Sensitivity and specificity of proposed Richards‐Campbell Sleep Questionnaire cut‐off scores for good quality sleep during an ICU stay

Abstract

Background: The 5-visual analogue scale Richards-Campbell Sleep Questionnaire subjective sleep measure is widely used in intensive care. A cut-off score indicative of good quality sleep has not been established and is required to guide the categorisation of individual patient and unit wide sleep quality. Design and Methods: The aim was to determine the global Richards-Campbell Sleep Questionnaire cut-off score for good to very good sleep during an intensive care unit stay in non-ventilated patients. The study was a secondary (cohort) retrospective analysis of patient self-report data (n = 32) from an interventional study testing a sleep promotion bundle. The Standards for Reporting Diagnostic Accuracy studies statement were used to report the study. The study was conducted in two mixed adult 12 and 20-bed ICUs of a tertiary referral hospital in a metropolitan area. In the morning, eligible patients were administered the Richards-Campbell SleepQuestionnaire together with a 5-category item Likert scale in which patients rated their nocturnal sleep quality as 'very poor', 'poor', 'fair', 'good' and 'very good'. Receiver Operator Curve analysis was performed.Results: Thirty-seven per cent (n = 32) of the total sample of 84 adult intensive care patients were females. The median age was 61.5 (51, 72) years. Self-reported median global Richards-Campbell Sleep Questionnaire score was 54.4 (30.1, 77.1) mm.A global score of ≥63.4 mm was the optimal cut-off for self-reported 'good sleep' (sensitivity: 87%, specificity: 81% and area under the curve: 0.896).Conclusions: Although the study requires replication in ventilated patients and other ICU settings, the cut-off score (63 mm) could be used to guide the categorisation of individual patient and unit wide sleep quality.

Does improving sleep for the critically ill reduce the incidence and duration of delirium? An evidence‐based review

“…Cut-off scores for healthy sleep (population norms) have not yet been established, but there is beginning evidence that a score of 63 mm is a reliable cut-off score for good-quality sleep. 16 Darby et al 9 reported a prospective quality improvement study in which data were collected for delirium-free days After the implementation of a not dissimilar study by Patel et al 10 patients reported an increase in sleep quality (pre: 60.8 ± 3.5 vs. post: 75.9 ± 2.24 mm) and the incidence of delirium was lower (pre: 33 % [n = 55/167] vs. post: 14 % [n = 24/171]). In this study the difference between nocturnal mean light and sound levels and compliance measured before and after the implementation of the intervention indicated that clinicians adopted many components (sound pre: 68.8 ± 4.2 dB vs. post: 61.8 ± 9.1 dB; light levels per: 594 ± 88.2 lux vs. post: 301 ± 53.5 lux).…”

“…Global sleep quality is the average of the VAS scores. Cut‐off scores for healthy sleep (population norms) have not yet been established, but there is beginning evidence that a score of 63 mm is a reliable cut‐off score for good‐quality sleep 16 …”

Sleep during and following critical illness: A narrative review

“…The RCSQ was specifically designed for use in the ICU population and uses five visual analogue scales to assess the domains of sleep latency, sleep efficiency, sleep depth, number of awakenings and overall sleep quality (Figure 1 )[ 141 ]. Individual domain scores can be interpreted respectively or combined into a global score, with a score of ≥ 63 out of 100 reported as the optimal cut-off for self-reported ‘good sleep’[ 142 ]. Both content and criterion validity have been established against polysomnography[ 143 ].…”