SLEEP QUALITY OF WOMEN WITH GYNECOLOGICAL AND BREAST CANCER

A qualidade de sono referida pelo próprio indivíduo é reconhecida atualmente como indicador de saúde e de qualidade de vida. Este estudo exploratório e descritivo teve por objetivo descrever a qualidade habitual do sono de mulheres com câncer ginecológico e mamário e compará-la à qualidade do sono das mesmas na hospitalização. Participaram 25 mulheres hospitalizadas para tratamento clínico do câncer que responderam ao Índice de Qualidade de Sono de Pittsburgh (PSQI) até 72 horas após a admissão e quando prevista a alta hospitalar. Verificou-se que 52% das mulheres apresentavam má qualidade de sono habitual e que, na hospitalização, esse percentual elevou-se para 80%. Como causas mais freqüentes de perturbação do sono na hospitalização destacaram-se: necessidade de usar o banheiro; despertar precoce; cuidados prestados pela equipe de enfermagem. Os resultados apontam para a necessidade de cuidados oncológicos que englobem a qualidade de sono desses pacientes, sobretudo na hospitalização.


QUALIDADE DO SONO DE MULHERES PORTADORAS DE CÂNCER GINECOLÓGICO E MAMÁRIO
A qualidade de

INTRODUCTION
Self-reported sleep quality and its impact in the daily lives of healthy or sick people has become one of the main foci of concern for researchers, as sleep is an essential physiological and behavioral process for the adequate functioning of the organism.
Knowledge about sleep quality started to be considered an important clinical tool to identify health problems (1) , as sleep disorders can be associated with fatigue, mood alterations and reduced pain tolerance (2) .
People affected by oncology problems are particularly subject to sleep disorder experiences, mainly when they have to be hospitalized for treatment (3)   .It is believed that these patients present greater difficulties to catch sleep and continue sleeping than other clinical or surgical patients, due to the symptoms associated with the disease or the very often aggressive therapeutics used for cancer treatment (2) .Therefore, hospitalization and other changes in the sleep place can precipitate sleep disorders among these patients (3) and exacerbate the damage caused by chronic diseases.
Among neoplastic disorders, gynecological and breast cancer diagnoses represent a real threat to countless women's lives, with negative repercussions on their quality of life.Although sleep disorders are an important theme for patients affected by neoplasms, coping with them still seems to be inadequate in the field of cancer care (4) .
Although few studies address sleep-related aspects in gynecological cancer patients, the health team is recommended to prioritize both the quality of specific cancer treatment and the impact the disease and its treatment provoke in the patients' quality of life (5) , implying sleep quality.
As women with gynecological and breast cancer are subject to a wide range of problems, it is interesting for the hospital environment to be able to favor a restoring sleep.This article aims to describe the habitual sleep quality of women with gynecological and breast cancer and compare it with sleep quality during hospitalization, in order to support the planning of nursing care that attempts to promote good sleep quality for these women, especially during this period.

SUBJECTS AND METHODS
We carried out an exploratory and descriptive study, with a quantitative approach.Data were collected through the following instruments: Identification Card (IC), elaborated for the study; the Pittsburgh Sleep Quality Index (PSQI) (1) , in the version used by other authors in Brazil (6) .Both     (12) .

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A considerable number of cancer patients take medication to sleep (7) .In our study, the proportion of women using this kind of drug was similar to other literature findings and predominant among subjects with bad habitual sleep quality.Sleep habits during hospitalization followed the same tendency found before this event.However, we found a statistically significant difference between subjects with good and bad sleep quality during hospitalization for sleep duration and efficiency, which were reduced among subjects with bad sleep quality.
Being ill is a stressing factor, mainly if hospitalization is needed.It is believed that the predominance of bad-quality sleep parameters during hospitalization, negatively affecting nocturnal sleep stages, lead to the inadequate recovery of hospitalized subjects (13) .
During hospitalization, the need to use the participation in their care (14)

FINAL CONSIDERATIONS
People affected by cancer can be vulnerable and depend on the support of relatives or partners during the different stages of coping with the disease.
During hospitalization, the nursing team is one of the responsibles for supporting patients in living with the disease.
Although cancer nursing care has evolved a lot since its appearance (15)   , these findings indicate the need for cancer care that covers aspects related to patients' sleep quality, mainly during hospitalization.
Evidence-based knowledge is essential for nurses, who are responsible for patient care, to support their care actions and guide the nursing team about the importance of favoring pleasant nights of sleep to patients, including during hospitalization.
instruments were filled out by the researcher, who filled out the subjects' answers.The IC aimed to record sociodemographic data, housing characteristics and factors related to the disease and to treatments realized earlier and during the current hospitalization.It was applied within 72 hours after the subjects' hospital admission.The PSQI was used to assess subjective sleep quality, sleep habits related to quality and the occurrence of sleep disturbances.The instrument consists of seven components (subjective quality, latency, duration, efficiency and sleep disturbances, sleep medication use and daytime sleepiness), resulting in a score that corresponds to global subjective sleep quality.A score of up to five indicates good sleep quality while a score of more than five marks bad sleep quality(1) .Data collected through the PSQI were retrospective, corresponding to a time interval before the date when it was filled out.In this study, each subject answered the instrument twice: within 72 hours after hospitalization, to provide data about sleep quality in the last 15 days, i.e. while they were at home (indicated in this study as habitual sleep quality); and as soon as hospital discharge had been scheduled, to supply data about sleep quality during hospitalization (referred to in this study as sleep quality during hospitalization).Cronbach's alpha coefficient was used to assess the instrument's internal consistency, observing an intermediary consistency with an alpha coefficient of 0.60 to assess habitual sleep quality, and 0.69 to assess sleep quality during hospitalization.Data were submitted to descriptive analysis.Next, PSQI data for all subjects were compared between the two study phases.Subjects were grouped according to sleep quality (good or bad), and the two groups were compared in each study phase.Subjects were also grouped according to the clinical evolution of their disease, in two categories: subjects whose clinical state was maintained and subjects whose clinical state worsened, according to data collected in October 2004.These groups were compared in terms of their sleep quality in the two study phases.Non-parametrical statistical tests were used for interphase (McNemar and Wilcoxon) and inter-group (Mann-Whitney, Chi-square and Fisher's Exact) comparisons, at a critical level of 5%.The research was approved by the Research Commission at CAISM at by the Research Ethics Committee at FCM/ UNICAMP.Subjects who complied with the study inclusion criteria signed the Free and Informed Consent Term, elaborated according to the standards of Resolution 196/96 by the National Health Council.

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sd (±): standard deviation **: significance level < 0.05 Twenty-five percent of subjects with good and 46.2% of those with bad habitual sleep quality indicated moderate or intense indisposition to develop their daily activities.Daytime sleepiness and sleep medication use were mentioned more frequently by subjects with bad sleep quality (46.2% and 23.1%, respectively) in comparison with patients with good sleep quality (25% and 16.7%, respectively).Subjects with good sleep quality mentioned the need to use the bathroom (75%) and pain (41.7%) as the main causes of disturbances in their habitual nocturnal sleep.The main causes among patients with bad habitual sleep quality were early awakening (92%) and need to use the bathroom (92%), followed by pain episodes (69.3%) and feeling hot during the night (46.2%).Table 4 shows the sleep patterns implied in sleep quality during hospitalization (nocturnal sleep latency, duration and efficiency).
bathroom and health care delivery stood out as the origin of nocturnal sleep disturbance in both patient groups.Pain control to reduce nocturnal sleep interruptions; control of illumination levels to maintain a close-to-normal light and dark cycle and care delivery compatible with nocturnal sleep promotion are some practices that need to be consolidated to obtain better nocturnal sleep quality.We found a study in which researchers identified a negative correlation between sleep quality and the number of disturbances, total time spent in the patient's room and patients' Sleep fragmentation deriving from such interventions can negatively affect subjects' perception of their sleep quality, which reinforces the need for nocturnal care planning, with a view to attending to nocturnal rest needs.Nursing care planning and practice for this sake can be considered in future studies.In this study, 20% of women with bad sleep quality indicated sleep disturbances provoked by other patients in bad general conditions or who were agitated.Sharing the room with other persons in the hospital environment can represent a sleep qualityimpairing factor.Controlling the illumination in the room and defining times to sleep depend on a consensus with other people; sleep habits, times to sleep and wake up can be different and health care needs probably vary among these subjects.These variations among people who share the same room could contribute to increased sleep latency and reduced duration during hospitalization.Daytime sleepiness was more frequent among women with bad sleep quality, and use of medication to sleep was identified in half of the subjects with bad sleep quality during hospitalization.It is believed that subjects with bad sleep quality concentrate factors that corroborate with sleep disturbances and, during hospitalization, culminate in the need to use medication to sleep.Participants with bad sleep quality also highlighted early awakening and feeling hot as nocturnal sleep disturbance factors.When grouped according to the clinical evolution of the disease, the analysis of participants' sleep quality showed that the PSQI scores of subjects whose clinical condition worsened had indicated bad sleep quality in both study phases, in comparison with patients whose clinical state did not change.It is believed that nocturnal sleep conditions interfere in people's sensations throughout the day, which highlights the importance of good nocturnal sleep quality for sick patients, so that they can feel welldisposed during the day and recover from the disease's harmful effects, from treatment or even from some situations that occurred during hospitalization.However, patients may not mention their sleep disorders during hospitalization, which makes it essential that nurses inquire about these difficulties and get to know their habitual sleep patterns.The bad clinical conditions in which some women are hospitalized or the rapid evolution of the disease impede the development of longer studies with a larger number of subjects.This difficulty was the main study limitation.

Table 1 -
Subjects' distribution in terms of hospitalization motive and habitual sleep quality.Campinas, 2004 sleep quality during hospitalization.The proportion of subjects with good habitual sleep quality who started to present bad sleep quality during hospitalization was statistically significant (p = 0.04 in McNemar's test).

Table 2 -
Subjects' distribution in terms of disease characteristics and habitual sleep quality.Campinas, 2004 * All metastases were of the diffuse bone type, in combination with other associations (meningeal or pulmonary metastases)These results tend towards a statistically significant difference (p = 0.06 on the Mann-Whitney test).As to PSQI scores during hospitalization, we found that data behaved similarly: subjects with a

Table 4 -
Nocturnal sleep patterns during