A Critical Review of Mindfulness Measures.

Background and Purpose: Mindfulness has been associated with many positive psychological benefits. It is usually measured by self-report, and there are numerous questionnaires available to measure mindfulness in this way. The purpose of this review is to offer a summary of the available self-assessment questionnaires for measuring mindfulness, their appropriate uses, and psychometrics. Methods: CINAHL, PubMed, and PsychINFO databases were queried along with hand searching reference lists based on the indicated criteria, including Mindfulness-Based Stress Reduction-related mindfulness measurement tools, based on self-report and designed for use in adults. Results: Fourteen tools, published between 2001 and 2021, were included in this review. The tools varied in their orientation and have been created to measure mindfulness as a state, trait, and process. Conclusions: There is a wide variety of available tools, and each conceptualizes mindfulness in a distinct way. Understanding these details is crucial to choosing the proper tool.

School Nurses' Reports on Reopening Roles, Practices, and Concerns During the COVID-19 Pandemic at the Start of the 2020-2021 School Year.

The COVID-19 pandemic has caused major disruptions to U.S. school systems since March 2020. To facilitate our understanding of how school nurses participated in school reopening and what support school nurses needed beginning the 2020-2021 school year during the COVID-19 pandemic, we conducted a national survey in late summer 2020. A sample of 747 school nurses from 43 states responded to an online survey about roles, practices, and concerns. Over one-third (36.9%) reported not being included in school reopening planning. Mitigation practices reported by respondents primarily included measuring temperatures of students before school (21.3%), mask wearing by students (79.9%), and 6 feet social distancing (76.7%). The respondents' greatest concerns were the educational impact on students with individualized education plans, parents sending children to school with COVID-19 symptoms, and the economic impact on families. Our results point to opportunities for greater school nurse involvement, improvements in practices, and measures to address school nurses' concerns.

Challenges of contact tracing in college students during COVID-19 pandemic.

Contact tracing is essential to help monitor and control the spread of the highly contagious COVID-19 virus. Many universities across the United States have developed and implemented contact tracing programs during the COVID-19 pandemic. In this viewpoint article, we characterized and reflected on the unique challenges of contact tracing in college students based on our extensive experience at a large urban private university. Three challenges of contact tracing were identified, including 1) contact tracers' difficulty building trust with students, 2) students' unwillingness to disclose information due to fear of consequences, and 3) students acting carelessly and not following guidelines. We made recommendations to address these challenges to enhance the practice of contact tracing to protect the health of this young adult population.

College students' motivations for using fitness related technology.

Objective: The purpose was to understand college students' motivations for the use and discontinued use of fitness related technology (FRT) in relation to their physical activity behaviors. Participants: Participants were undergraduate students (n = 22) who were eligible if they were between 18-24 years of age (emerging adulthood) and current or previous users of FRT. Methods: Qualitative descriptive design was used with semi-structured interviews conducted virtually. Thematic analysis was used to analyze the data. Results: Participants discussed four themes; (1) Motivations for physical activity, (2) Motivations for using FRT, (3) Social connection improves accountability for physical activity, and (4) The ups and downs of FRT goal setting and data display. Conclusions: Best practice guidelines need to be established for the use of FRT along with approaches to promote physical activity among this population. Additional research is needed to identify reasons for discontinuation of use and to develop potential interventions to promote sustained engagement with FRT.

Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a prevalent and debilitating condition that is significantly underdiagnosed. The majority of adults sleep with someone-a partner. Partners can play a significant role in the patient's OSA diagnosis. The goal of this work is to describe facilitators and barriers to OSA diagnosis as discussed by patients with OSA and their partners. METHODS: This was a qualitative secondary analysis with results drawn from 20 dyadic interviews, conducted 1 couple at a time, in 20 newly diagnosed adult patients with OSA and their partners. Qualitative interview data were analyzed using conventional content analysis. RESULTS: Facilitators of OSA diagnosis were partners pushing patients to seek care, patients actively seeking care, and care providers identifying the patient's risk of OSA. Barriers to OSA diagnosis were patients' lack of serious attention to symptoms, patients' negative perceptual framing of diagnosis and treatment of OSA, and poor coordination of health care services. CONCLUSIONS: We recommend engaging partners in the OSA diagnosis and developing educational and behavioral interventions to raise public awareness about OSA. It is important to educate clinicians on atypical presentations of OSA. Further investigation is needed to evaluate the impact of health care services on OSA diagnosis. CITATION: Ye L, Li W, Willis DG. Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners. J Clin Sleep Med. 2022;18(3):835-841.

Developing OurSleepKit: A Couple-focused mHealth Tool to Support Adherence to Positive Airway Pressure Treatment.

BACKGROUND AND AIM: Existing interventions promoting positive airway pressure (PAP) adherence focus only on the diagnosed individual, despite the fact that partners are often the most impacted by obstructive sleep apnea (OSA), and are delivered mostly by health professionals, with limited success. The goal of this work is to develop a prototype of OurSleepKit, a couple-focused mobile health (mHealth) tool to coach mutual engagement and promote adherence to PAP treatment. METHODS: We used an iterative participatory approach working with future end users of OurSleepKit to support the development of this prototype. We conducted a total of 14 semi-structured in-depth open-ended dyadic interviews with OSA patients and their partners. Phase 1 of the development was to inform key functions of an engaging tool. Phase 2 focused on developing functions to engage positive conversation in the dyad and obtained feedback for this initial prototype. RESULTS: The OurSleepKit prototype was developed and demonstrated high acceptability and engagement. Three key functions included periodic assessments based on developmental stages of PAP treatment, a Coaching Board which provides customized and dynamically updated support content - primarily brief story-telling videos featuring real-life couples' experiences - and timely tailored prompts (for action, learning, and conversation) through push notifications in the evening to facilitate positive conversation in the dyad and offer in-the-moment support for PAP use. CONCLUSIONS: Going beyond the traditional and prevailing view of PAP use as an individual phenomenon, OurSleepKit is a novel mHealth intervention engaging both the patient and partner holding great promise to promote PAP adherence.

Individualized sleep promotion in acute care hospitals: managing specific factors that affect patient sleep.

BACKGROUND: Improving sleep for hospitalized patients is an essential clinical need. Compared to the traditional "one-size-fits-all" interventions designed by clinicians for all patients, an individualized strategy engaging patients to identify salient sleep disruptors and seek their input how to address these disruptors are more likely to succeed. Followed by our work of developing the Factors Affecting Inpatient Sleep (FAIS) scale, in this report we developed a set of icons illustrating 14 common sleep disruptors on the FAIS scale, and proposed behavioral sleep promotion tips addressing each sleep disruptor. The set of icons and sleep promotion tips were built into the mobile health (mHealth) tool SLEEPKit, which was the start of our endeavor using mHealth technology to support individualized sleep promotion. METHODS: A participatory iterative approach including feedbacks from patients, family members, and clinicians was used to develop and refine the icons and sleep promotion tips. Focus groups were used to inform the initial development and to brainstorm for the refinement of the icons. Individual interviews with patients and clinicians were conducted to validate each version of the icons using a standardized Content Validity Index (CVI) on a 4-point Likert scale, and offered comments and suggestions for improvement. Strategies of sleep promotion were first identified by the literature review, and then enriched by the summary of data from our previous work. Focus groups were conducted in order to learn empirically if the sleep promotion tips on the current version were acceptable to both patients and clinicians, and how they could be improved. RESULTS: Six focus groups were conducted and achieved saturation in suggestions for improvement. A total of 5 patients and 3 family members who served on the Patient/ Family Advisory Council, and 42 nurses who served on the interdisciplinary professional practice committees participated in the focus groups. A total of 75 patients and 50 clinicians offered individual feedback and the CVI test for the icons. Successive two or four phases of iterative icon evaluation and refinement were carried out until the average CVI ratings for each icon achieved 3 and above. The sleep promotion tips were created to demonstrate a collaborative effort between patients and clinicians. To empower patients for bedside communication related to their sleep, examples of communication starters ("Try saying") were included in the tips for patients. CONCLUSIONS: By using the participatory iterative approach, these icons for common sleep disturbing factors were understandable by both patients and clinicians, and the sleep promotion tips were perceived to be feasible and effective in the acute care hospital setting. This work moved the individualized sleep promotion forward, and supported the development of a novel mHealth tool for inpatient sleep promotion tailored to individual patient's needs.

A Systematic Review of Sleep Measurement in Critically Ill Patients.

Background: Clinical trialists and clinicians have used a number of sleep quality measures to determine the outcomes of interventions to improve sleep and ameliorate the neurobehavioral consequences of sleep deprivation in critically ill patients, but findings have not always been consistent. To elucidate the source of these consistencies, an important consideration is responsiveness of existing sleep measures. The purpose of an evaluative measure is to describe a construct of interest in a specific population, and to measure the extent of change in the construct over time. This systematic literature review identified measures of sleep quality in critically ill adults hospitalized in the Intensive Care Unit (ICU), and assessed their measurement properties, strengths and weaknesses, clinical usefulness, and responsiveness. We also recommended modifications, including new technology, that may improve clinical usefulness and responsiveness of the measures in research and practice. Methods: CINAHAL, PubMed/Medline, and Cochrane Library were searched from January 1, 2000 to February 1, 2020 to identify studies that evaluated sleep quality in critically ill patients. Results: Sixty-two studies using polysomnography (PSG) and other electroencephalogram-based methods, actigraphy, clinician observation, or patient perception using questionnaires were identified and evaluated. Key recommendations are: standard criteria are needed for scoring PSG in ICU patients who often have atypical brain waves; studies are too few, samples sizes too small, and study duration too short for recommendations on electroencephalogram-based measures and actigraphy; use the Sleep Observation Tool for clinician observation of sleep; and use the Richards Campbell Sleep Questionnaire to measure patient perception of sleep. Conclusions: Measuring the impact of interventions to prevent sleep deprivation requires reliable and valid sleep measures, and investigators have made good progress developing, testing, and applying these measures in the ICU. We recommend future large, multi-site intervention studies that measure multiple dimensions of sleep, and provide additional evidence on instrument reliability, validity, feasibility and responsiveness. We also encourage testing new technologies to augment existing measures to improve their feasibility and accuracy.

The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea. An Official American Thoracic Society Workshop Report.

Continuous positive airway pressure (CPAP) remains the major treatment option for obstructive sleep apnea (OSA). The American Thoracic Society organized a workshop to discuss the importance of mask selection for OSA treatment with CPAP. In this workshop report, we summarize available evidence about the breathing route during nasal and oronasal CPAP and the importance of nasal symptoms for CPAP outcomes. We explore the mechanisms of air leaks during CPAP treatment and possible alternatives for leak control. The impact of nasal and oronasal CPAP on adherence, residual apnea-hypopnea index, unintentional leaks, and pressure requirements are also compared. Finally, recommendations for patient and partner involvement in mask selection are presented, and future directions to promote personalized mask selection are discussed.

Sleep and Memory: The Promise of Precision Medicine.

Given the complex and bidirectional nature of sleep and mild cognitive impairment/Alzheimer's disease and related dementias, a precision medicine approach to education, lifestyle changes, and early assessment in patients with a family history of snoring, sleep apnea, diabetes, and heart disease is warranted. Furthermore, a team-based approach allows for a coordinated precision diagnosis and management of common comorbid chronic illnesses. The significance of sleep disturbances in this population, contributing factors, assessment and diagnostic challenges, common sleep disorders and mechanisms, tailored behavioral and pharmacologic interventions, knowledge gaps, and future research ideas are discussed.

Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.

BACKGROUND/AIM: One major challenge of inpatient sleep promotion is that there is no "one-size-fits-all" intervention as patients' sleep may be bothered by different factors. A tool evaluating factors that disturb patient sleep is greatly needed as a foundation for generating a personalized action plan to address the patient's specific need for sleep. Unfortunately such tools are currently unavailable in clinical practice. In this study we developed and psychometrically evaluated a brief assessment tool for sleep disruptors important for hospitalized patients, the Factors Affecting Inpatient Sleep (FAIS) scale. METHODS: The FAIS items were developed by literature review and validated by content validity testing. A survey collected from 105 hospitalized patients was used to select the most significant sleep disruptors. Psychometric evaluation using survey data included item analysis, principal components analysis, and internal consistency reliability. RESULTS: The final FAIS scale included 14 items in three subscales explaining 56.4% of the total variance: 1) emotional or physical impairment due to illness or hospitalization; 2) sleep disturbance due to discomfort or care plan schedule; 3) sleep interruption due to hospital environment or medical care. The Cronbach's alpha coefficient for the FAIS scale was 0.87, and the reliability of the subscales ranged from 0.72 to 0.81. CONCLUSION: The FAIS is a brief tool assessing sleep disruptors important for patients, and is empirically grounded, judged to have content validity, and has demonstrated psychometric adequacy. The FAIS scale can be used to guide the development of an individualized patient-centered sleep promotion plan.

Sleep and Long-Term Care.

Long-term care (LTC) involves a range of support and services for people with chronic illness and disabilities who can not perform activities of daily living independently. Poor sleep increases the risk of LTC placement, and sleep disturbance is extremely common among LTC residents. The identification and management of sleep disturbance in LTC residents is a vital, but perhaps underappreciated, aspect of offering high-quality care for this already compromised population. This review describes the nature and consequences of sleep disturbances in LTC, clinical assessment and management of sleep disturbances in LTC, and implications for future research and clinical practice.

Changing Faces of Obstructive Sleep Apnea: Treatment Effects by Cluster Designation in the Icelandic Sleep Apnea Cohort.

Study Objectives: Distinct clinical phenotypes of obstructive sleep apnea (OSA) have been identified: Disturbed Sleep, Minimally Symptomatic, and Sleepy. Determining whether these phenotypes respond differently to standard treatment helps us to create a foundation for personalized therapies. We compared responses to positive airway pressure (PAP) therapy in these clinical OSA phenotypes. Methods: The study sample included 706 patients from the Icelandic Sleep Apnea Cohort with moderate-to-severe OSA who were prescribed PAP. Linear and logistic mixed models were used to compare 2-year changes in demographics, comorbid diseases, and sleep-related health issues within and across OSA clinical phenotypes. Relationships between changes in symptoms and PAP adherence were also examined. Results: Overall, effect sizes were moderate to large when comparing sleepiness, insomnia-related, and apneic symptom changes in the Sleepy group with changes in other two groups, especially those in the Minimally Symptomatic group. Within the Disturbed Sleep group, PAP users and nonusers demonstrated similar changes in insomnia-related symptoms. The Minimally Symptomatic group remained relatively asymptomatic, but reported significant decreases in daytime sleepiness and physical fatigue; PAP users generally had larger improvements. The Sleepy group had reductions in nearly all measured symptoms, including large reductions in drowsy driving; almost all of these improvements were greater among PAP users than nonusers. Conclusions: OSA treatment response patterns differed by initial clinical phenotype and PAP adherence. Individuals with insomnia-related symptoms may require additional targeted therapy for these complaints. These findings underscore the need for a personalized approach to management that recognizes patients with a range of OSA presentations.

Couples' experiences with continuous positive airway pressure treatment: a dyadic perspective.

OBJECTIVE: The majority of adults sleep with a partner, making sleep a dyadic experience. However, interventions to improve sleep have primarily focused on individuals. This qualitative analysis used a dyadic approach to identify facilitators and barriers to successful treatment of one of the most common sleep disorders, obstructive sleep apnea, with continuous positive airway pressure (CPAP). METHODS: Twenty joint qualitative interviews were conducted with couples, one couple at a time, with a sample of 20 patients with obstructive sleep apnea and their partners to develop an understanding of couples' experiences with CPAP use. Interviews were audio recorded and transcribed. Conventional qualitative content analysis was used to analyze the interview data. RESULTS: Facilitators of CPAP use were the following: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use. Major barriers to CPAP use were the following: anxiety related to CPAP use particularly in the beginning of therapy, bothersome equipment causing disruptions in sleep and bedtime routine, interruptions to intimacy, and concern about image change while wearing CPAP. CONCLUSIONS: Findings from this study suggest that couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence. Further research evaluating the potential of couple-focused interventions to improve sleep health is warranted.

Developing and Testing a Sleep Education Program for College Nursing Students.

BACKGROUND: The need to educate the future nursing workforce to increase understanding of healthy sleep practices, adverse health consequences of impaired sleep, and common sleep disorders is pressing. Unfortunately, education about sleep and sleep disorders has not been part of established undergraduate nursing curricula. METHOD: This study developed a sleep education program for college nursing students and tested its effect on knowledge about sleep and sleep disorders. RESULTS: With a total time commitment of 10 hours, this program included three sequential components: traditional in-classroom teaching, guided online virtual self-learning, and interactive simulation-based discussion. This innovative education program was implemented in a core course offered to senior nursing students in spring 2013, and demonstrated its effectiveness in improving knowledge about sleep and sleep disorders. CONCLUSION: Translating into undergraduate nursing curriculum, it will lay a foundation for improving health care of patients and decreasing the health risks of nurses as care providers.

Napping in college students and its relationship with nighttime sleep.

UNLABELLED: Abstract. OBJECTIVE: To examine the habit of napping and its relationship with nighttime sleep in college students. PARTICIPANTS: Four hundred and forty undergraduate students who responded to an anonymous online survey in April 2010. METHODS: Three questions were asked to determine the frequency, length, and timing of napping during the past month. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The PSQI score significantly differed among self-reported nap-frequency (p=.047) and nap-length (p=.017) groups, with those who napped more than 3 times per week and those who napped more than 2 hours having the poorest sleep quality. Students who napped between 6 and 9 pm had shorter sleep on school nights compared with students in other nap-timing groups (p=.002). CONCLUSIONS: College students who are self-reported frequent, long, and late nappers may have a higher risk of poor nighttime sleep quality and more severe sleep deprivation.

Spousal involvement and CPAP adherence: a dyadic perspective.

Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention. Developing understanding of the role of spouses in adherence to CPAP has been identified to be a critical research need. This review expands the investigation of CPAP adherence to a broader context, from an exclusive focus on individual patients to a dyadic perspective encompassing both patients and their spouses. A conceptual framework based on social support and social control theories is proposed to understand spousal involvement in CPAP adherence. Methodologies for future investigations are discussed, along with implications for developing interventions that engage both patients and their spouses to improve CPAP use.

The different clinical faces of obstructive sleep apnoea: a cluster analysis.

Although commonly observed in clinical practice, the heterogeneity of obstructive sleep apnoea (OSA) clinical presentation has not been formally characterised. This study was the first to apply cluster analysis to identify subtypes of patients with OSA who experience distinct combinations of symptoms and comorbidities. An analysis of baseline data from the Icelandic Sleep Apnoea Cohort (822 patients with newly diagnosed moderate-to-severe OSA) was performed. Three distinct clusters were identified. They were classified as the "disturbed sleep group" (cluster 1), "minimally symptomatic group" (cluster 2) and "excessive daytime sleepiness group" (cluster 3), consisting of 32.7%, 24.7% and 42.6% of the entire cohort, respectively. The probabilities of having comorbid hypertension and cardiovascular disease were highest in cluster 2 but lowest in cluster 3. The clusters did not differ significantly in terms of sex, body mass index or apnoea-hypopnoea index. Patients with OSA have different patterns of clinical presentation, which need to be communicated to both the lay public and the professional community with the goal of facilitating care-seeking and early identification of OSA. Identifying distinct clinical profiles of OSA creates a foundation for offering more personalised therapies in the future.

Inpatient pharmacological sleep aid utilization is common at a tertiary medical center.

BACKGROUND: Sleep is known to be poor in the hospital. Patients frequently request pharmacological sleep aids, despite the risk of altered mental status (delirium) and falls. Little is known about the scope of pharmacological sleep aid use in hospitalized patients. METHODS: We performed a single center, retrospective review of all patients admitted to the general adult (age >18 years) medical and surgical units of a tertiary care center during a recent 2-month period (January 2013-February 2013). Review of the electronic medication administration system was performed to assess for medications administered for sleep. RESULTS: Of 642 unique admissions, 168 patients (26.2%) received a medication for sleep. Most (n = 115, 68.5%) had no known history of insomnia or regular prior sleep medication use. Patients most frequently were treated with trazodone (30.4%; median dose, 50 mg; range, 12.5-450 mg), lorazepam (24.4%; median, 0.5 mg; range, 0.25-2 mg), and zolpidem tartrate (17.9%; median, 10 mg; range, 2.5-10 mg). Of the medications given, 36.7% were given early (before 9 pm) or late (after midnight). Of patients not known to be previously taking a pharmacological sleep aid, 34.3% of them were discharged with a prescription for one. CONCLUSIONS: Despite increasing evidence of risks such as delirium or falls, pharmacological sleep aid use in general wards remains common, even in elderly patients. Medication administration time is frequently suboptimal. Many previously sleep medication-naïve patients leave the hospital with a sleep aid prescription. Further research is needed to understand the factors that contribute to the high rate of sleep medication use in hospitalized patients.

How do clinicians assess, communicate about, and manage patient sleep in the hospital?

OBJECTIVE: The objective of this study was to characterize how clinicians assess, communicate about, and manage patient sleep, with the focus on identifying existing barriers and facilitators to sleep promotion in clinical practice. BACKGROUND: Sleep is a critical need for improving for hospitalized patients. METHODS: Content analysis was used to interpret descriptive data from 4 group interviews with a total of 62 clinicians. RESULTS: Clinicians reported they did not formally assess for patient sleep, which led to largely unmanaged sleep disruption during hospitalization. Major barriers to effective sleep management were limited understanding of the importance of sleep, lack of a standardized tool for assessment, and inadequate communication. Facilitators included collaborative communication with patients and the healthcare team and customized patient-centered interventions. CONCLUSIONS: It is critical to inform clinicians on the importance of sleep, to standardize sleep assessment, and to facilitate collaboration among caregivers to promote sleep for hospitalized patients.