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Volume 13, Issue 3 (12-2023)
cmja 2023, 13(3): 67-76 |
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Alijaniranani H, Noruzi Zamengani M, Amin Asnafi A. The Effectiveness of Aromatherapy with Orange Essential Oil on Improving Sleep Disturbances of School-Aged Children with Leukemia. cmja 2023; 13 (3) :67-76
URL: http://cmja.arakmu.ac.ir/article-1-944-en.html
URL: http://cmja.arakmu.ac.ir/article-1-944-en.html
1- Faculty of Nursing and Midwifery School, Jundishapur University of Medical Sciences, Ahvaz, Iran
2- Department of Paramedicine, Arak University of Medical Sciences, Arak, Iran , masoomehnoruzi@gmail.com
3- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2- Department of Paramedicine, Arak University of Medical Sciences, Arak, Iran , masoomehnoruzi@gmail.com
3- Health Research Institute, Research Center of Thalassemia & Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Keywords: Aromatherapy, orange essential oil, sleep disturbances, school-aged child, Acute lymphoblastic leukemia
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Table 1. Comparision of sleep habits among control and test groups before and after of intervention
*Independent t-test; **paired t-test
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INTRODUCTION
Acute lymphoblastic leukemia is the most common childhood cancer and ¼ of these patients are school-age children. One of the problems in these patients, such as other cancer patients is the sleep disorder; sleep disorders in children with ALL may be caused by brain radiotherapy or indirect chemotherapy. In addition, pain, fatigue, stress, prescribing steroids, hospitals environments and health centers staff activities can directly or indirectly affect children's sleep. In Maslow's hierarchy of needs, sleep is one of the most basic needs of human such as children; sleep in children leads to the secretion of growth hormone, development promotion, weight gain and better growth. Sleep is one of the necessities of life and it is clear that good quality of sleep is important for maintaining good health and freedom from disease, therefore, a solution should be found for sleep disorders in children with cancer. Sleep disorders reduces good sleep quality and causes physical and psychological disorders. Sleep disorders include resistance to going to bed, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnia, sleep disordered breathing and daytime sleepiness. There are different drug treatments such as benzodiazepines for sleep disorders, but today, due to side effects and contraindications of these chemical drugs, using complementary and alternative therapies as a low-risk, cost-effective, easy treatment with limited side effects is growing in nursing care of many medical centers.
Aromatherapy is a treatment that has been increased dramatically in recent years in comparison with other methods of complementary medicine. Orange is one of the plants whose essential oils are used in aromatherapy so that the anxiolytic effects and sleep effective of inhalation of orange essential oils are mentioned, and no serious side effects have been reported.
Considering the prevalence of sleep disturbances among children with leukemia and since no research has been done on the effects of aromatherapy with essential oils of orange on the sleep disorders of children with leukemia, and due to general trend in the use of herbal medicines, peer review in order to achieve a more safe and yet effective treatment for sleep disorders is essential. Therefore, this study aimed to determine the impact of aromatherapy with essential oils of orange on the sleep disorders of children with leukemia.
METHODS
This quasi-experimental study was conducted in two groups of control and test on children with Acute Lymphoblastic Leukemia (ALL) admitted to the pediatric oncology department of Shafa hospital in the city of Ahwaz. The sample size was calculated equal to 19 by considering confidence=95%, test power=80% and assuming differences of the sleep disturbances in two groups d=10 which was increased to 30 people in each group for more accuracy. To conduct the study, the researcher went to the research environment after research project approval and obtaining permission from the ethics committee of the Jondi Shapour University of Medical Sciences. After introducing herself and explaining the objectives of the research and its methodology to the parents of the subjects, the researcher started sampling after obtaining written consent from parents of the children, if they were eligible to enter the study. It should be noted that the subjects were selected based purpose-based sampling, and then, they were located in one of the test or control groups. Sampling was conducted 2014. The inclusion criteria were: 6–12-year-old children, received ALL treatment protocol, a sleep quality score greater than 41, no history of allergic rhinitis and respiratory problems, the absence of known mental illness. The exclusion criteria were tendencies of children and parents to withdraw from the study and creation of unforeseen crisis or accident during the intervention.
In the first phase, CSHQ questionnaire was completed through interviews with children and their parents, and children whose sleep quality score were more than 41 and met other inclusion criteria were included in the study. In the next phase, the samples were randomly divided into control and test groups. The intervention in the test group was done through pouring two drops of essential oil of orange manufactured by Gorgan Plant Essence Co. using a dropper on a 10×10 gauze; it was put in an open box at a distance of 5 cm from the child’s nose and the child was asked to take a deep breath for two minutes, and finally, the soaked gauze was placed under the outer layer of the child’s pillows. This was done for 3 days a week (Saturday, Monday, and Wednesday) and 3 times a day (10 am, 4 pm and at night before usual sleeping hours in the unit). In the control group, the intervention was the same as in the test group with the exception that distilled water was used instead of orange essential oil. It should be noted for error prevention, control and test samples were not in contact with each other, and the intervention was conducted in the control and test group, respectively. At the end of the intervention, CSHQ was completed again, and the data obtained were analyzed by SPSS software. Data collection tools in this study were demographic information and standard CSHQ questionnaire which were completed through interviews with parents of participants. Score greater than 41 indicates low sleep quality, and higher score shows the lower sleep quality This standard index is used in several studies to assess sleep quality and determine the sleep disorder of school-age children and it is of high validity. Previous studies have shown reasonable agreement between the results of this index and laboratory studies using polysomnography. Many studies indicate high validity and reliability of these standard tools.
RESULTS
All 30 children participated in each group until the end of the study. The information contained in Table 1 shows that based on the results of paired t-test in the test group, except for sleep disordered breathing, the mean score of other sleep disturbances (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnia and daytime sleepiness) after the intervention is significantly lower than before the intervention (P < 0.05), while in the control group, there is no significant statistical difference between the mean scores of sleep disturbances (P >0.05). Independent t-test results also show that for the mean scores of sleep disturbances (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, insomnia and daytime sleepiness) there was significant statistical difference between the two groups of control and test after the intervention (P < 0.05).
Acute lymphoblastic leukemia is the most common childhood cancer and ¼ of these patients are school-age children. One of the problems in these patients, such as other cancer patients is the sleep disorder; sleep disorders in children with ALL may be caused by brain radiotherapy or indirect chemotherapy. In addition, pain, fatigue, stress, prescribing steroids, hospitals environments and health centers staff activities can directly or indirectly affect children's sleep. In Maslow's hierarchy of needs, sleep is one of the most basic needs of human such as children; sleep in children leads to the secretion of growth hormone, development promotion, weight gain and better growth. Sleep is one of the necessities of life and it is clear that good quality of sleep is important for maintaining good health and freedom from disease, therefore, a solution should be found for sleep disorders in children with cancer. Sleep disorders reduces good sleep quality and causes physical and psychological disorders. Sleep disorders include resistance to going to bed, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnia, sleep disordered breathing and daytime sleepiness. There are different drug treatments such as benzodiazepines for sleep disorders, but today, due to side effects and contraindications of these chemical drugs, using complementary and alternative therapies as a low-risk, cost-effective, easy treatment with limited side effects is growing in nursing care of many medical centers.
Aromatherapy is a treatment that has been increased dramatically in recent years in comparison with other methods of complementary medicine. Orange is one of the plants whose essential oils are used in aromatherapy so that the anxiolytic effects and sleep effective of inhalation of orange essential oils are mentioned, and no serious side effects have been reported.
Considering the prevalence of sleep disturbances among children with leukemia and since no research has been done on the effects of aromatherapy with essential oils of orange on the sleep disorders of children with leukemia, and due to general trend in the use of herbal medicines, peer review in order to achieve a more safe and yet effective treatment for sleep disorders is essential. Therefore, this study aimed to determine the impact of aromatherapy with essential oils of orange on the sleep disorders of children with leukemia.
METHODS
This quasi-experimental study was conducted in two groups of control and test on children with Acute Lymphoblastic Leukemia (ALL) admitted to the pediatric oncology department of Shafa hospital in the city of Ahwaz. The sample size was calculated equal to 19 by considering confidence=95%, test power=80% and assuming differences of the sleep disturbances in two groups d=10 which was increased to 30 people in each group for more accuracy. To conduct the study, the researcher went to the research environment after research project approval and obtaining permission from the ethics committee of the Jondi Shapour University of Medical Sciences. After introducing herself and explaining the objectives of the research and its methodology to the parents of the subjects, the researcher started sampling after obtaining written consent from parents of the children, if they were eligible to enter the study. It should be noted that the subjects were selected based purpose-based sampling, and then, they were located in one of the test or control groups. Sampling was conducted 2014. The inclusion criteria were: 6–12-year-old children, received ALL treatment protocol, a sleep quality score greater than 41, no history of allergic rhinitis and respiratory problems, the absence of known mental illness. The exclusion criteria were tendencies of children and parents to withdraw from the study and creation of unforeseen crisis or accident during the intervention.
In the first phase, CSHQ questionnaire was completed through interviews with children and their parents, and children whose sleep quality score were more than 41 and met other inclusion criteria were included in the study. In the next phase, the samples were randomly divided into control and test groups. The intervention in the test group was done through pouring two drops of essential oil of orange manufactured by Gorgan Plant Essence Co. using a dropper on a 10×10 gauze; it was put in an open box at a distance of 5 cm from the child’s nose and the child was asked to take a deep breath for two minutes, and finally, the soaked gauze was placed under the outer layer of the child’s pillows. This was done for 3 days a week (Saturday, Monday, and Wednesday) and 3 times a day (10 am, 4 pm and at night before usual sleeping hours in the unit). In the control group, the intervention was the same as in the test group with the exception that distilled water was used instead of orange essential oil. It should be noted for error prevention, control and test samples were not in contact with each other, and the intervention was conducted in the control and test group, respectively. At the end of the intervention, CSHQ was completed again, and the data obtained were analyzed by SPSS software. Data collection tools in this study were demographic information and standard CSHQ questionnaire which were completed through interviews with parents of participants. Score greater than 41 indicates low sleep quality, and higher score shows the lower sleep quality This standard index is used in several studies to assess sleep quality and determine the sleep disorder of school-age children and it is of high validity. Previous studies have shown reasonable agreement between the results of this index and laboratory studies using polysomnography. Many studies indicate high validity and reliability of these standard tools.
RESULTS
All 30 children participated in each group until the end of the study. The information contained in Table 1 shows that based on the results of paired t-test in the test group, except for sleep disordered breathing, the mean score of other sleep disturbances (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, parasomnia and daytime sleepiness) after the intervention is significantly lower than before the intervention (P < 0.05), while in the control group, there is no significant statistical difference between the mean scores of sleep disturbances (P >0.05). Independent t-test results also show that for the mean scores of sleep disturbances (bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night waking, insomnia and daytime sleepiness) there was significant statistical difference between the two groups of control and test after the intervention (P < 0.05).
Table 1. Comparision of sleep habits among control and test groups before and after of intervention
| Sleep habits | Before intervention, Mean ± SD | After intervention, Mean ± SD | p-value** |
| Bedtime resistance | |||
| Control | 11.68 ± 1.99 | 11.53 ± 1.90 | 0.56 |
| Test | 12.76 ± 6.35 | 9.07 ± 1.77 | 0.004 |
| p-value* | 0.75 | 0.005 | |
| Sleep onset delay | |||
| Control | 2.70 ± 0.53 | 2.73 ± 0.44 | 0.66 |
| Test | 2.76 ± 0.43 | 1.53 ± 0.44 | 0.001 |
| p-value* | 0.79 | 0.001 | |
| Sleep duration | |||
| Control | 2.70 ± .53 | 2.73 ± 0.44 | 0.71 |
| Test | 2.76 ± 0.43 | 1.53 ± 0.44 | 0.001 |
| p-value* | 0.79 | 0.001 | |
| Sleep anxiety | |||
| Control | 6.61 ± 1.46 | 6.13 ± 1.35 | 0.71 |
| Test | 6.00 ± 1.53 | 5.03 ± 1.29 | 0.001 |
| p-value* | 0.92 | 0.01 | |
| Night wakening | |||
| Control | 6.16 ± 1.26 | 5.93 ± 1.33 | 0.10 |
| Test | 5.93 ± 1.33 | 4.20 ± 1.37 | 0.001 |
| p-value* | 0.49 | 0.001 | |
| parasomnias | |||
| Control | 15.50 ± 1.61 | 15.36 ± 1.67 | 0.43 |
| Test | 15.13 ± 1.94 | 9.90 ± 2.98 | 0.001 |
| p-value* | 0.75 | 0.001 | |
| Sleep disordered breathing | |||
| Control | 4.70 ± 1.17 | 4.76 ± 1.13 | 0.32 |
| Test | 6.63 ± 1.96 | 3.76 ± 1.21 | 0.056 |
| p-value* | 0.82 | 0.06 | |
| Daytime sleepiness | |||
| Control | 18.41 ± 1.93 | 18.56 ± 1.67 | 0.63 |
| Test | 18.80 ± 1.7 | 14.92 ± 1.40 | 0.001 |
| p-value* | 0.74 | 0.001 |
CONCLUSION
According to the results of the present study, it seems that aromatherapy with orange essential oil can improve sleep disorders and, as a result, the quality of sleep in children with ALL, and is suggested as a low-cost treatment without side effects. Therefore, according to the results of the present study and the desire of people to use herbal medicines and to remove the limitations of this study, it is suggested to do other studies in the field of using aromatherapy with orange essential oil compared to other complementary medicine methods, such as other essential oils and Music therapy with the aim of improving sleep disorders in children with ALL.
Compliance with Ethical Guidelines
This article has the code of ethics 2013∙12. ajums.REC and clinical trial code 1N20140909102 is from Jundishapur University of Medical Sciences, Ahvaz. Ethical principles including obtaining permission to conduct the research, obtaining the written informed consent of the research participants, the absence of any compulsion to participate in the research and keeping the information obtained from them confidential, the announcement of the research results without mentioning the names and personal characteristics of the patients were observed.
Funding
The above article is the result of the research project number U-93002 and the research and technology vice-chancellor of Ahvaz University of Medical Sciences has provided financial support for this research.
Conflicts of Interest
The authors declared no conflict of interest.
Acknowledgements
The researcher would like to express her gratitude to the respected lecturers and Vice-Chancellor of Education and Research of Jundishapur University of Ahvaz, the respected staff of the Pediatric Oncology Department of Shafa Hospital, and especially the children and their parents who helped the researcher.
According to the results of the present study, it seems that aromatherapy with orange essential oil can improve sleep disorders and, as a result, the quality of sleep in children with ALL, and is suggested as a low-cost treatment without side effects. Therefore, according to the results of the present study and the desire of people to use herbal medicines and to remove the limitations of this study, it is suggested to do other studies in the field of using aromatherapy with orange essential oil compared to other complementary medicine methods, such as other essential oils and Music therapy with the aim of improving sleep disorders in children with ALL.
Compliance with Ethical Guidelines
This article has the code of ethics 2013∙12. ajums.REC and clinical trial code 1N20140909102 is from Jundishapur University of Medical Sciences, Ahvaz. Ethical principles including obtaining permission to conduct the research, obtaining the written informed consent of the research participants, the absence of any compulsion to participate in the research and keeping the information obtained from them confidential, the announcement of the research results without mentioning the names and personal characteristics of the patients were observed.
Funding
The above article is the result of the research project number U-93002 and the research and technology vice-chancellor of Ahvaz University of Medical Sciences has provided financial support for this research.
Conflicts of Interest
The authors declared no conflict of interest.
Acknowledgements
The researcher would like to express her gratitude to the respected lecturers and Vice-Chancellor of Education and Research of Jundishapur University of Ahvaz, the respected staff of the Pediatric Oncology Department of Shafa Hospital, and especially the children and their parents who helped the researcher.
Type of Study: Applicable |
Subject:
Nursing and Midwifery
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