Perception of Sleep Disturbances due to Bedtime Use of Blue Light-Emitting Devices and Its Impact on Habits and Sleep Quality among Young Medical Students

Introduction. The use of blue light-emitting devices (smartphones, tablets, and laptops) at bedtime has negative effects on sleep due to light stimulation and/or problematic excessive use. We aimed to evaluate, among young medical students, if the perception of sleep disturbances due to bedtime use of these devices is consistent with healthier habits and a better sleep quality. Materials and methods. 294 medical students in medicine and pharmacy from the Faculty of Medicine and Pharmacy of Rabat, Morocco, took part in this anonymous and voluntary cross-sectional study and answered an electronic questionnaire. Student and Mann–Whitney U tests were used to compare variables between 2 groups based on their perception of sleep disturbances. The level of significance was p≤0.05. Results. 286 students (97.3%) used a blue light-emitting smart device at bedtime before sleep, and sleep quality was poor (Pittsburgh Sleep Quality Index, PSQI > 5) in 101 students (35.3%). The perception of sleep disturbances due to this night usage was reported by 188 of them (65.7%). In this group, 154 (81.9%) used their device with all the lights turned off in the room (p=0.02), 34 (18.1%) put devices under pillows (p=0.04), 114 (60.6%) interrupted sleep to check messages (p<0.001), and the mean duration use of these technologies at bedtime was 2 h ± 23 min per night (p=0.02). Also, the mean sleep duration was 6.3 hours ± 1.25 (p=0.04), 119 (63.3%) presented fatigue on waking more than one time per week (p=0.04), and 76 (40.4%) presented poor sleep quality (75.2% of the students with PSQI > 5) (p=0.005). Conclusions. Despite the perception of sleep disturbances due to bedtime use of blue light-emitting devices, unhealthy sleep habits tend to be frequent in young medical students and worrying because it is associated to significant poor sleep quality.

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POS0159-HPR IMPACT OF SLEEP DISTURBANCES ON ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.408 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 292.1-292

Author(s):

M. Sellami ◽

O. Hamdi ◽

S. Miladi ◽

A. Fazaa ◽

L. Souabni ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Elderly Patients ◽

Sleep Quality ◽

Disease Activity ◽

Functional Status ◽

Sleep Disturbances ◽

Tender Joint Count ◽

Poor Sleep ◽

Poor Sleep Quality ◽

The Mean

Background:Sleep disturbances have been reported in various rheumatic diseases especially in the elderly. It may be caused by pain and depressive mood. However, reports on the impact of sleep problems in rheumatoid arthritis (RA) activity and functional status were limited.Objectives:To assess sleep quality in elderly patients with RA and its impact on disease activity and functional status.Methods:This cross-sectional study included 70 RA patients aged ≥ 65 years fulfilling the ACR/EULAR criteria. Sociodemographic data were collected. RA activity was assessed with the Disease Activity Score (DAS28) and functional status with the Health Assessment Questionnaire (HAQ). Sleep quality was assessed using Arabic translated versions of two indexes: the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). An ISI score of [8-14], [15-21], and [22-28] determined respectively mild, moderate, and severe insomnia. A PSQI score > 5 determined poor sleep quality. ANOVA test was used to assess the relationship between DAS28 erythrocyte sedimentation rate (ESR), HAQ, and sleep quality indexes.Results:This study included 52 females and 18 males with a mean age of 68.3 ± 25 years [65-81]. Seventy percent of patients were married, 27% were widowed and 2% were divorced. Seventy-one percent of patients were illiterate, 18% had primary education and 11% had secondary education. Eighteen percent of patients were employed whereas 34.7% were retired. A history of depression was noted in 16.5% of patients. The mean duration of RA was 17.4 ± 5.2 years. Eighty-five percent of patients were on conventional synthetic DMARD whereas 15% were treated with biologic treatment. The mean patient’s global assessment of disease activity was 5.2 ± 1.3. The mean tender joint count and mean swollen joint count were 8 ±1.5 and 5 ±1 respectively. The mean DAS28 ESR was 4.7 ±0.9. The mean HAQ was 2.4 ± 0.45. Poor sleep quality was detected in 84% of cases according to the PSQI score. Mild insomnia was detected in 46% of cases, moderate insomnia in 34% of cases, and severe insomnia in 12% of cases. RA activity was higher in patients with poor sleep quality: the mean DAS28 ESR was 5.2 in patients with severe insomnia, 4.82 in moderate insomnia, and 4.13 in mild insomnia; p= 0.00 respectively. The mean ESR was 31.5 mm in patients with severe insomnia, 22.1 mm in moderate insomnia, and 10.6 mm in mild insomnia; p= 0.01 respectively. Furthermore, the higher the PSQI was, the higher DAS28 ESR is (p =0.01). However, no association was found between poor sleep quality and joint count, swollen joint count, CRP, and HAQ.Conclusion:Disease activity was a major contributor to poor sleep quality in elderly patients with RA. Functional status however wasn’t associated with insomnia. Physicians should include sleep in the clinical assessment of RA patients to improve their quality of life.Disclosure of Interests:None declared

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Association between Sleep Quality and Gastroesophageal Reflux in Medical Students

Middle East Journal of Digestive Diseases ◽

10.34172/mejdd.2021.217 ◽

2021 ◽

Vol 13 (2) ◽

pp. 139-144

Author(s):

Azam Teimouri ◽

Babak Amra

Keyword(s):

Medical Students ◽

Gastroesophageal Reflux ◽

Sleep Quality ◽

Sleep Disturbances ◽

Gastrointestinal Symptoms ◽

Cross Sectional Study ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Increased Risk

BACKGROUND Due to stressful occupational conditions, irregular dietary and sleep schedules, medical students are at increased risk of developing gastrointestinal disorders, gastroesophageal reflux (GERD) in particular, as well as sleep disturbances. Therefore, for the first time, we aimed to assess the correlation between GERD and sleep disturbances among medical students. METHODS The current cross-sectional study was done on 290 medical students at different study periods in Iran during 2018-2019. Age, sex, stage of studying, residence, and body mass index were gathered. The frequency scale for the symptoms of gastroesophageal reflux (FSSG) was utilized to assess gastrointestinal symptoms among them and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Eventually, the association of sleep disturbances with demographic factors and gastrointestinal symptoms was evaluated. RESULTS Living in the dormitory (p = 0.048; OR: 1.73; 95%CI: 1.01-2.99) and being overweight (p < 0.001; OR: 3.09; 95%CI: 1.58-6.06) were independently correlated with impaired sleep quality. GERD presented either by heartburn (p < 0.001) or regurgitation (p < 0.001) was associated with a lower quality of life. CONCLUSION GERD was correlated with poor sleep quality among medical students. In addition, residence in dormitory and being overweight were correlated with poor sleep quality.

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Sleep Quality in Semi-Professional Male Basketball Players in Bermuda

Caribbean Medical Journal ◽

10.48107/cmj2021.04.011 ◽

2021 ◽

Author(s):

Sharmella Roopchand-Martin

Keyword(s):

Sleep Quality ◽

Epworth Sleepiness Scale ◽

Quality Index ◽

Sleep Disturbances ◽

Pittsburgh Sleep Quality Index ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Basketball Players ◽

Ethical Approval ◽

The Mean

Objectives: This study sought to determine the quality of sleep using the Pittsburgh Sleep Quality Index (PSQI), the presence of sleepiness using the Epworth Sleepiness Scale (ESS) and the association between sleep quality and sleepiness in basketball players in Bermuda. Methods: Once ethical approval was granted, players were recruited from the Bermuda Basketball Association League. All participants completed the PSQI and the ESS questionnaires based on their recollection of events as they occurred over the previous 30 days. Their responses were analysed using the IBM SPSS version 19 for Windows. Results: A total of 71 subjects, mean age 24.96 ± 3.19 years, participated in this study. The mean PSQI score was 7.8 ± 4.7 (scores of 5 or more indicate poor sleep quality). Thirty percent of players rated their sleep quality as fairly bad to very bad. The mean sleepiness score was 7.35 ± 4.17 and over 60% of persons surveyed had more than normal levels of sleepiness. There was a significant correlation between sleep quality and sleepiness; 0.61 (p < 0.01), as well as a correlation between age and Global PSQI which had a score of 0.31 (p < 0.01). Conclusion: Basketball players in Bermuda are experiencing less than optimal sleep. Insomnia was among the most popular self-reported cause of sleep disturbances. Further research is required in this population, exploring causal factors for poor sleep quality. Key words: Athletes, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Sleep Quality.

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Quality of Sleep and Its Correlates among Yemeni Medical Students: A Cross-Sectional Study

Sleep Disorders ◽

10.1155/2021/8887870 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Bothaina Ahmed Attal ◽

Mohammed Bezdan ◽

Abdulwahab Abdulqader

Keyword(s):

Academic Performance ◽

Medical Students ◽

Sleep Quality ◽

Poor Sleep ◽

Quality Of Sleep ◽

Poor Sleep Quality ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Mean

Background. Sleep disturbance is particularly common among medical students worldwide and affects their wellbeing and academic performance. However, little is known about this issue in Yemen. This study looks at sleep quality and its association with personal and life-style factors and self-reported academic performance among medical students at the largest Yemeni university. Methods. A cross-sectional survey was conducted at Sana’a University, Yemen, in 2017. The Pittsburgh Sleep Quality Index (PSQI), consisting of 19 items and 7 components ( score range = 0 ‐ 3 ), was used to assess sleep quality. The summation of the components’ scores yields the global PSQI score ( range = 0 ‐ 21 ). A global PSQI value higher than 5 indicates poor quality of sleep. Logistic regression was applied to look at relationships. Results. 240 male (41%) and female (59%) medical students took part in the study with 54% being preclinical and 46% clinical with an average age of 23.3 years ( SD = 1.7 ). The mean global score (SD) was 6.85 (2.8), and 68% of the students ( N = 163 ) were identified as poor sleepers. The mean global PSQI score (SD) and proportion of poor sleepers were higher among males (7.7 (2.8) and 81%, respectively) than females (6.27 (2.42) and 59.2%, respectively), p ≤ 0.001 . Good sleep quality was more likely (OR (95% CI)) among females (3.4 (1.3-8.8)), the unmarried (2.8 (1-7.8)), those in good health (2.3 (1.1-4.5)), and nonkhat chewers (4.9 (1.4-17.1)). Nonsmokers were less likely to have good quality sleep compared to occasional smokers (0.185 (0.071-.485)). Stress (30%) and academic workload (21%) were the most commonly reported causes of poor sleep quality. Almost two-thirds of the students (65%) mentioned that disturbed sleep undermined their academic performance. Conclusions. Poor sleep quality is common among Sana’a medical students and impacts their academic performance. Specific stress management and sleep hygiene promoting programs should be incorporated early on in medical education.

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Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study

Global Psychiatry ◽

10.2478/gp-2019-0019 ◽

2019 ◽

Vol 2 (2) ◽

pp. 211-220

Author(s):

Ahmed Waqas ◽

Aqsa Iftikhar ◽

Zahra Malik ◽

Kapil Kiran Aedma ◽

Hafsa Meraj ◽

...

Keyword(s):

Social Support ◽

Depressive Symptoms ◽

Medical Students ◽

Sleep Quality ◽

Severe Depression ◽

Dental Students ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Medical And Dental Students

AbstractObjectivesThis study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample.MethodsThis observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a self-administered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression.ResultsIn total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P < 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress.ConclusionsAccording to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.

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Association between depression and sleep quality in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Sleep And Breathing ◽

10.1007/s11325-021-02405-0 ◽

2021 ◽

Author(s):

Rulan Yin ◽

Lin Li ◽

Lan Xu ◽

Wenjie Sui ◽

Mei’e Niu ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Sleep Quality ◽

Lupus Erythematosus ◽

Sleep Disturbances ◽

Cochrane Library ◽

Poor Sleep ◽

Moderate Correlation ◽

Systemic Lupus ◽

Poor Sleep Quality ◽

Subjective Sleep Quality

Abstract Background Currently, there is no consistent understanding of the relationship between depression and sleep quality in patients with systemic lupus erythematosus (SLE). This study aimed to explore the correlation between depression and sleep quality in SLE patients. Methods Five English (PubMed, Web of Science, EMBASE, Cochrane Library, and CINAHL) databases were systematically searched from inception to January 12, 2021. Two authors independently screened publications and extracted data according to set inclusion and exclusion criteria. Statistical analyses were performed with STATA 16.0. Data were pooled using a random-effects model. Results A total of 9 identified studies matched the inclusion criteria, reporting on 514 patients with SLE in the analysis. A moderate correlation of depression with sleep quality was found (pooled r = 0.580 [0.473, 0.670]). Compared to good sleepers, patients with SLE and poor sleep quality had higher levels of depression (standardized mean difference = − 1.28 [− 1.87, − 0.69]). Depression was associated with subjective sleep quality (r = 0.332 [0.009, 0.592]), sleep latency (r = 0.412 [0.101, 0.649]), sleep disturbances (r = 0.405 [0.094, 0.645]), daytime dysfunction (r = 0.503 [0.214, 0.711]), the four dimensions of Pittsburgh Sleep Quality Index (PSQI), while no significant correlation was found in the other three PSQI dimensions. Conclusion Depression had a moderate correlation with sleep quality in patients with SLE. Patients with poor sleep quality tended to have higher level of depression than that of good sleepers. Awareness of the correlation may help rheumatology physicians and nurses to assess and prevent depression and improve sleep quality in patients with SLE.

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Quality of sleep and burnout among undergraduate medical students at the university of Nairobi, Kenya

BJPsych Open ◽

10.1192/bjo.2021.742 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S279-S279

Author(s):

Linda Nyamute ◽

Muthoni Mathai ◽

Anne Mbwayo

Keyword(s):

Academic Performance ◽

Medical Students ◽

Sleep Quality ◽

Poor Sleep ◽

Quality Of Sleep ◽

Undergraduate Medical Students ◽

Poor Sleep Quality ◽

Significant Positive Association ◽

The University

AimsThe main objective was to determine whether quality of sleep is associated with burnout among undergraduate medical students at the University of Nairobi.The null hypothesis in our study population was; 'There is no significant association between poor sleep quality and burnout'.BackgroundIn a pressure prevailing environment, medical students find themselves in a vicious cycle of cutting down on sleep in attempts to cope and adjust to increasing workloads. Students with poor sleep quality have been found to perform worse in their board exam and have strained social engagements. Ultimately, this chronic sleep deprivation may lead to burnout which may cause diminished sense of accomplishment and impaired professional conduct, that may be carried on to the career as a physician. High levels of burnout have been associated with suicides.MethodThe sample size obtained was 384 and participants were selected by a mixed sampling method. Data collection was through self-administered questionnaires. Scales used for this study were the Pittsburg Sleep Quality Index(PSQI) and the Oldenburg Burnout Inventory(OLBI).Ethical considerations were adhered to and approval obtained from the Kenyatta National Hospital-University of Nairobi(KNH-UON) Ethics Board. Data entry and analysis was by SPSS v23. Data from 336 questionnaires were deemed fit for analysis.ResultWith a response rate of 87.5%, the prevalence of poor sleep quality and burnout were 69.9% and 74.7% respectively. There was a significant positive association between poor sleep quality and female gender, clinical years of study, living with family, poorly perceived socio-economic state and poor subjective academic performance. In addition, being female, younger, pre-clinical years, living independently off-campus and poor subjective academic performance were significantly associated with higher levels of burnout.Burnout had a significant correlation with poor sleep quality. Daytime functioning, a component of sleep quality had the highest correlation with components of burnout, disengagement and exhaustion. Overall, 57% of the respondents had both poor sleep quality &burnout, while only 12% were good sleepers with no burnout. Furthermore, having poor sleep increased the risk of having burnout by 2.8times. It is crucial that students adopt better sleeping habits to reduce the risk of burnout.ConclusionWith the high prevalence of poor sleep quality and burnout, peer-support groups and peer-led mentorship programs are recommended within this population to help deal with expectations, challenges and difficulties encountered within the course of medical education, in addition to preparing for the early future careers.

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Sleep Quality and Its Associated Factors among Low-Income Adults in a Rural Area of China: A Population-Based Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15092055 ◽

2018 ◽

Vol 15 (9) ◽

pp. 2055 ◽

Cited By ~ 6

Author(s):

Wenwen Wu ◽

Wenru Wang ◽

Zhuangzhuang Dong ◽

Yaofei Xie ◽

Yaohua Gu ◽

...

Keyword(s):

Sleep Quality ◽

Low Income ◽

Rural Areas ◽

Population Based ◽

Poor Sleep ◽

Chinese Adults ◽

Poor Sleep Quality ◽

Related Factors ◽

Health Related ◽

The Mean

Background: There is limited population-based research focusing on sleep quality among low-income Chinese adults in rural areas. This study aimed to assess sleep quality among low-income adults in a rural area in China and identify the association between sleep quality and sociodemographic, lifestyle and health-related factors. Methods: The study was conducted from September to November in 2017 using a cross-sectional survey questionnaire. A total of 6905 participants were recruited via multistage, stratified cluster sampling. Data were collected using the Chinese versions of Pittsburgh Sleep Quality Index and Food Frequency Questionnaire, while we also determined the sociodemographic profiles of the participants. Results: The mean age of the sample was 58.71 ± 14.50 years, with 59.7% being male, while the mean duration of daily sleep was 5.95 ± 1.31 h, with 56.7% reportedly experiencing poor sleep quality. Multiple regression analysis revealed that older age, unemployment, lower income, disability and chronic disease comorbidities were significant factors associated with an increased risk of poor sleep quality for both genders. Moreover, married and higher education level were associated with decreased risk of poor sleep quality for females, while a meat-heavy diet and illness during the past two weeks increased the risk of poor sleep quality for males. Conclusions: Sociodemographic, lifestyle and health-related factors had an impact on the frequently poor sleep quality of low-income Chinese adults in rural areas. Thus, comprehensive measures must be developed to address the modifiable predictive factors that can possibly enhance sleep quality.

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Poor sleep quality in systemic lupus erythematosus: does it depend on depressive symptoms?

Lupus ◽

10.1177/0961203314540762 ◽

2014 ◽

Vol 23 (13) ◽

pp. 1350-1357 ◽

Cited By ~ 22

Author(s):

L Palagini ◽

C Tani ◽

R M Bruno ◽

A Gemignani ◽

M Mauri ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Depressive Symptoms ◽

Sleep Quality ◽

Lupus Erythematosus ◽

Sleep Disturbances ◽

Control Group ◽

Poor Sleep ◽

Systemic Lupus ◽

Poor Sleep Quality ◽

Obstructive Sleep

Objectives Sleep disturbances are frequently observed in rheumatic diseases including systemic lupus erythematosus (SLE). This study aimed at evaluating the prevalence of insomnia, poor sleep quality and their determinants in a cohort of SLE patients. Methods Eighty-one consecutive SLE female patients were evaluated in a cross-sectional study. The Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI) and the Self-rating Anxiety Scale (SAS) were administered. Patients with previous diagnosis of obstructive sleep apnea or restless legs syndrome were excluded. Fifty-three women with hypertension (without SLE) were enrolled as control group (H). Results In the SLE cohort poor sleep quality (65.4% vs 39.6%, p < 0.01) and difficulty in maintaining sleep and/or early morning awakening (65.4% vs 22.6%, p < 0.001), but not insomnia (33.3% vs 22.6%, p = ns), were more prevalent than in H. Depressive symptoms were present in 34.6% of SLE vs 13.2% H patients ( p < 0.001) while state anxiety was more common in H patients (H 35.8% vs SLE 17.3%, p < 0.005). SLE was associated with a 2.5-times higher probability of presenting poor sleep quality in comparison to H (OR 2.5 [CI 1.21–5.16]). After adjusting for confounders, both depressive symptoms (OR 4.4, [1.4–14.3]) and use of immunosuppressive drugs (OR 4.3 [CI 1.3–14.8]) were significantly associated with poor sleep quality in SLE patients. Furthermore, poor sleep quality was not associated either with disease duration or activity. Conclusions In a cohort of SLE women, insomnia and poor sleep quality, especially difficulties in maintaining sleep, were common. Depressive symptoms might be responsible for the higher prevalence of poor sleep quality in SLE.

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Factors associated with poor sleep quality in women with cancer

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1478.2858 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 4

Author(s):

Thalyta Cristina Mansano-Schlosser ◽

Maria Filomena Ceolim

Keyword(s):

Sleep Quality ◽

Quality Index ◽

Sleep Disturbances ◽

Pittsburgh Sleep Quality Index ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Factors Associated ◽

Scale Data

ABSTRACT Objectives: to analyze the factors associated with poor sleep quality, its characteristics and components in women with breast cancer prior to surgery for removing the tumor and throughout the follow-up. Method: longitudinal study in a teaching hospital, with a sample of 102 women. The following were used: a questionnaire for sociodemographic and clinical characterization, the Pittsburgh Sleep Quality Index; the Beck Depression Inventory; and the Herth Hope Scale. Data collection covered from prior to the surgery for removal of the tumor (T0) to T1, on average 3.2 months; T2, on average 6.1 months; and T3, on average 12.4 months. Descriptive statistics and the Generalized Estimating Equations model were used. Results: depression and pain contributed to the increase in the score of the Pittsburgh Sleep Quality Index, and hope, to the reduction of the score - independently - throughout follow-up. Sleep disturbances were the component with the highest score throughout follow-up. Conclusion: the presence of depression and pain, prior to the surgery, contributed to the increase in the global score of the Pittsburgh Sleep Quality Index, which indicates worse quality of sleep throughout follow-up; greater hope, in its turn, influenced the reduction of the score of the Pittsburgh Sleep Quality Index.

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