Jung

, Eun-Hye Lee

, You-Jin Yang

, Bo-Yoon Jang

Department of Nursing, The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea.

Address reprint requests to: Jung, Jin. Department of Nursing, The Catholic University of Korea Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: +82-2258-5297, Fax: +82-02-2258-5357, jini659@cmcnu.or.kr

Received 28 May 2017 Revised 5 July 2017 Accepted 31 July 2017

Korean Oncology Nursing Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This is a descriptive study conducted in order to survey sleep patterns and factors responsible for sleep disturbance among adolescent cancer patients after hospital admission.

Methods

The study group included 46 adolescent cancer patients aged 10 to 19 who received admission care in multi-bed hospital rooms from March to June 2016. Data on patterns and quality of sleep, and factors causing sleep disturbance were recorded using the Verran and Snyder-Halpern (VSH) Sleep Scale, the Pittsburgh Sleep Quality Index (PSQI), and a sleep disturbance questionnaire.

Results

There was no difference in patterns and quality of sleep prior to and after hospital admission in the study group. However, patients experienced sleep disturbance, as defined by PSQI > 5, both before (5.43) and after (6.30) admission. The most important physical, emotional and environmental factors causing sleep disturbance after admission were nocturnal diuresis, monotony of admission care, and crying of younger patients respectively.

Conclusion

This study focused on sleep patterns and factors causing sleep disturbance after hospital admission for adolescent cancer patients. Future studies should aim to develop nursing interventions resulting in an environment that improves sleep quality. Additional studies should focus on developing daytime programs to determine the impact of admission care on other quality of life parameters.

Keywords: Neoplasms, Adolescent, Sleep Wake Disorders

Figures and Tables

Table 1

General Characteristics of Subjects (N=46)

Characteristics	Categories	n (%)	M ± SD
Age (year)	10~12	13 (28.3)	14.2 ± 2.28
	13~15	19 (41.3)
	16~18	14 (30.4)
Gender	Male	28 (60.9)
Gender	Female	18 (39.1)
Education level	Elementary school	13 (28.3)
	Middle school	16 (34.7)
	High school	17 (37.0)
Diagnosis	AML	10 (21.8)
	ALL	26 (56.5)
	Lymphoma	4 (8.7)
	Solid tumor	3 (6.5)
	Others	3 (6.5)
Treatment duration (month)	<4	15 (32.6)	15.2 ± 20.97
	4~12	19 (41.3)
	>12	12 (26.1)
Treatment type	Induction	12 (26.1)
	Consolidation	17 (37.0)
	Re-induction	5 (10.9)
	HSCT	6 (13.0)
	Others	6 (13.0)
Relapse	Yes	11 (23.9)
Relapse	No	35 (76.1)
Health statusat hospital	Good	21 (45.7)
	Moderate	19 (41.3)
	Bad	6 (13.0)
Total admission frequency (times)	0	10 (21.7)	7.7 ± 8.79
	1~5	15 (32.6)
	6~10	11 (23.9)
	>10	10 (21.7)
Admission duration (week)	<2	16 (34.8)	3.1 ± 16.52
	2~4	17 (37.0)
	>4	13 (28.3)
A day using the smartphone, games, internet and so on at home (hour)	<4	21 (45.7)	4.7 ± 2.68
	4~7	18 (39.1)
	≥ 8	7 (15.2)
Bedtime using the smartphone, games, internet and so on at home (hour)	<1	27 (58.7)	1.6 ± 1.64
	1~2	11 (23.9)
	≥ 3	8 (17.4)
A day using the smartphone, games, internet and so on at hospital (hour)	<4	9 (19.5)	6.5 ± 2.88
	4~7	20 (43.5)
	≥ 8	17 (37.0)
Bedtime using the smartphone, games, internet and so on at hospital (hour)	<1	22 (47.8)	1.9 ± 2.23
	1~2	18 (39.1)
	≥ 3	6 (13.0)

AML= Acute myeloblastic leukemia; ALL= Acute lymphoblastic leukemia; HSCT= Hematopoietic stem cell transplantation.

Table 2

Sleep Quality before and after Admission (N=46)

Variable	Before	After	t (p)
Variable	M ± SD	M ± SD	t (p)
Sleeping depth	7.39 ± 1.94	6.91 ± 2.21	1.58 (.121)
Rising feel	6.61 ± 2.28	6.13 ± 2.48	1.33 (.192)

Before= at home; After= at hospital.

Table 3

Sleep Pattern before and after Admission by Pittsburgh Sleep Quality Index (N=46)

Variables^*	Before	After	t (p)
Variables^*	M ± SD	M ± SD	t (p)
Sleep quality	1.43 ± 0.54	1.62 ± 0.67	−1.98 (.052)
Sleep disturbances	1.00 ± 0.52	1.37 ± 0.61	−3.89 (＜.001)
Daytime dysfunction	1.15 ± 0.47	1.35 ± 0.57	−2.03 (.048)
Sleep latency	1.17 ± 1.08	0.98 ± 0.95	1.42 (.162)
Sleep efficiency	0.30 ± 0.66	0.50 ± 0.83	−1.20 (.237)
Sleep duration	0.37 ± 0.71	0.30 ± 0.66	0.48 (.636)
Medication use	0.00 ± 0.00	0.15 ± 0.47	-2.20 (.033)
Global PSQI score	5.43 ± 2.65	6.30 ± 3.18	−1.83 (.074)

^*Possible range of components (0~3) and global score (0~21); Before= at home; After= at hospital; PSQI= Pittsburgh Sleep Quality Index.

Table 4

Sleep Disturbing Factors before and after Admission (N=46)

Factors^*		Before	After	t (p)
Factors^*		M ± SD	M ± SD	t (p)
Physical score	Using toilet	1.78 ± 1.01	2.85 ± 1.38	−5.09 (<.001)
	Vital sign check	1.28 ± 0.58	2.17 ± 1.14	−4.90 (<.001)
	Nausea or vomiting	1.48 ± 1.07	2.02 ± 1.42	−2.48 (.017)
	Pain	1.65 ± 1.02	1.93 ± 1.18	−1.39 (.171)
	Taking a nap	1.96 ± 0.97	1.93 ± 1.04	0.14 (.893)
	Central vein catheter	1.33 ± 0.67	1.91 ± 1.01	−3.60 (.001)
	Changing sleeping habit	1.52 ± 1.01	1.78 ± 1.07	−2.01 (.050)
	Using smartphone	1.80 ± 1.11	1.78 ± 0.99	0.13 (.901)
	Fatigue	1.70 ± 0.99	1.76 ± 1.08	−0.57 (.569)
	Motion restriction	1.65 ± 1.08	1.76 ± 1.08	−0.68 (.360)
	Fever	1.33 ± 0.76	1.54 ± 0.96	−1.75 (.806)
	Watching TV	1.50 ± 0.96	1.59 ± 0.83	−0.75 (.456)
	Subtotal	1.58 ± 0.52	1.92 ± 0.71	−4.30 (<.001)
Emotional score	Boredom of hospital living	1.39 ± 0.77	2.00 ± 1.19	−3.96 (<.001)
	Anxiety about academy or future	1.76 ± 1.10	1.74 ± 0.98	0.18 (.860)
	Strange circumstance and atmosphere	1.26 ± 0.77	1.65 ± 0.95	−3.20 (.003)
	Isn't acquainted with medical care and management	1.54 ± 0.84	1.65 ± 0.95	−0.78 (.498)
	Anxiety about a disease	1.33 ± 0.67	1.61 ± 0.93	−2.30 (.026)
	Bad dream	1.43 ± 0.69	1.39 ± 0.68	0.44 (.660)
	Medical fee troubles	1.26 ± 0.65	1.39 ± 0.71	−0.92 (.441)
	Fear of death	1.15 ± 0.52	1.22 ± 0.42	−0.68 (.497)
	Subtotal	1.39 ± 0.48	1.58 ± 0.62	−2.93 (.005)
Environmental score	Crying of other patients	1.63 ± 1.08	2.63 ± 1.40	−3.90 (<.001)
	Noises of snoring or grinding their teeth	1.50 ± 0.86	2.17 ± 1.25	−3.56 (.001)
	Communal room	1.35 ± 0.88	2.02 ± 1.20	−3.72 (.001)
	High or low temperature	1.50 ± 0.96	2.00 ± 1.08	−2.95 (.005)
	Inconvenience of sheet, pillow, clothes	1.41 ± 0.86	2.00 ± 1.16	−4.50 (<.001)
	Loudness of other patients or caregivers	1.50 ± 0.96	1.96 ± 1.23	−2.06 (.045)
	Loud-sounding call bell or machine alarm	1.33 ± 0.76	1.96 ± 1.12	−3.12 (.003)
	Sound of TV	1.28 ± 0.54	1.80 ± 1.03	−3.45 (.001)
	Noises of cleaning at dawn	1.26 ± 0.54	1.59 ± 0.88	−2.29 (.027)
	Lamp give a excessive light	1.37 ± 0.83	1.57 ± 0.86	−1.50 (.141)
	Rounding the medical team at night	1.33 ± 0.70	1.57 ± 0.81	−2.30 (.026)
	Noises of pushing a door or closing	1.28 ± 0.58	1.52 ± 0.78	−1.91 (.062)
	Noises of flushing the toilet	1.28 ± 0.58	1.46 ± 0.59	−2.07 (.044)
	Noises of clattering a wheel or dragging shoes	1.24 ± 0.52	1.43 ± 0.58	−2.93 (.005)
	Voices of people (doctor, nurse, of attendant)	1.17 ± 0.44	1.41 ± 0.65	−2.54 (.015)
	Subtotal	1.36 ± 0.55	1.81 ± 0.69	−4.14 (<.001)
Total		50.54 ± 16.32	62.78 ± 21.76	−4.59 (<.001)

^*Possible range of components (1~5) and Total score (35~175); Before= at home; After= at hospital.

Notes

This study received research fund support from the Catholic University of Korea Seoul St. Mary's Hospital.

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ORCID iDs

Jin Jung
https://orcid.org/0000-0002-6289-9264

Eun-Hye Lee
https://orcid.org/0000-0002-7298-0437

You-Jin Yang
https://orcid.org/0000-0001-9904-7818

Bo-Yoon Jang
https://orcid.org/0000-0003-2646-0825

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