الفهرس 
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Abstract
Globally, Type Two Diabetes Mellitus (T2DM) is the most common chronic diseases in nearly all countries. On the other hand the most recent reports evidenced that the DM complications have been more distressed by sleep disturbances. As documented, sleep is a significant component of DM patient’s health and it must be as a self-managed item by each individual. Therefore, sleep hygiene program which described as “practicing for certain behaviors that facilitate sleep and avoid other behaviors that interfere with it” is essential for facilitating healthy self-sleep behaviors that promote glycemic control as part of DM comprehensive care plan.
Providing information, directing and supporting T2DM patients are the responsibility of nurse who is the corner stone af any health care team.
This study was carried out to determine the effect of applying a sleep hygiene program on glycemic control among type two diabetic patients
Materials and method:
The present study was carried out at the diabetic outpatient’s clinics of the Alexandria Main university Hospital and Ophthalmological Hospital. Sample of 70 adult patients with diagnosis of (T2DM) were divided randomly into two equal groups (study and control) 35 patients in each group, and it has been included in the study according to the following criteria.
Inclusion criteria:
1) Age: 30 to < 60 years of both sex.
2) Patients diagnosed with type two diabetes for at least 1 years and not more than 10 years, treated with oral hypoglycemic agents or insulin.
3) Patients had a bed partner or roommate.
4) Agreed to participate in the current study.
5) Able to communicate verbally, to read and write.
6) Free from any infection lesions, wounds and any diabetic complications.
7) Free from other co-morbid illnesses.
8) Patients were not consuming medications that may cause sleep disturbances.
9) Non-pregnant women.
Tools:
Three tools were used by the researcher to collect data in order to fulfill the aim of the study:
Tool I: Biosocio-demographic data
Tool II: Pittsburg Sleep Quality Index:
The Pittsburg Sleep Quality Index (PSQI) contains 24 questions was developed by Buysse and Reynolds (2000) to assess sleep quality and patterns of sleep in the adult over the last month.
Tool III: Blood glucose profile:
- Random blood glucose (RBG): tested by using one of Blood-Glucose Meters (ACCU-CHEK).
- Glycosylated hemoglobin (HbA1C) level: Blood samples collected by the researcher and sent to the lab.
The study design was accomplished as follow:
1. Tools of the study were translated to colloquial Arabic language and tested for face validity, by a jury of 7 experts from the Medical Surgical Nursing Department and the Endocrinology Medicine Department, changes were introduced accordingly.
2. Each patient in the study was assessed for bio-socio demographic data and all patients in both groups were individually interviewed by the researcher using three tools
3. All patients were individually interviewed, by the researcher using the biosocio-demographic data (Tool I), the Pittsburgh Sleep Quality Index(PSQI) (tool II) to assess sleep quality and patterns ,the Blood glucose profile (tool III) to assess the effect of sleep hygiene program on glycemic control. It was implemented individually for the study group in three consecutive interviews (1st, 2nd, and 3rd).
4. Schedule of patients’ interviews and tools used in each interview , with time intervals ( one month between each two interviews).
The main results of this study were:
•The age of vast majority of total patients were ranged between (>40-60) years old.
• Gender, almost nearly of three quarters (72.9 %) of all patients were females.
• Half of the total patients were obese and achieved a primary level of education. As well as, they were diagnosed as DM from less than 5 years ago.
•The vast majority among both study and control groups (94.3%) were treated by oral hypoglycemic agents.
•Nearly about ⅔ of the total patients (57.1%) were suffering from emotional stress.
•The finding of studied patients, regarding to the global PSQI 70% was mentioned that, they suffering from moderate and sever sleep difficulties in all areas.
•There is no statistical significant difference was detected between global PSQI and bio-socio demographic data as (Age, sex, body mass index, education level, marital status, number of kids, work, income, residence, duration of DM diagnosis, treatment, previous admission, previous surgeries).
•There is statistical significant difference was detected between global PSQI and emotional stress.
•More than two thirds of patients in study group suffering from moderate difficulties in all areas of sleep assessment in 1st interview. While, in 4th interview was noticed that this percent dropped to less than one quarter. Also, there is a highly statistically significant correlation was observed between 1st interview and each other interview (2nd, 3rd, 4th).
•Majority of studied patients were suffering from poor glycemic control.
•There is statistical significant difference was found among patients in study group, as well as between study and control groups, throughout the four interviews regarding global PSQI, random blood sugar and HbA1c.
The main recommendations coming out from the study are:
•Utilization of sleep hygiene program for patients can improve their sleep quality as well as their glycemic control and reflected positively on their general health and wellbeing.
• Educational module of “sleep hygiene program” must be explained for all T2DM patients and how they can utilize it.
•In-service education program and continuing educational sessions should be conducted for HCGs about importance of sleep, sleep physiology, sleep disturbances and its negative impact on general health as well as wellbeing .In addition to, how they can management of raised sleep problems and its preventive measures.
•Attractive simple booklets or teaching aids must be available for all patients about sleep hygiene as a new concept for management of all health problems.
•Further research is recommended as involving large samples, for being generalization.