@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2015;7(3):127-132

Background
… [1-11] Persons’ quality of life and their activities are mainly affected by the sleep quality. Sleep, also, affects the immune system of body [12]. … [13] Unfavorable sleep quality leads to daily drowsiness, mood changes, and risk of drug consumption [14].
Previous Studies
The most prevalent sleep disorders are breath problems and foot frequent movements [15], as well as insomnia, snoring, late sleeping, and early getting up [16], hugely affecting the rehabilitation process in patients with spinal cord injury. … [17]
Aim(s)
The aim of this study was to determine the sleep quality of patients with spinal injuries.
Research type
This is a cross-sectional descriptive-analytic study.
Research society, place and time
Patients with spinal injuries referred to Khatamolanbia Hospital (Tehran; Iran) for periodical visits were studied in 2014.
Sampling method and number
Using Cochran formula, 100 patients willing to participate in the study were selected through Simple Random Method. The inclusion criteria were informed consent to participate in the study, no variable work shift, no psychological diseases, delirium, Alzheimer, and mental retardation.
Used devices&materials
The study tool was 2-section Pittsburgh Sleep Quality. The first section includes patients’ demographic characteristics (12 questions) and the second one is about patients’ mental quality of sleep. Totally, the questionnaire investigates 7 items including mental quality of sleep, sleep delay, sleep length, beneficial sleep, sleep disorders, hypnotic drugs consumption, and daily activities disorders. Each question receives a score between zero and 3, and finally, 7 items receive scores between zero and 21 [7].Its credibility for Iranian population has been confirmed with 0.89 Cronbach’s Alpha [18]. Data was analyzed, using SPSS 19 software, Descriptive Statistics (Mean and Standard Deviation), and Inferential Statistics (Independent T, ANOVA, and Pearson Correlation Coefficient).
Findings by Text
Most of the subjects were male, married, and veteran with a high school diploma. Most of them were working 5-8 hours a day (mean work time 5.5±1.2hours). Mean age of the subjects was 37.00±10.14years, and age range of most of them was between 21 and 40 years. Most of them consumed hypnotic medications, most of which were of Benzodiazepine Group (Lorazepam, diazepam, and clonazepam). 93% of the subjects, 32% of the subjects, and 4% of the subjects consumed tea, coffee, and alcohol, respectively. And 11% of the subjects were smoking. Their mean BMI was 32.68±8.24kg/m², and their mean neck circumference was 39.36±4.64cm (Table 1). Mean total score of sleep quality of patients with spinal cord injuries was 11.90±2.35 (12.18±2.46 in male persons and 10.70±1.89 in female persons). In male subjects, sleep disorders and mental quality of sleep were the most prevalent items. In female subjects, mental quality of sleep and delay to asleep were the most prevalent items. Totally, the most and the least prevalent items were sleep disorders and daily activities disorders, respectively (Table 2). There were significant differences between sleep quality scores in the patients based on gender, marital status, BMI, underlying diseases, and neck circumference, in such a case that the sleep quality of male, married, and obese patients with diabetes and blood pressure and with neck circumference more than 40cm was lower. Nevertheless, there was no significant difference based on the injury level, age, occupation, and daily work time.
Main comparison to the similar studies
The sleep quality of all the subjects (100%) was not good, and all subjects received more than 5 scores in Pittsburgh Questionnaire. Unfavorable sleep quality in patients with spinal injuries is 38% [7], and in medical students, it is 40% [19], which are inconsistent with the present result. Unfavorable sleep quality percentages in male patients with heart systolic failure, veterans with chemical injuries, the nurses, the students, patients with heart failure, and the dialysis patients are 100%, 93%, 90%, 86%, 81%, and 80%, respectively [11, 20-23]. The results are consistent with the present results. Mean score of sleep quality of patients with spinal injuries was 11.90±2.35. Mean scores of sleep quality in veterans with chemical injuries, male patients with heart systolic failure, nursing students, and the elderly are 11.73, 13.24, 14.16, and 16.16, respectively [12, 22, 24, 25]. The most prevalent items in the male subjects were sleep disorders and mental quality of sleep. And the most prevalent items in the female persons were mental quality of sleep and sleep delay. Totally, the most and the least prevalent items were sleep disorders and daily activities disorders, respectively. In male and female persons, sleep length and beneficial sleep are higher, respectively. In addition, in the nursing students, the most and the least prevalent items are sleep delay and consumption of hypnotic medications, respectively [24]. There is sleep disorder in all veterans with chemical injuries (100%) [12], which is consistent with the present results. Mean length of the interval between going to bed and sleeping in patients with spinal injuries was 29min. The length is 32.30min [12]. There were differences between male and female subjects in sleep delay, sleep length, sleep disorders, and hypnotic medications consumption. There are significant differences between male and female persons in mental quality of sleep, sleep delay, sleep length, and beneficial sleep [24]. There was a significant difference between the scores of sleep quality in men (12.18±2.46) and women (10.70±1.89). There is a significant difference between men and women in sleep quality [24], which is consistent with the present results. However, the results are not consistent with some other studies showing no significant difference between two genders in the mean score of sleep quality [7, 19, 20, 26]. There was lower sleep quality in married subjects. There is lower sleep quality in married students [19]. There was a significant correlation between sleep quality and BMI in the patients, and there was worse sleep quality in patients with BMI more than 30. There was a correlation between neck circumference and unfavorable sleep quality, and there was worse sleep quality in patients with neck circumference more than 40cm. An increase in weight leads to worse sleep quality, which confirms the present result. Nevertheless, in some other studies, BMI is not identified as a predictor of sleep quality [19, 22]. Underlying diseases like diabetes and blood pressure led to worse sleep quality. There is worse sleep quality in patients with diabetes and high blood pressure [27-29]. There were not significant correlations between sleep quality and age, injury level, education level, occupation, and daily work time. There is not a significant correlation between injury level and sleep quality [7]. Age does not affect sleep quality of the hospitalized patients [30]. However, there is worse sleep quality in the older drivers [31]. Elderly and low education level affects unfavorable sleep quality, while occupation does not have such an effect [29]. … [31]
Suggestions
Studies with greater sample size in other environments and more female and quadriplegic patients should be done. Studies through polysomnography should be done in the sleep laboratory.
Limitations
Small female number and most patients with paraplegia were of the limitations for the study.
Conclusions
Sleep disorders and worse and unfavorable sleep quality are hugely prevalent in patients with spinal injuries.
Acknowledgments
Manager and Educational and Research Committee of Khatamolanbia Hospital and the participants are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
Research Committee of Khatamolanbia Hospital confirmed the study. The patients participated voluntarily and they were assured of ineffectiveness of the study on their treatment process.
Funding Sources
Education and Research Committee of Khatamolanbia Hospital funded the study.

TABLES and CHARTS

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