Boudjeltia et al., in their study “Sleep restriction increases white blood cells, mainly neutrophil count, in young healthy men: A pilot study,” examined what would happen if sleep were restricted to around four hours a night. The title itself is extremely appropriate; it gets directly to the point, and even indicates the results of the study, thus intriguing the reader and making them want to know how this was determined. It focuses on the results moreso than the purpose of the study, which is interesting and intriguing – the big picture (atherosclerosis and/or cardiovascular events) is not elaborated upon, which could potentially work against it in a literary context. The reader has to go to the abstract or the introduction to find out the point of the study.
The abstract offers a short and to-the-point summary of the overall study. The abstract is divided into easy to read sentences, and each one provides the most essential information the reader needs to know about the study. This abstract does exactly what an abstract should do: provide a truncated version of the entire study. If a casual reader did not want to read the entire study, they could read the abstract and know exactly what was studied and what the results were. The primary goal of the study is also showcased (blood parameters associated with cardiovascular risk), allowing the reader to know exactly why they should be reading the study.
At the beginning of the study, it is made clear that the problem that is being examined is atherosclerosis, detailing what it does to the human body. The introduction also offers some background and context on sleep deprivation and its relationship to mortality and hypertension. This helps set the stage for the study, so the reader is fully aware of the problem that has necessitated this study.
It is also made evident that this study is meant to increase knowledge of an issue that has not been properly studied. This makes it incredibly significant for the medical world at large, because it will shed light on the relationship between sleep deprivation and ill effects on the body. Nurses can use this information to help stress the importance of sleeping to patients suffering from atherosclerosis.
Considering the nature of the problem (atherosclerosis and sleep deprivation), the methods used in the study match with what is needed to investigate the effects of sleep restriction on the human body. The concept is very simple; make young healthy men get a predetermined amount of restricted sleep, and see what happens to their body. The simplicity of the concept makes the research very easy to follow, with fewer errors and factors to have to take into consideration.
The literature review of the article is not strictly found in a specific section. Rather, the data is used to back up claims during the introduction and discussion sections. This allows the information to be disseminated throughout the article in an organic way. All of the different articles range from as early as the 1980s to as recently as 2007. While there may be temptation to write off the older articles as not having much scientific validity, part of their purpose is to track the field of research into this particular subject, further showcasing that additional research is required to gain a better understanding of the phenomenon linking sleep to adverse health effects, such as atherosclerosis.
The conceptual model of the study – that restricting sleep can cause inflammation – is appropriate, due to the fact that atherosclerosis deals with inflammation of the arteries, and therefore it is targeting the correct condition.
The hypothesis – that sleep restriction could activate inflammatory processes and affect blood variables in young men – is very clearly stated, as is the logic behind this hypothesis (these variables are associated with cardiovascular events such as atherosclerosis). Based on the literature review, the authors were able to come to the conclusion that CHD risk and leukocyte count are interrelated, and as such wanted to confirm or further their suspicions with the help of this study.
The research design is well thought out and appropriate, and proper steps were taken to reduce risks to validity. In studies that rely upon something that the subjects need to actively do (sleep), it can be tough to get accurate readings, as, for example, this study carried the risk of the subjects sleeping more or less than the amount they were supposed to. However, these hazards were curtailed with the help of EEG monitors that would record their sleep – this allowed the researchers to monitor and regulate the amount of sleep the subjects got. Their sleep schedule was closely monitored, so they were forced to sleep or not sleep at the same time, creating a greater consistency with the findings among each subject.
The population sample was established and communicated with a great deal of specificity and appropriateness. Great efforts were made to find young healthy men between the ages of 22 and 29, making sure to not stray too far from that middle age of 24 and 24.5, respectively. Power calculation was used to ensure the consistency in the ages of the subjects. Because the purpose of this study is to help illustrate that atherosclerosis and cardiovascular events can also happen to young men, particularly as a result of sleep restriction, this method of selection fits in adequately. Another consideration for the use of young, healthy men is to allow for the encouragement of inflammation without risk to the subject. The only criticism that could be levied against the population sample is that it could have been of a greater size to promote more accurate results, but for the purposes of this small-scale pilot study, seventeen people is an appropriate number.
The variables collected in this study were blood cell counts, lipids, cholesterol, leucocytes and subsets, fibrinogen, and several more – all taken through blood samples. The samples were all taken at the exact same time for all subjects. All of the different levels counted in the blood were evaluated through the most appropriate materials – EDTA-treated tubes for whole blood, citrated vacuum tubes for plasma, SYNCHROM LX automate and Immage devices, among others. The specificity of the article in naming the devices used to evaluate the blood samples allows for easy recreation of the study by future researchers.
The data was analyzed very appropriately, using Wilcoxin paired tests to compare the values taken as a baseline (at the beginning of the study) with the second set of samples, taken at night 3. The results of the test are presented in a very comprehensive and easy-to-read table – showcasing the baseline, third night, and Wilcoxon p values at a glance with the variables. This helps to show the changes in the levels of each variable and how they changed over the course of the study, allowing for a progression to be seen as sleep deprivation took its toll on the health of the subjects.
The statistical methodology used on the data is extremely sound; the entire process is very straightforward and logical, as each step makes the following step necessary. The sample follows along with the needs of the hypothesis (young, healthy men), the data is appropriate to the problem being investigated (blood cell levels and inflammation), and the design is meant to clearly collect the data in a reliable way (regulating sleep schedule, taking blood samples at appropriate times and testing them through reliable methods, evaluating the results through statistical methods such as the Wilcoxon p values).
The findings were summarized in a very coherent way through the table – information is available at a glance and answer the research questions. They do not suggest any new hypotheses, however, as the information is arranged in a way that directly relates to the hypothesis of this study and no other. The other studies and theories brought in through the literature review are used to supplement the findings and tie them into previous work by other researchers, grounding the research thoroughly.
As this is a pilot study, the express purpose for its existence is to act as preliminary study to precede a more detailed, comprehensive and full-scale research project. As a result, there are many implications for further study and research, as the findings need to be confirmed and the mechanisms that cause sleep restriction to affect the blood must be determined and explored. These implications are reasonable, as they are the purpose of the study, and they provide specific directions for future researchers to go.
The report, on the whole, had a great deal of specificity without being confusing, and was clearly categorized and defined. Organization of the sections and the table were very well thought out, leading the reader from one section to the next without a great deal of searching around. The literature review was peppered in throughout the text, however, and as such it was difficult to delineate what was said through the text.
The authors would simply bring the appropriate literature to the point that it discusses and bring it up there. This actually helped apply the literature to its appropriate context instead of sequestering it in one large chunk of information. This helped to lend a narrative feel to the study which makes it easier to follow than a strict empirical study. The appropriate context is given in the introduction, the material and methods are clearly defined, the results are discussed with incredible detail and theoretical connection, and the conclusion is succinct and evocative.
While there is plenty of useful information for practitioners in this study, it is perhaps wise to hold out for the full, detailed study of the phenomenon that this was a pilot for in order to truly apply it to their medical care practices.
The findings in this study seem to be perfectly valid; they are examined in a logical manner, and no leaps in reasoning occur throughout the text. One step leads to another, and this strict adherence to the scientific and research process helps to lend validity and credibility to the findings. Many variables in the data collection process were accounted for, such as regulating the sleep and activities of the subjects to prevent an outside element from affecting the data, and the basis for the hypothesis was grounded in real scientific and medical precedent.
This study does present new evidence as to a contributing factor for atherosclerosis, and will be very much applicable to practitioners provided that this pilot study receives a full experimental treatment. If successful, health care professionals can cite this study as evidence that their patients need to get the appropriate amount of sleep in their lives and during their hospital care. It provides very strong correlations between atherosclerosis and sleep levels, and as such can be very convincing to patients in order to make them maintain a proper sleep schedule.
