Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Suzanne Ameringer, Ph.D., RN, FAAN

Second Advisor

R. K. Elswick, Jr., Ph.D.

Third Advisor

Shelly Orr, Ph.D., RN, CNE

Fourth Advisor

Samuel Taylor, Jr., M.D., M.S.


Palliative care patients may be at a higher risk for sleep-related problems and their negative effects compared to the general population, yet limited sleep research has been done with this population. The purpose of this dissertation was to determine prevalence rates for excessive sleepiness, insomnia, restless legs syndrome (RLS), and high risk for sleep apnea (HRSA); examine relationships between the aforementioned sleep-related problems, sleep-related distress (SD), and sleep-related functional status (SFS); and to determine which sleep-related problem measures along with age and gender predicted SD and SFS among a sample of adult palliative care inpatients. Secondary aims were to understand causes of SD and find out participant willingness to accept inconveniences/risks to alleviate SD. Participants (N = 38) were recruited from an urban, academic medical center in Virginia and asked to participate in an interview and complete sleep-related instruments. Measures included the STOP-Bang Questionnaire (STOP-Bang) for HRSA, Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), 2012 International Restless Legs Syndrome Study Group (IRLSSG) revised consensus diagnostic criteria, Sleep-Related Distress Thermometer (SDT), and Functional Outcomes of Sleep Questionnaire – 10 (FOSQ-10) for SFS. Prevalence rates were 62% for insomnia (ISI score > 7), 57% for HRSA (STOP-Bang score > 2), 41% for excessive sleepiness (ESS score > 10), and 14% for RLS (met all IRLSSG criteria). Significant relationships (p < 0.05) were found between insomnia and SD (Spearman’s ρ = 0.75, p < 0.0001), and excessive sleepiness and SFS (Spearman’s ρ = -0.59, p = 0.0001). Based on regression models, ISI score was found to be a predictor of SD (F = 48.14, p < 0.0001); and age, ISI score, and ESS score were found to be predictors of SFS (F = 10.85, p < 0.0001). The most frequently reported causes of SD were anxiety/distressing thoughts (32%) and pain/physical discomfort (19%). Most participants expressed willingness to accept minimal risk interventions (97%), prescription medication (68%) and positive airway pressure therapy (57%) to alleviate SD. In conclusion, sleep-related problems were found to be common among the study sample, frequent causes of SD included anxiety/distressing thoughts and pain/physical discomfort, and the majority of participants were willing to accept the inconvenience of standard treatment options to alleviate SD. While associations were found between variables, due to limitations of the study including small sample size and uncertainty of the reliability/validity of the measures used with this population, more research is needed to better understand these relationships. Future research is also needed to establish tolerability and efficacy of interventions for sleep-related problems among palliative care inpatients.


© Lisa C. Sievers

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