OriginalPsychometric evaluation of the Freedman questionnaire to assess sleep in critical patientsEvaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico☆
Introduction
Sleep is a basic necessity that modulates the immune system, regulates homeostasis, and improves some cognitive functions; moreover, it contributes to the adjustment of physiological functions through hormonal secretion and anabolic stimulation.1, 2
At intensive care units (ICU), due to their characteristics and the high severity of their patients’ conditions, there are more sleep alterations, and patients suffer from both qualitative and quantitative deprivations.3 Studies conducted on the incidence of sleep alteration in the critically ill patient report a prevalence of 22% to 61%. Sleep pattern alterations are observed in the critically ill patient and they consist in a predominance of the stage N1 – light sleep and stage N2 – muscle tone reduction of the sleep cycle with a decrease or absence of stages N3-deep, restorative sleep, and REM sleep. The patients often experience awakenings, a high index of arousal, and periods of daytime sleep (40%–50% of the sleep can occur during the day)4, 5, 6; patients rarely complete a full sleep cycle.7, 8
Assessing the sleep of patients admitted at the ICU is a complex process,9, 10, 11 and this situation requires tools to evaluate it objectively; but these tools like polysomnography and actigraphy are not available in all ICUs. They also require trained researchers for their interpretation. That is why, in order to assess sleep and the factors that interrupt it, there is the alternative of assessment through subjective methods based on questionnaires. This process is less expensive. In contrast, questionnaires, even when they have been validated through comparison with objective evaluation methods, they have not been submitted for psychometric studies.12, 13, 14
These psychometric studies assess the characteristics that every measuring tool should have, which necessarily includes controlling its precision by studying its reliability and validity. Validity refers to the degree to which the tool measures what it intends to measure; reliability refers to the trustworthiness conferred to the data obtained from it and it is associated with the internal coherence or consistency and precision of the measures collected.15 The objective of the present study is to assess whether the modified Freedman questionnaire is suitable, due to its psychometric characteristics, for sleep assessment in critically ill patients.
Section snippets
Design of the study
Psychometric study conducted at the Intensive Medicine Service (IMS) of the Hospital General Universitario de Castellón, Spain. It is a multipurpose ICU including 15 beds and 1 intermediate care unit with 6 beds. The reliability, stability, and validity of the construct and content were assessed.
Participants
Patients admitted to the IMS during the study period from February 23, 2016 through December 20, 2017. Work was conducted with a convenience sample that included the patients that met the inclusion
Results
A sample of n = 129 patients was analyzed. The mean age was 60.61 ± 13.88 years, range (25-85); 62% were males. The mean stay of the period were 10.31 ± 14.41 days, range (3–117). Regarding the reason for ICU admission, 46.5% was for medical reasons, 23.3% for postoperative reasons, 18.6% due to coronary disease, and 11.6% for traumatic reasons.
The results of exploring the validity of the content of the questionnaire from the answers given by members of the expert group to the questions of variable
Discussion
The Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) proposes a series of recommendations to improve safety and quality of clinical practice in critically ill patients. We should mention here that, regarding the issue at hand, the Sedation, Analgesia, and Delirium Working Group at SEMICYUC gives great importance to facilitating sleep and controlling environmental stimuli during the night. Sleep control and evaluation, together with other recommendations, are
Conclusions
The results of this study indicate that the Freedman questionnaire modified by Gómez Sanz shows good psychometric characteristics, which leads us to think that it can turn out to be a reliable tool to evaluate the quality of sleep in the ICU patient with a RASS between −1 and +1, as well as the environmental and human factors that can interfere with sleep.
Funding
This study has received no public or private funding whatsoever.
Conflicts of interest
None reported.
References (27)
- et al.
Sleep promotion in the intensive care unit. A survey of nurses’ interventions
Intens Crit Care Nurs
(2011) - et al.
Nurse's perceptions of sleep in the intensive care unit environment: a literature review
Intens Crit Care Nurs
(2014) Calidad del sueño de los pacientes ingresados en una Unidad de Cuidados Intensivos
Enferm Intensiva
(2013)- et al.
A note on the use of the intraclass correlation in the evaluation of agreement between two methods of measurement
Comput Biol Med
(1990) - et al.
Recomendaciones de “no hacer” en el tratamiento de los pacientes críticos de los grupos de trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
Med Intens
(2018) - et al.
Recomendaciones para el tratamiento de los pacientes críticos de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
Med Intens
(2017) - et al.
Sleep: a health imperative
Sleep
(2012) - et al.
El sueño en el paciente hospitalizado en una unidad de cuidados intensivos
Investig Enferm Imagen Desarro
(2014) - et al.
Sleep disturbances in critically ill patients in ICU: how much do we know?
Acta Anaesthesiol Scand
(2012) - et al.
Sleep in the Intensive Care Unit
Am J Respir Crit Care Med
(2015)
Calidad de sueño de los pacientes ingresados en UCI: relación con estresantes ambientales
Enferm Docente
Factors affecting sleep quality of patients in intensive care unit
J Clin Sleep Med
Factors influencing patients’ sleep in the intensive care unit: perceptions of patients and clinical staff
Am J Crit Care
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Please cite this article as: Bernat Adell MD, Bisbal Andrés E, Galarza Barrachina L, Cebrián Graullera G, Pages Aznar G, Melgarejo Urendez A, et al. Evaluación psicométrica del cuestionario Freedman para la valoración del sueño en el paciente crítico. Med Intensiva. 2020;44:344–350.