Development and validation of the sleep assessment instrument for older adults with pain

Santana, Márcia Valéria de Andrade; Félix, Ricardo Humberto; Bersani, Ana Laura de Figueiredo; Frange, Cristina; Coelho, Fernando Morgadinho Santos; Custódio, Osvladir; Santos, Fania Cristina

doi:10.1590/0004-282X-ANP-2020-0433

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Article • Arq. Neuro-Psiquiatr. 79 (10) • Oct 2021 • https://doi.org/10.1590/0004-282X-ANP-2020-0433 copy

Development and validation of the sleep assessment instrument for older adults with pain

Desenvolvimento e validação do instrumento de avaliação de sono para idosos com dor

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness.

Objective:

Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults.

Methods:

Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items.

Results:

We applied the “Sleep Assessment Instrument for Pain in older adults” (SAIOAP) in a sample of 100 older individuals. A Cronbach’s alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults.

Conclusions:

The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.

Keywords:
Sleep; Pain; Aged; Surveys and Questionnaires; Health Impact Assessment

Qualitative variables		n	%	p-value
Age (years)	60–69	3	3.0	<0.001
	70–79	24	24.2	<0.001
	≥80	72	72.2	Ref.
Gender	Female	86	86.9	<0.001
Gender	Male	13	13.1	Ref
Race	Black	13	13.1	<0.001
	White	59	59.6	Ref.
	Brown	26	26.3	<0.001
	Asian	1	1.0	<0.001
Marital status	Married	30	30.3	<0.001
	Separated/divorced	7	7.1	<0.001
	Widowed	54	54.5	Ref.
	Single	8	8.1	<0.001
ADLs	1–2	1	1.0	<0.001
	3–4	4	4.0	<0.001
	5–6	94	94.9	Ref.
IADLs	09–15	6	6.1	<0.001
	16–20	14	14.1	<0.001
	21–25	30	30.3	0.006
	26–27	49	49.5	Ref.
Self-perception of health	Excellent	5	5.1	<0.001
	Good	26	26.3	<0.001
	Regular	61	27.3	Ref.
	Poor	7	7.1	<0.001
Polypharmacy	No polypharmacy	20	20.2	<0.001
	Polypharmacy	52	52.5	Ref.
	Severe polypharmacy	27	27.3	<0.001
Pain type	Nociceptive	77	77.8	Ref.
	Neuropathic	7	7.1	<0.001
	Mixed	15	15.2	<0.001
Pain frequency	Continuous	46	46.5	Ref.
	Intermittent	45	45.5	0.887
	Occasional	8	8.1	<0.001
Pain localization	Muscle	26	26.3	<0.001
	Joint	82	82.8	Ref.
	Nerve	20	20.2	<0.001
	Others	2	2	<0.001
Pain intensity (VNS)	Mild	4	4.0	<0.001
	Moderate	36	36.4	<0.001
	Severe	59	59.6	Ref.
Pain by GPM	Mild	7	7.1	<0.001
	Moderate	60	60.6	Ref
	Severe	32	32.3	<0.001
GEAP	No or mild depression	43	43.4	Ref
	Moderate depression	37	37.4	0.385
	Severe depression	19	19.2	<0.001
PSQI	Good sleeper	43	43.4	0.065
PSQI	Poor sleeper	56	56.6	Ref.

Quantitative variables	Mean	SD	Range
Age (years)	83.13	±7.21	64–98
Education (years)	3.84	±3.14	0–15
Comorbidity (number)	5.71	±2.29	2–11
Medication (number)	7.93	±3.04	2–14
Pain duration (months)	9.15	±9.74	0.25–50
Pain intensity (VNS)	7.10	±1.95	3–10
Pain by GPM	61.40	±19.41	4.7–99.9
GEAP	6.86	±4.59	0–21
PSQI	6.54	±3.93	1–18
SAIOAP	1.96	±1.55	1–7

SAIOAP	Corrected total-item correlation
Item 1	0.520
Item 2	0.533
Item 3	0.589
Item 4	0.580
Item 5	0.496
Item 6	0.613
Item 7	0.598
Cronbach alpha (Total)	0.602

	Correlation (r)	p-value
Sleep quality (PSQI)	68.3%	<0.001
Pain intensity (VNS)	28.5%	0.004
Multidimensional aspects of pain (GPM)	40.5%	<0.001
Depression (GEAP)	46.1%	<0.001
Comorbidity (number)	28.2%	0.005
Medication (number)	32.6%	0.001

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[1] Correspondence: Cristina Frange; Email: cristina.frange15@gmail.com.