MEASUREMENT OF NOCTURNAL SLEEP PATTERNS IN MULTISYSTEM TRAUMA PATIENTS.

Description

The purpose of this study was to determine the reliability and validity of a sleep perception tool and a sleep observation instrument for the trauma patient in a critical care setting as compared to the polysomnograph (PSG). The research investigated the relationship among the measures of (a) observed patient sleep, (b) patient perception of sleep, and (c) PSG sleep data on the three sleep traits of (a) sleep latency (SL), (b) mid-sleep awakening (MSA), and (c) wake after sleep onset (WASO). A purposive sample of 20 subjects between the ages of 18-45 years with multisystem trauma, without head injury, and able to provide informed consent participated in this study. Instruments used to measure PSG, observed, and perceived sleep were the Beckman Dynograph R-511A, the Patient's Sleep Behavior Observational Tool (Echols, 1968), and the Verran/Snyder Halpern (VSH) Sleep Scale. Data were collected on injury severity score, presence of pain, medications, monitoring equipment, and care related interruptions. Nocturnal sleep patterns were measured for one night. All night PSG was measured via continuous recording of electroencephalogram, electrooculogram, and electromyogram from the onset of the sleep cue to final waking. Nursing observation of sleep was recorded at 5 minute intervals on the Patient's Sleep Behavior Observational Tool. The patient completed the VSH sleep scale, a visual analogue scale, upon waking. A descriptive correlational design was used. Pearson product moment correlations for the three sleep methods and the three sleep traits were placed in a multitrait-multimethod matrix and analyzed for reliability, convergent validity and discriminant validity according to the criteria of Campbell and Fiske (1959). Findings supported observed WASO as a valid and reliable measure of trauma patients' sleep as compared to PSG (r =.59, p $<$.01). Observed WASO met all the criteria for reliability, convergent and discriminant validity. Reliability for the three instruments was.69-.96. Patient perception of sleep was not a valid measure of sleep compared to PSG. Conclusions suggested that nursing observation of sleep was valid and reliable for WASO alone. Further sleep measurement research and selective monitoring of trauma patients using observed WASO is indicated.

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