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Sleep Quality and Risk for Sleep Apnea in Incarcerated Women

Harner, Holly M.; Budescu, Mia

doi: 10.1097/NNR.0000000000000031

Background Little is known about characteristics of women’s sleep during incarceration.

Objectives The study objectives were to describe incarcerated women’s sleep quality, document incarcerated women’s risk for sleep apnea, and identify other factors that contribute to poor sleep quality during incarceration.

Methods This cross-sectional descriptive exploratory investigation was conducted in a maximum security women’s prison in the United States. Incarcerated women’s sleep quality and their risk for sleep apnea was assessed by using the Pittsburgh Sleep Quality Index and the Multivariable Apnea Prediction Score, respectively.

Results Four hundred thirty-eight incarcerated women participated in this investigation. Results indicate that 72% of the sample met the Pittsburgh Sleep Quality Index criteria for “poor sleepers.” Poor sleepers were significantly more likely to report sleep disturbances and scored significantly higher on the risk for sleep apnea scale compared to women who did not meet the poor sleep threshold. Approximately 10% of the sample had a probability for sleep apnea higher than .50. Factors that contributed to poor sleep included (a) “racing thoughts/worry/thinking about things,” (b) environmental noise and other factors, (c) physical health conditions/pain, (d) nightmares and flashbacks, and (e) not taking sleep medication.

Discussion Most participants reported poor sleep quality during incarceration. Poor sleep might exacerbate existing health conditions and contribute to the development of new health problems for incarcerated women. Furthermore, poor sleep quality may reduce a woman’s ability to fully participate in beneficial prison programming. This investigation provides a first look at how women sleep in prison and offers recommendations for future research.

Holly M. Harner, PhD, MPH, MBA, CRNP, WHCNP-BC, is Assistant Professor and Director of the Master of Public Health Program, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania.

Mia Budescu, PhD, is an Assistant Professor, Lehman College, New York.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Accepted for publication February 13, 2014.

The authors acknowledge receipt of the following financial support for the research and/or authorship of this article: American Nurses Foundation/Eastern Nursing Research Society; Sigma Theta Tau International – Xi Chapter; T-32-Research on Vulnerable Women, Children, and Families; and the Center for Health Equity Research at the University of Pennsylvania.

The authors also wish to acknowledge the incarcerated women who participated in this investigation.

The authors have no conflicts of interest to disclose.

Corresponding author: Holly M. Harner, PhD, MPH, MBA, CRNP, WHCNP-BC, School of Nursing and Health Sciences, La Salle University, St. Benilde Tower-Office 3333, 1900 W. Olney Ave., Philadelphia, PA 19141 (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.