Pflegebezogene Assessmentinstrumente - Internationales Handbuch für Pflegeforschung und -praxis
von: Bernd Reuschenbach, Cornelia Mahler
Hogrefe AG, 2020
ISBN: 9783456960623
Sprache: Deutsch
632 Seiten, Download: 12306 KB
Format: PDF, auch als Online-Lesen
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Pflegebezogene Assessmentinstrumente - Internationales Handbuch für Pflegeforschung und -praxis
7. Sleep-Assessment
Christine Hedges, Jeanne S. Ruggiero and Nancy S. Redeker Deutsche Übersetzung s. S. 505; 509 – 526.
7.1 Introduction
Measurement of human sleep is important to both research and clinical practice. Its importance has grown as the relevance of sleep and sleep disorders to human health and functioning has become increasingly recognized. Critical to the choice of sleep measurement strategies is a detailed understanding of the attributes of this multidimensional biobehavioral phenomenon and consistency of indicators and measurement strategies with these characteristics.
Sleep is a recurring state that has circadian (about a day), infradian (longer than a day), and ultradian (shorter than a day) cycles and has been conceptualized from physiological, behavioral, and perceptual perspectives. It includes two primary physiological states that differentiate it from wake: rapid eye movement sleep (REM), characterized by musculoskeletal atonia and variability in the EEG, neurological, and cardiorespiratory systems; and non-rapid eye movement sleep (NREM), characterized by slowing of the EEG and decreased rate and depth of respiration and heart rate. Physiological measurement of sleep using polysomnography may include evaluation of associated physiological processes (e. g., heart rate, oxygen saturation, gastric pH). From a behavioral perspective, sleep is characterized by closed eyelids, recumbent body posture, decreased responsiveness to environmental stimuli, motility and muscular activity and voluntary activity compared with wake. Perception of sleep state, as reported by the sleeper, represents the individual’s point of view about the quality or quantity of sleep and may not always correspond with objective attributes of sleep.
Sleep has quantitative, qualitative, and temporal aspects that can be measured by both self-report and objective measures. The importance of various attributes is determined by the need to evaluate the extent to which sleep patterns deviate from normal or typical sleep patterns. Quantitative measures include the duration of total daily sleep, nocturnal sleep, and napping.
Temporal aspects of sleep are the timing of sleep during the 24 hour day and progression of these patterns over time. Sleep latency is usually defined as the duration of time from lights out to sleep onset. Sleep continuity reflects the extent to which the sleep period is fragmented by awakenings, EEG arousals, or changes to lighter sleep stages. Indicators of sleep continuity include number and duration of awakenings or arousals, sleep efficiency, and proportion of wake time after sleep onset. Frequency of sleep stage changes measured by polysomnography may also indicate sleep continuity. Qualitative evaluation of sleep may include the sleeper’s perception of overall sleep quality or sleep disturbance. Consequences, such as sleepiness or satisfaction with sleep may also be of interest.
7.2 Choice of sleep measurement
Objective measures include polysomnography (EEG, EMG, EOG), direct behavioral observation, and wrist actigraphy (direct measure of physical activity). Perceptual measures are self-report questionnaires and sleep diaries or sleep logs that are delivered in several formats. Also of relevance to sleep evaluation are measurements of excessive daytime sleepiness and attitudes or behaviors related to sleep. However, these measures should not be confused with measurements of sleep itself. Recent advances also have enabled objective measurement of sleep using ambulatory polysomnographic and actigraphic methods.
Choice of a strategy for sleep measurement should be determined primarily by the sleep attributes of interest and temporal considerations, such as the duration and frequency of measurement, and the need for realtime vs. retrospective (recall) data. The nature of the study population (developmental and health states), sleep environment (home, health care facility, laboratory), the need for ecological validity, and available human and material resources are important considerations.