9 9 8
Rev Lat ino- am Enfer m agem 2007 set em br o- out ubr o; 15( 5) : 998- 1004w w w . eer p. usp. br / r lae Art igo Original
1 St udy ext ract ed fr om Mast er Thesis; 2 Nur se, Sc.M. in Nur sing, e- m ail: ellenber gam asco@gm ail.com ; 3 Nur se, Full Pr ofessor, Univer sit y of São Paulo at Ribeir ão Pr et o, College of Nur sing Br azil, e- m ail: m t m [email protected]
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e
ADAPTATI ON OF THE VI SUAL AN ALOG SLEEP SCALES TO PORTUGUESE
1Ellen Cr ist in a Ber gam asco2
Diná de Alm eida Lopes Mont eir o da Cr uz3
Ber g am asco EC, Cr u z DALM. Ad ap t at ion of t h e Visu al An alog Sleep Scales t o Por t u g u ese. Rev Lat in o- am
En f er m agem 2 0 0 7 set em br o- ou t u br o; 1 5 ( 5 ) : 9 9 8 - 1 0 0 4 .
This ar t icle r epor t s t he adapt at ion of t he Visual Analog Sleep ( VAS) Scales developed t o assess pat ient s’
per cept ion about t heir sleep on t he pr evious 24 hour s. Or iginal scales, t r anslat ed t o Por t uguese and subm it t ed
t o cont ent validat ion, w er e t est ed for r eliabilit y and validit y. Convenience sam ple w as com posed of 180 pat ient s
on t he fir st post oper at iv e day ( m ean age 39. 3± 12. 3 y ear s; 68. 3% fem ale) . The Dist ur bance Scale w as k ept
w it h 7 it em s (α= .80) and t he Effect iveness Scale w it h 5 it em s (α= .78) ; bot h m aint ained t he or iginal st r uct ur e. I t em 13 ( Wake aft er final ar ousal) had t o be excluded fr om Supplem ent at ion Scale, t hat kept 3 out of it s 4 it em s
(α= . 7 2 ) . Th er e w as n egat iv e cor r elat ion bet w een Dist u r ban ce an d Ef f ect iv en ess ( r = - . 6 8 p< . 0 0 1 ) , as it w as ex pect ed. The adapt ed v er sion is suit able t o sleep assessm ent of post oper at iv e pat ient s. The behav ior of t he
ex cluded it em has t o be analy zed w it h ot her sam ples.
DESCRI PTORS: sleep; n u r sin g assessm en t ; per ioper at iv e n u r sin g; psy ch om et r ics
ADAPTACI ÓN DEL VI SUAL AN ALOG SLEEP SCALES A LA LEN GUA PORTUGUESA
Est e ar t iculo r elat a la adapt ación de las Visual Analog Sleep ( VAS) Scales, que ev alúan la per cepción
cuant o el sueño en el día ant er ior . Las escalas, t r aducidas par a el por t ugués y aj ust adas después de validación
ap ar en t e, f u er an som et id as a t est es d e con f iab ilid ad y v alid ad . La m u est r a d e con v en ien cia ab ar có a 1 8 0
pacient es en el pr im er o día post oper at or io ( edad m edia 39,3± 12,3 anos; 68,3% m uj er es) . La escala de Dist ur bio
se m an t u v o con 7 ít em s (α= 0 , 8 0 ) y la Escala de Efect iv idad con 5 ít em s (α= 0 , 7 8 ) . El ít em 1 3 ( Lev an t ar se despu és de el desper t ar fin al) t u v o qu e ser ex clu ido de la escala de Su plem en t ación , r est án dole 3 de los 4
ít em s (α= 0 , 7 2 ) . Hu b o cor r elación n eg at iv a en t r e el Dist u r b io y Ef ect iv id ad ( r = - 0 , 6 8 p < 0 , 0 0 1 ) , con f or m e esper ado. El inst r um ent o adapt ado dem ost r ó car act er íst icas adecuadas par a ev aluar el sueño de pacient es en
p ost op er at or io. El com p or t am ien t o d el ít em ex clu id o se d eb e an alizar en est u d ios con ot r as m u est r as d e
p acien t es.
DESCRI PTORES: su eñ o; ev alu ación en en f er m er ía; en f er m er ía per ioper at or ia; psicom et r ía
ADAPTAÇÃO DAS VI SUAL AN ALOG SLEEP SCALES PARA A LÍ N GUA PORTUGUESA
Est e ar t ig o r elat a a ad ap t ação d as Visu al An alog Sleep ( VAS) Scales q u e av aliam a p er cep ção d a
pessoa quant o ao sono do dia ant er ior . As escalas, t r aduzidas par a o por t uguês ( Escalas Visuais Análogas
-Sono) e aj ust adas após v alidação apar ent e, for am subm et idas a t est es em pír icos de confiabilidade e v alidade.
A am ost r a de conv eniência foi de 180 pacient es em pr im eir o pós- oper at ór io ( idade m édia de 39,3± 12,3 anos;
6 8 , 3 % m u lh er es) . Com o n o or igin al, a Escala de Dist ú r bio m an t ev e- se com 7 it en s (α= 0 , 8 0 ) e a Escala de Efet ividade com 5 it ens (α= 0,78) . Da Escala de Suplem ent ação, or iginalm ent e com post a por 4 it ens, foi excluído o it em 1 3 ( Tem po par a lev an t ar após desper t ar ) , fican do com 3 it en s (α= 0 , 7 2 ) . Hou v e cor r elação n egat iv a en t r e Di st ú r b i o e Ef et i v i d ad e ( r = - 0 , 6 8 p < 0 , 0 0 1 ) , co n f o r m e esp er ad o . O i n st r u m en t o ad ap t ad o m o st r o u
p r op r ied ad es ad eq u ad as p ar a av aliar o son o d e p acien t es em p ós- op er at ór io. O com p or t am en t o d o it em
ex cluído dev e ser analisado em est udos com out r as am ost r as de pacient es.
I NTRODUCTI ON
S
leep alt er at ions ar e fr equent r esponses insam ples of pat ien t s in differ en t clin ical an d su r gical
sit uat ions( 1- 7). The pr oposal of int er v ent ions t hat help
p at ien t s t o d eal w it h t h ese alt er at ion s d ep en d s on
adequat e assessm ent of sleep dur ing t he night s t he
pat ient spends in hospit al.
Th is p ap er r ep or t s on a st u d y in w h ich an
inst rum ent creat ed in English t o assess a night ’s sleep
w as adapt ed and v alidat ed for Por t uguese. Assessing
sleep an d r est is par t of r ecom m en dat ion s for daily
n u r si n g a sse ssm e n t s a n d a i m s t o d e scr i b e t h e i r
efficacy in t he client ’s per spect iv e( 8).
Having an inst r um ent t o assess a night ’s sleep
is im por t ant for r esear ch about fact or s int er fer ing in
t he sleep of hospit alized pat ient s, as w ell as for st udies
t e s t i n g i n t e r v e n t i o n s t o r e l i e v e s l e e p p r o b l e m s
der iv ing fr om or st r essed by hospit alizat ion.
Sleep is defined as a funct ional, physiological,
r ev er sible and cy clical st at e t hat int er r upt s t he w ak e
per iod, per m it s r est or ing t he condit ions fr om t he st ar t
of t h e p r eced in g w ak e an d p r esen t s ch ar act er ist ic
behavior al m anifest at ions, such as r elat ive im m obilit y
a n d i n cr e a se d t h r e sh o l d o f r e sp o n se t o e x t e r n a l
st im uli( 9).
Th e m et h ods u sed t o assess sleep an d r est
can be separ at ed in t w o gr oups: t hose using equipm ent
and self- r epor t m et hods. Ex am ples of t he fir st gr oup
a r e p o l y s o n o g r a p h y a n d a c t i g r a p h y , w h i c h u s e
eq u ip m en t t o p r ov id e in f or m at ion ab ou t sleep , b u t
ar e expensive and com plex t o apply. The ot her gr oup
i n c l u d e s i n t e r v i e w s , d i a r i e s a n d s t a n d a r d i z e d
inst r um ent s, filled out by t he pat ient s t hem selv es or
by an evaluat or. Sleep diar ies ar e used in st udies t o
assess t h e pat ien t ’s sleep an d r est pat t er n ov er an
ex t en d ed p er iod an d ar e com p let ed b y t h e p at ien t
ev er y day. Lit er at u r e pr esen t s dif f er en t in st r u m en t s
dev eloped t o ou t lin e a per son ’s sleep pat t er n or t o
obt ain infor m at ion about specific sleep condit ions( 10).
Co n si d e r i n g t h e i m p o r t a n ce o f a sse ssi n g
hospit alized pat ient s’ sleep on a daily basis and t he
inexist ence of inst rum ent s in Port uguese for t his goal,
t h is ar t icle r ep or t s on a st u d y t o ad ap t t h e Visu al
Analog Sleep ( VAS) Scales( 11- 12).
Visu al An alog Sleep Scales ( VAS Scales)
Th e i n s t r u m e n t w a s d e v e l o p e d a s a
m o d i f i ca t i o n o f t h e Ve r r a n Sn y d e r - Ha l p e r n Sl e e p
Scale( 11), aim ed at perform ing a subj ect ive evaluat ion
of sleep ef f icien cy d u r in g t h e 2 4 h ou r s b ef or e t h e
assessm ent . I t is applicable t o hospit alized pat ient s,
r elat iv ely easy t o use and t her e is infor m at ion about
it s psychom et ric propert ies in t he environm ent it w as
creat ed in. I t consist s of 16 it em s: 15 self- report it em s
in a visual analog form at and 1 it em obt ained by adding
t he scores of t wo of t he 15 self- report it em s. The 16
it em s are dist ribut ed in t hree dom ains or scales. Table
1 present s t he operat ional definit ions of t he scales and
char act er ist ics and, t o pr eser v e space, t he num ber s
of t he cor r esponding it em s in t he or iginal v er sion of
t he inst rum ent ( in English) are also included.
Table 1 - Definit ions of scales and charact er ist ics of
VAS Scales*
p e e l s k l u b e h t e e r g e d e h t f o n o i t p e c r e P -e l a c S e c n a b r u t s i D . 1 y c n e t a l p e e l s d n a n o i t a t n e m g a r f o t e u d d e b r u t s i d s a w d o i r e p s c i t s i r e t c a r a h C n o i t a t n e m g a r F . 1 . 1 ) 9 m e tI ( g n i n e k a w A p e e l S -d i
M Percepitonofthenumberof
d o i r e p p e e l s e h t g n i r u d s g n i n e k a w a ) 1 m e tI ( t e s n O p e e l S r e t f A e k a W e m it f o t n u o m a e h t f o n o it p e c r e P p e e l S l a t o T e h t g n i r u d e k a w a t n e p s d o i r e P ) 1 1 m e tI ( p e e l S g n i r u D t n e m e v o
M Percepitonoftheamountof
p e e l s g n i r u d t n e m e v o m ) 7 m e tI ( p e e l S f o s s e n d n u o
S Percepitonofsleepdepth
) 8 m e tI ( e c n a b r u t s i D f o y t il a u
Q Percepitonofthedegreeofdififcutly
e c n a b r u t s i d p e e l s h t i w s c i t s i r e t c a r a h c y c n e t a L . 2 . 1 ) 6 m e tI ( y c n e t a L p e e l S m o r f e m it f o t n u o m a e h t f o n o it p e c r e P g n il l a f li t n u p e e l s o t n w o d g n il t t e s p e e l s a ) 0 1 m e tI ( y c n e t a L f o y t il a u
Q Percepitonofthedegreeofdififcutly
p e e l s o t g n i o g n i p e e l s k l u b e h t e e r g e d e h t f o n o i t p e c r e P -e l a c S s s e n e v i t c e f f E . 2 e v i t c e f f e e b o t d e r e d i s n o c s a w d o i r e p s c i t s i r e t c a r a h C y t il a u Q . 1 . 2 ) 2 1 m e tI ( g n i n e k a w A n o p U t s e
R Percepitonofhowrestedtheperson
g n i n e k a w a n o p u s i ) 4 1 m e tI ( p e e l S f o y t il a u Q e v it c e j b u
S Percepitonofsleepadequacyin
y t il a u q ll a r e v o f o s m r e t ) 5 1 m e tI ( n o it a u l a v E y c n e i c if f u S p e e l
S Percepitonofadequacyofamountof
p e e l s s c i t s i r e t c a r a h C h t g n e L . 2 . 2 ) 2 m e tI ( e m i T p e e l S l a t o T n i t n e p s e m it l a t o t e h t f o n o it p e c r e P p e e l s k l u b e h t g n i r u d p e e l s l a u t c a d o i r e p + 1 m e tI = 6 1 m e tI ( d o i r e P p e e l S l a t o T ) 2 m e tI n i t n e p s e m it l a t o t e h t f o n o it p e c r e P p e e l s o t g n it p m e t t a d e b e h t h c i h w o t e e r g e d e h t f o n o i t p e c r e P -e l a c S n o i t a t n e m e l p p u S . 3 e m i t p e e l s l a n o i t i d d a h t i w d e t n e m g u a s a w d o i r e p p e e l s k l u b ) 3 m e tI ( p e e l S e m it y a
D Percepitonofitmeasleepotherthan
d o i r e p p e e l s y r a m i r p ) 4 m e tI ( p e e l S g n i n r o M f o t n u o m a f o n o it p e c r e P e h t g n i r u d p e e l s l a t n e m e l p p u s s r u o h g n i n r o m ) 5 m e tI ( p e e l S n o o n r e t f A f o t n u o m a f o n o it p e c r e P n o o n r e t f a g n i r u d p e e l s l a t n e m e l p p u s s r u o h ) 3 1 m e tI ( l a s u o r A l a n i F r e t f a e k a W d e b n i t n e p s e m it e h t f o n o it p e c r e P l a n if o t l a s u o r a g n i n r o m l a it i n i m o r f g n i n e k a w a
1 0 0 0
The inst r um ent can be self adm inist er ed w it h
a com plet ion t im e of fiv e t o t en m inut es. Each it em
con sist s of t w o st at em en t s w it h opposit e m ean in gs
locat ed at t he ends of a 100- m m . line. Respondent s
ar e r equest ed t o answ er t he it em s by put t ing a ver t ical
m ar k on t h e lin e bet w een t h e st at em en t pair s at a
point t hat best r eflect s t heir opinion about t hem . They
ar e also r equest ed t o answ er in t er m s of last night ’s
sleep. A “ night ’s sleep” is considered t o be t he period
from w hen t he person t ried t o sleep unt il ( s) w as finally
up in t he m or ning, including m or nings or aft er noons
bef or e t h e assessm en t m om en t .
To score t he answers, a t ransparency is m ade
wit h 100- m m . lines, m arked in 5 m m . increm ent s. The
left end of the line corresponds to 0m m . and the right to
100m m . The transparency is placed on top of the answer
lines of each item in the com pleted instrum ent to obtain
a num erical reading in m illim et ers. The score for it em
16 is calculated by adding the scores of item s 1 and 2.
I tem s 7 and 15 are presented reversedly, which is why
the score obtained when reading these item s should be
subtracted from 100 (100-X1). The scores for each scale
( Dist ur bance, Effect iveness and Supplem ent at ion) ar e
obt ained by adding t he scores of t he pert inent it em s.
The higher the score, the greater the sleep Disturbance,
Effect iveness or Supplem ent at ion. Adding up t he scale
scores is not recom m ended. Therefore, there is no total
score for the three scales.
The inst r um ent dev eloper s pr esent ed r esult s
of r eliabilit y an d v alidit y est im at es in fou r sam ples:
healt hy adult s in t heir usual sleep environm ent ; adult s
w it h insom nia, also in t heir usual sleep env ir onm ent ,
hospit alized adult s in t he Unit ed St at es and hospit alized
adult s in Taiwan. These result s show Thet a coefficient s
b et w een 0 . 8 2 an d 0 . 8 6 f or t h e Dist u r b an ce Scale,
bet ween 0.72 and 0.81 for t he Effect iveness Scale, and
bet ween 0.45 and 0.84* for t he Supplem ent at ion Scale.
The Thet a coefficient is an int ernal consist ency est im at e,
based on Fact or Analysis result s, and t heir values are
sim ilar t o t hose produced t hrough Cronbach’s alpha( 13).
METHOD
Adapt at ion of VAS Scales
The aut hors of t he VAS Scales aut hor ized t he
adapt at ion t o Por t uguese. The or iginal inst r um ent in
English w as t r anslat ed t o Por t uguese by a professional
t r anslat or. The obt ained m at er ial w as back- t ranslat ed
t o En glish b y a secon d pr of ession al t r an slat or, w h o
w as n ot f am iliar w it h t h e or ig in al in st r u m en t . Th e
or iginal and back- t r anslat ed ver sions w er e com par ed
b y t h e a u t h o r s o f t h i s s t u d y. Co m m e n t s a n d
suggest ions w er e discussed w it h t he t w o pr ofessional
t ranslat ors unt il a Port uguese version w as defined for
su bsequ en t t est in g.
The Por t uguese ver sion w as subm it t ed t o face
validat ion by nine nur ses w ho w er e gr aduat e st udent s,
ex per ienced in sur gical pat ient car e and par t icipat ed
i n a co u r se su b j e ct a b o u t t h e d e v e l o p m e n t a n d
v alid at ion of m easu r in g in st r u m en t s. Ex p er ien ce in
su r g i ca l p a t i en t ca r e w a s d ef i n ed b eca u se o f t h e
in t en t ion t o obt ain dat a fr om post oper at iv e pat ien t s
for t he psy chom et r ic t est s of t he inst r um ent adapt ed
t o Por t uguese. Aft er adj ust m ent s accor ding t o t he face
validat ion and a pr et est on 20 pat ient s, t he it em s w er e
for m at t ed w it h a sim ilar pr esent at ion t o t he or iginal
in or der t o collect dat a for t he v alidit y and r eliabilit y
est im at es.
Em p ir ical p r oced u r es
A f t e r a f a v o r a b l e o p i n i o n f r o m t h e
I n st it u t ion al Rev iew Boar d , t h e ad ap t ed in st r u m en t
w as t est ed at t he m edical and surgical clinical unit s of
a lar ge pr ivat e hospit al in São Paulo cit y. Dat a w er e
col l ect ed i n Ju n e an d Ju l y 2 0 0 4 . Th e con v en i en ce
sam p le in clu d ed 1 8 0 p at ien t s ov er 1 8 , on t h e f ir st
p o s t o p e r a t i v e d a y ( PO) , w h o c o u l d a n s w e r t h e
inst r um ent and w ho, aft er t he r esear cher pr esent ed
t he st udy, agr eed t o par t icipat e and signed t he fr ee
and infor m ed consent t er m . The pat ient s w er e invit ed
t o par t icipat e in t he st udy and, if t hey agr eed, t hey
com plet ed t h e in st r u m en t an d a for m w it h per son al
and clinical dat a, during t he aft ernoon of t he first PO.
The obt ained dat a r efer t o t he night follow ing t he day
t h ey u n der w en t su r ger y.
Dat a an aly sis
D a t a w e r e a n a l y z e d t h r o u g h d e s c r i p t i v e
st at ist ics and reliabilit y and validit y est im at es. Reliabilit y
was est im at ed using Cronbach’s alpha. The st ruct ures
* Per sonal cor r espondence of Snyder - Halper n R, Ver r an JA. Visual Analog Sleep ( VAS) Scales ( 1990) .
Adapt at ion of t he Visual Analog Sleep Scales...
Ber gam asco EC, Cr uz DALM.
of t he Dist urbance, Effect iveness and Supplem ent at ion
scales were st udied wit h Fact or Analysis, wit h previous
definit ion of t he num ber of com ponent s accor ding t o
t he or iginal scale and Var im ax r ot at ion. Cor r elat ions
b e t w e e n t h e D i s t u r b a n c e , Ef f e c t i v e n e s s a n d
Supplem ent at ion scales w er e t est ed.
RESULTS
The sam ple included 180 pat ient s, w it h a m ean
age of 39.3 ( ± 12.3) year s; 123 ( 68.3% ) w er e w om en
and 62.2% had finished or unfinished higher educat ion.
All pat ient s w ere on t he fir st PO of sm all and m edium
-dim en sion su r ger ies. Th e m ost f r equ en t pr ocedu r es
w er e gy necological ( 38.8% ) , gast r oint est inal ( 23.3% )
and or t hopedic ( 1 3 . 3 % ) .
Th e V A S S c a l e s a d a p t e d t o Po r t u g u e s e
st ar t ed t o be called t he Escalas Visuais Análogas de
Sono ( EVA - Sono) .
Tab le 2 - Descr ip t iv e st at ist ics of EVA - Son o it em
scor es ( n= 180) . São Paulo, SP, 2004
Table 3 - Reliabilit y est im at es of EVA - Sono ( n= 180) .
São Paulo, SP, 2004
s m e t
I Median Mean SD 95%CI
1 WakeAfterSleepOnset 20 29.6 25.1 25.933.3
2 TotalSleepTime 65 58 32.2 53.362.8
3 DaytimeSleep 40 40.1 33.9 35.145.1
4 MorningSleep 10 34.1 35.8 28.839.3
5 AfternoonSleep 47.5 46.4 38.9 40.7 52.1
6 SleepLatency 25 34.9 32.3 30.239.7
7 SoundnessofSleep 65 59.2 34.6 54.164.1
8 QuailtyofDisturbance 37.5 42.2 35.4 37 47.5
9 Mid-SleepAwakening 65 59.5 33.8 54.564.4
0
1 QuailtyofLatency 17.5 36.2 35.9 30.941.5
1
1 MovementDuringSleep 40 42.7 36.1 37.4 48
2
1 RestUponAwakening 57 60.1 33.8 55.165.1
3
1 WakeAfterFinalArousal 55 51.9 36.8 46.557.4 4
1 SubjectiveSleepQuailty 55 56.2 35.6 50.961.5 5
1 SleepSufficiencyEvaluation 60 55.8 37.6 50.361.3 6
1 TotalSleepPeriod 95 87.6 30.7 83.192.2
I t em s 1 t o 15 could r ange fr om 0 t o 100, and
it em 16 fr om 0 t o 200, as it adds it em s 1 and 2. The
r ange of t he Dist ur bance Scale is fr om 0 t o 700 ( seven
it em s) , of t h e Effect iv en ess Scale fr om 0 t o 6 0 0 ( 4
it em s plus it em 16) and of t he Supplem ent at ion Scale
fr om 0 t o 400 ( 4 it em s) .
Scale r eliabilit y
I n t he scale correlat ion m at rixes, no negat ive
cor r elat ion w as found. I n t he Supplem ent at ion Scale,
it em 13 present ed low cor r elat ion w it h t he ot her it em s,
r anging fr om 0.02 t o 0.20.
e l a c S e c n a b r u t s i
D TotalAlpha=0.80
s m e t
I Pearson* R2** Alphaexcludingthe m e t i
.
9 Mid-SleepAwakening 0.68 0.51 0.74
.
1 WakeAfterSleepOnset 0.56 0.35 0.77
. 1
1 MovementDuringSleep 0.39 0.17 0.80
.
7 SoundnessofSleep 0.32 0.14 0.81
.
8 QuailtyofDisturbance 0.58 0.44 0.76
.
6 SleepLatency 0.56 0.40 0.76
. 0
1 QuailtyofLatency 0.63 0.47 0.75
e l a c S s s e n e v i t c e f f
E TotalAlpha=0.78
s m e t
I Pearson* R2** Alphaexcludingthe m e t i
. 2
1 RestUponAwakening 0.54 0.41 0.75
. 4
1 SubjectiveSleepQuailty 0.69 0.64 0.70
. 5
1 SleepSufifciencyEvaluaiton 0.59 0.46 0.74 .
2 TotalSleepTime 0.69 0.69 0.70
. 6
1 TotalSleepPeriod 0.31 0.56 0.82
e l a c S n o i t a t n e m e l p p u
S TotalAlpha=0.63
s m e t
I Pearson* R2** Alphaexcludingthe m e t i
.
3 DaytimeSleep 0.52 0.45 0.48
.
4 MorningSleep 0.43 0.22 0.53
.
5 AfternoonSleep 0.55 0.41 0.44
. 3
1 WakeAfterFinalArousal 0.16 0.08 0.72
* bet w een t he it em and t he sum of ot her it em s’ scores * * t he it em as dependent var iable
Scale v alidit y
Table 4 - Fact orial analysis of t he EVA - Sono ( n= 180) .
São Paulo, SP, 2004
e l a c S e c n a b r u t s i D -s m e t
I F1 F2
.
9 Mid-SleepAwakening 0.71 0,38
.
1 WakeAfterSleepOnset 0.71 0,17
. 1
1 MovementDuringSleep 0.24 0,67
.
7 SoundnessofSleep 0.08 0,84
.
8 QuailtyofDisturbance 0.74 0,16
.
6 SleepLatency 0.74 0,10
. 0
1 QuailtyofLatency 0.80 0,13
e c n a i r a
V 59.9%
e l a c S s s e n e v i t c e f f E -s m e t
I F1 F2
. 2
1 RestUponAwakening 0.81 0,06
. 4
1 SubjectiveSleepQuailty 0.89 0,18
. 5
1 SleepSufficiencyEvaluation 0.82 0,14
.
2 TotalSleepTime 0.44 0,83
. 6
1 TotalSleepPeriod(item1+item2) -0.03 0,96
e c n a i r a
V 79.6%
e l a c S n o i t a t n e m e l p p u S -s m e t
I F1 F2
.
3 DaytimeSleep 0.89 -0,12
.
4 MorningSleep 0.69 0,18
.
5 AfternoonSleep 0.81 0,15
. 3
1 WakeAfterFinalArousal 0.08 0,99
e c n a i r a
V 74.3%
I t e m 1 3 w a s e x cl u d e d f r o m t h e Pe a r so n
cor r elat ion t est s bet w een t he scor es of t he EVA- Sono,
t he reasons for w hich w ill be det ailed in t he discussion.
1 0 0 2
and Effect iveness; r = - 0.021, p= 0.777 for Dist ur bance
a n d Su p p l e m e n t a t i o n a n d r = - 0 . 0 1 5 , p = 0 . 8 3 6 f o r
Su pplem en t at ion an d Ef f ect iv en ess.
DI SCUSSI ON
Dist u r b an ce Scale
Th e Dist u r ban ce scale pr odu ced a r eliabilit y
coef f icien t of 0 . 8 0 . Table 3 sh ow s a low cor r elat ion
b et w een t h e t ot al scor e an d it em 7 ( Sou n d n ess of
sleep) ( r= 0.32) and t hat , w hen consider ing it em 7 as
a dependent v ar iable in a Mult iple Regr ession, R2 is
also v er y low ( 0.14) , w hich m eans t hat only 14% of
t his it em ’s score variabilit y is explained by t he scores
of t he ot her it em s. Som et hing sim ilar occurs w it h it em
11 ( Movem ent dur ing sleep) , w hose R2 w as 0.17, w it h
t h is dif f er en ce t h at t h e cor r elat ion coef f icien t s w it h
t he ot her it em s w er e not as low as for it em 7 . The
alpha coefficient of 0.80 w ould slight ly im prove if it em s
7 or 11 w er e excluded. How ever, as t his im pr ovem ent
w ould be ver y sm all, it em s 7 and 11 w er e m aint ained.
I n t h r e e sa m p l e s o f p a t i e n t s a n d o n e o f h e a l t h y
people, t he Thet a coefficient of t he Dist ur bance scale
r anged bet w een 0.82 and 0.86* , w hich show s t hat , in
t h i s st u d y, t h i s sca l e ’ s i n t e r n a l co n si st e n cy w a s
com pat ible w it h t he est im at es obt ained for t he or iginal
scal e.
Th e Fa ct o r An a l y si s w i t h t w o co m p o n en t s
( Table 4) r ev ealed t hat it em s 9, 1, 8, 6 and 10 ar e
par t of t he sam e fact or and t hat it em s 11 and 7 ar e
co r r e l a t e d i n a se co n d f a ct o r. Th i s a n a l y si s w a s
ex pect ed t o pr esen t a solu t ion in w h ich t h e secon d
fact or consist ed of it em s 6 and 10, w hich did not occur.
D e s p i t e t h e a b o v e i n d i c a t e d l i m i t a t i o n s , t h e
Dist u r ban ce Scale w as def in ed, lik e in t h e or igin al,
w it h sev en it em s and t he com posit ion of t he it em s,
w hich in t his st udy did not correspond t o t he original
st r uct ur ed, should be v er ified in ot her sam ples.
Ef f ect iv en ess Scale
Th e r eliab ilit y est im at e p r od u ced an alp h a
o f 0 . 7 8 , i n d i ca t i n g g o o d co n si st e n cy a m o n g t h e
i t em s. Th e a l p h a w o u l d i n cr ea se i f i t em 1 6 w er e
ex clu ded ( Table 3 ) , alt h ou gh t h e im pr ov em en t w ou ld
be v er y sm all, w h ich is w h y t h e decision w as m ade
t o m a i n t a i n i t . I n s t u d i e s u s i n g t h e o r i g i n a l
in st r u m en t , t h e Th et a coef f icien t r an g ed f r om 0 . 7 2
t o 0 . 8 1 * * , w h ich sh ow s t h at t h e r esu lt s of t h is st u dy
w er e com pat ible w it h t h ose obt ain ed w it h t h e or igin al
sca l e .
Th e Fa ct o r An a l y si s w i t h t w o co m p o n en t s
( Table 4 ) ex plain ed alm ost 8 0 % of t h e var ian ce f or
t he Effect iveness Scale. I t em s 12, 14 and 15 ar e par t
of one fact or, w hile it em s 2 and 16 w ere gr ouped in a
second fact or. This can be ex plained by t he fact t hat
it em 1 6 is t he sum of it em s 1 and 2 . The obt ained
solu t ion r ep r od u ces t h e ex p ect ed st r u ct u r e, as t h e
su b- scales of t h is scale gr ou p it em s 1 2 , 1 4 an d 1 5
w it h r espect t o sleep qualit y and it em s 2 and 16 r elat ed
t o sl e e p d u r a t i o n . Th e Ef f e ct i v e n e ss sca l e i n t h e
ad ap t ed in st r u m en t con t ain s f iv e it em s, lik e in t h e
or igin al scale.
Su p p lem en t at ion Scale
I t em 1 3 d isp lay ed low cor r elat ion w it h t h e
ot h er it em s, r an g in g b et w een 0 . 0 2 an d 0 . 2 0 . Tot al
alpha for t he four it em s w as 0. 63. I t is obser v ed in
Table 3 t hat t he exclusion of it em 13 w ould raise alpha
f r om 0 . 6 3 t o 0 . 7 2 , w h ich is a su bst an t ial in cr ease.
I t em 13 ( “ Aft er m or ning awak ening, st ay ed awak e/
Aft er m or ning aw akening dozed off and on” ) m ay not
r ef lect h osp it alized p at ien t s’ r ealit y, m ain ly t h at of
sur gical pat ient s. I n t his st udy sam ple, pat ient s w er e
advised not t o get up w it hout nur sing help. This m ay
hav e r equir ed t hem t o spend m or e t im e in bed aft er
a r o u sa l , e v e n w i t h o u t t h e n e e d t o sl e e p l o n g e r.
Ther efor e, it em 13 m ay not have cont r ibut ed t o assess
Su p p l e m e n t a t i o n , e x p l a i n i n g t h e b e h a v i o r o f t h e
r el i a b i l i t y est i m a t e a n d f a ct o r so l u t i o n , d i scu ssed
b elow .
The Fact or Analy sis w it h t w o com ponent s for
t h e S u p p l e m e n t a t i o n S c a l e ( Ta b l e 4 ) e x p l a i n e d
alm ost 7 5 % of v ar iab ilit y. How ev er, it is ob ser v ed
t h at , in t h is solu t ion , it em 1 3 is isolat ed f r om t h e
ot her s, w it h a load of 0. 99. This r esult confir m s t he
r eliabilit y r esult for it em 13 and can be ex plained by
t h e r e a s o n s m e n t i o n e d a b o v e w h e n d i s c u s s i n g
r eliab ilit y.
I n v iew of t he r eliabilit y and fact or analy sis
r esu lt s, t h e d ecision w as m ad e t o ex clu d e it em 1 3
* Per sonal cor r espondence of Snyder - Halper n R, Ver r an JA. Visual Analog Sleep ( VAS) Scales ( 1990) . * * Per sonal cor r espondence of Snyder - Halper n R, Ver r an JA. Visual Analog Sleep ( VAS) Scales ( 1990) .
Adapt at ion of t he Visual Analog Sleep Scales...
Ber gam asco EC, Cr uz DALM.
for subsequent analy ses. The Supplem ent at ion scale
in t h e ad ap t ed in st r u m en t w as d ef in ed w it h t h r ee
it em s, inst ead of four lik e in t he or iginal. The Thet a
r eliab ilit y coef f icien t s f or Su p p lem en t at ion f ou n d in
r esear ch w it h t he or iginal inst r um ent ( 4 it em s) w er e
0 . 4 5 for healt hy per sons, against 0 . 6 8 and 0 . 8 4 for
insom niac and hospit alized pat ient s* . The alpha v alue
i n o u r s t u d y ( 0 . 7 2 ) f o r t h e t h r e e - i t e m
S u p p l e m e n t a t i o n s c a l e i s a b i t l o w e r t h a n f o r
h o sp i t al i zed p at i en t s w i t h t h e o r i g i n al i n st r u m en t .
How ev er, t h e com par ison is lim it ed b y t h e dif f er en t
n u m b er o f i t em s. Th e h o sp i t al i zed p at i en t sam p l e
i n c l u d e d 4 2 % o f h o s p i t a l i z a t i o n s d u e t o c l i n i c a l
r e a s o n s . N o i n f o r m a t i o n i s a v a i l a b l e a b o u t t h e
p r o p o r t i o n o f s u r g i c a l p a t i e n t s , n o r a b o u t
assessm en t s on t h e f ir st day af t er su r ger y.
Th e in ad eq u acy of it em 1 3 can b e sp ecif ic
f or assessm en t s on t h e f ir st PO an d in clu d e ot h er
sit u at ion s in w h ich p at ien t s, in d ep en d en t ly of t h eir
sleep Su p p lem en t at ion n eed s, h av e t o st ay in b ed
aft er ar ou sal. Th er efor e, t h e in clu sion of it em 1 3 is
r ecom m ended in st udies w it h ot her sam ples, for t he
sak e of a bet t er under st anding of it s behav ior in t he
Su pplem en t at ion scale.
Cor r elat ions bet w een EVA - Sono
The Dist ur bance Scale pr esent ed a negat iv e,
m oder at e and significant cor r elat ion ( - 0.68 p< 0.001)
w it h t he Effect iveness Scale, w hich w as expect ed and
indicat es t he validit y of t he inst rum ent . The correlat ion
c o e f f i c i e n t s b e t w e e n t h e t o t a l s c o r e s o f t h e
Su pplem en t at ion Scale ( w it h ou t it em 1 3 ) an d t h ose
o f t h e o t h e r t w o s c a l e s ( D i s t u r b a n c e a n d
Ef f ect iv en ess) w er e n eg at iv e, in d icat in g an in v er se
cor r elat ion . How ev er, lev els w er e low an d w it h ou t
st at ist ical sig n if ican ce. Th ese r esu lt s ar e con sist en t
w it h t he scales’ t heor et ical definit ions.
CONCLUSI ON
T h e i n t e r n a l c o n s i s t e n c y a n d s t r u c t u r e
an aly ses sh ow ed ad eq u at e p sy ch om et r ic p r op er t ies
f o r t h e a d a p t e d i n st r u m e n t . Fo r t h e se v e n - i t e m
D i s t u r b a n c e S c a l e , Cr o n b a c h ’ s a l p h a w a s 0 . 8 0 ,
i n d i ca t i n g g o o d i n t e r n a l co n si st e n cy. Li k e i n t h e
o r i g i n a l , t h e D i st u r b a n ce sca l e w a s d e f i n e d w i t h
sev en it em s an d t h e com posit ion of t h e it em s n eeds
t o be con f ir m ed in ot h er sam ples. Th e Ef f ect iv en ess
Scale m ain t ain s t h e fiv e it em s of t h e or igin al v er sion ,
w it h a Cr on bach ’s alph a of 0 . 7 8 , w h ich is adequ at e.
On e it em w as r em ov ed f r om t h e Su p p lem en t at ion
Sca l e ( i t e m 1 3 ) t o a sse ss sl e e p o n t h e f i r st PO,
r esu lt in g in t h r ee it em s w it h a Cr on bach ’s alph a of
0 . 7 2 .
St udies w it h ot her sam ples ar e needed for a
b e t t e r a n a l y si s o f t h e b e h a v i o r o f i t e m 1 3 . Th e
av ailab ilit y of t h e EVA- Son o p er m it s assessin g t h e
sleep of hospit alized pat ient s during t he hospit alizat ion
p e r i o d , f a v o r i n g n o t o n l y p a t i e n t ca r e , b u t a l so
i n st r u m en t s f o r r esear ch ab o u t sl eep p r o b l em s o f
hospit alized pat ient s and about int ervent ions t o relieve
t h em .
* Per sonal cor r espondence of Snyder - Halper n R, Ver r an JA. Visual Analog Sleep ( VAS) Scales ( 1990) .
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Recebido em : 3.8.2006 Apr ovado em : 9.4.2007
Adapt at ion of t he Visual Analog Sleep Scales...
Ber gam asco EC, Cr uz DALM.
