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Yang TH, Lin HH, Hsu HL, Chiou AF. Factors associated with sleep quality in patients undergoing cardiac surgery: A longitudinal study. Nurs Crit Care 2024; 29:477-485. [PMID: 38410051 DOI: 10.1111/nicc.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/03/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Poor sleep quality is associated with multiple factors in cardiac surgery patients. AIM To examine the trajectory of sleep quality and its associated factors over 3 months in Taiwanese patients undergoing cardiac surgery. STUDY DESIGN A longitudinal study. This study enrolled 95 patients undergoing cardiac surgery in northern Taiwan. Sleep quality was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale before surgery, at discharge, and at 1 month and 3 months postsurgery. RESULTS The majority of participants reported poor sleep quality before cardiac surgery (76.8%) and at discharge (81.6%), and they showed significant improvements in sleep quality at 1 month (B = -0.93, p = .023) and 3 months postsurgery (B = -1.50, p < .001). Significant daytime sleepiness was reported by 25.3% of patients before cardiac surgery, and this proportion significantly decreased at 3 months postsurgery (B = -2.59, p < .001). The significant predictors of sleep quality in cardiac surgery patients were symptom distress, sleep medications, occupation, left ventricular ejection fraction, ACE-I drugs and potassium ions, which explained 53.7% of the total variance in sleep quality. Having a nap habit was an independent predictor of daytime sleepiness in cardiac surgery patients, which could explain 3.7% of the total variation. CONCLUSION Poor sleep quality was common in patients undergoing cardiac surgery and was associated with multiple factors, including symptom distress, cardiac function, medications, and psychosocial and environmental factors. RELEVANCE TO CLINICAL PRACTICE Poor sleep quality was observed in cardiac surgical patients before surgery and at discharge postsurgery. Patient education on symptom management, medication adherence and sleep hygiene are suggested to improve sleep quality in patients undergoing cardiac surgery.
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Affiliation(s)
- Ting-Hui Yang
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsuan-Hua Lin
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Lung Hsu
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biotechnology, Ming Chuan University, Taipei, Taiwan
| | - Ai-Fu Chiou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Alghadir AH, Khan M, Alshehri MM, Alqahtani AS, Aldaihan M. In hypertensive individuals, sleep time and sleep efficiency did not affect the number of angina episodes: a cross-sectional study. Sci Rep 2022; 12:16290. [PMID: 36175431 PMCID: PMC9523051 DOI: 10.1038/s41598-022-20255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Previous studies have reported adverse effects of short and long sleep duration on cardiovascular health. However, how sleep time and sleep efficiency affect angina have not been studied in hypertensive individuals. This study aimed to assess the relationship of sleep with angina. Using a cross-sectional design, data from 1563 hypertensive individuals were collected from the parent Sleep Heart Health Study (SHHS). Age, alcohol use, average diastolic blood pressure (ADBP), average systolic blood pressure (ASBP), cigarette use, sleep time, sleep efficiency, percent time in stage N3 of sleep, and body mass index (BMI) were used as covariates. Multiple linear regression, the Chi-Square test, and Pearson’s correlation coefficient were used for data analysis. Unadjusted sleep efficiency, sleep time, ADBP, and age were significant (p < 0.05) predictors of the number of angina episodes (Anginan). When the covariates were adjusted, only ADBP and ASBP were significant (p < 0.05) predictors of Anginan. Sleep efficiency, BMI, ADBP, sleep time, and age had a significant (p < 0.05) correlation with Anginan. In hypertensive individuals, sleep time and sleep efficiency did not affect Anginan when adjusted for covariates. ADBP and ASBP were found to be significant predictors of Anginan when the covariates were adjusted.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Masood Khan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | | | - Abdulfattah S Alqahtani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mishal Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Tighe CA, Buysse DJ, Weiner DK, Beehler GP, Forman DE. Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT. J Cardiopulm Rehabil Prev 2022; 42:316-323. [PMID: 35522949 PMCID: PMC9437109 DOI: 10.1097/hcr.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health. REVIEW METHODS A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR. SUMMARY Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.
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Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo
| | - Daniel E. Forman
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
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Hu XM, Wei WT, Huang DY, Lin CD, Lu F, Li XM, Liao HS, Yu ZH, Weng XP, Wang SB, Hou CL, Jia FJ. Sleep patterns and potential risk factors for disturbed sleep quality in patients after surgery for infective endocarditis. J Cardiothorac Surg 2022; 17:121. [PMID: 35581652 PMCID: PMC9116038 DOI: 10.1186/s13019-022-01828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The current study aimed to investigate the sleep quality of patients after valve replacement surgery due to infective endocarditis and identify risk factors for disturbed sleep post hospitalisation. Methods Eighty patients were assessed postoperatively using subjective scale measures, the Pittsburgh sleep quality index (PSQI) and the Epworth sleepiness scale, and an objective measure, actigraphy. Scale measures were assessed approximately 2 weeks and 6 months after surgery. Actigraphy monitoring was performed for 2 consecutive weeks during hospitalisation. Logistic regression was used to identify risk factors for disturbed sleep. Results The study population (n = 80) had an average age of 42.8 ± 14.2 years, and 67.5% were male. The median sleep efficiency was 85.3% in week 1 and 86.8% in week 2. The frequency of awakenings was significantly higher in week 1 (20.0 times vs. 19.3 times, p = 0.017). The scale measures showed significant improvement in sleep by 6 months after surgery compared to that during hospitalisation. Multivariable logistic regression analysis suggested that the possible risk factors for disturbed sleep 6 months after surgery included age (OR = 1.479, 95%CI 1.140–1.920) and a few parameters of early postoperative disturbed sleep quality (PSQI: OR = 2.921, 95%CI 1.431–5.963; sleep efficiency: OR = 0.402, 95%CI 0.206–0.783; and average duration of awakenings: OR = 0.006, 95%CI 0.000–0.827). Conclusions Disturbed sleep quality was witnessed in postoperative patients during hospitalisation and up to 6 months after surgery. Over time, the patients’ sleep quality improved significantly. Age and a few early postoperative sleep quality variables were risk factors for disturbed sleep 6 months after surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01828-4.
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Affiliation(s)
- Xiang-Ming Hu
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Wen-Ting Wei
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - De-Yi Huang
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Cai-Di Lin
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Fen Lu
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Xiao-Ming Li
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Huo-Sheng Liao
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Zhi-Hong Yu
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Xiao-Ping Weng
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China
| | - Fu-Jun Jia
- Department of Comprehensive Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China. .,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 123 Huifu Road, Yuexiu District, Guangzhou, 510080, Guangdong Province, China.
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Muthukrishnan A, Muralidharan TR, Subash J, Lathamangeswari C. Association of poor sleep quality with risk factors after coronary artery bypass graft surgery—A prospective cohort study. JOURNAL OF VASCULAR NURSING 2020; 38:83-92. [DOI: 10.1016/j.jvn.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
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Kessler R, Knutson KL, Mokhlesi B, Anderson SL, Shah M, Meltzer DO, Arora VM. Sleep and activity patterns in older patients discharged from the hospital. Sleep 2019; 42:zsz153. [PMID: 31310317 PMCID: PMC6802567 DOI: 10.1093/sleep/zsz153] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/23/2019] [Indexed: 01/05/2023] Open
Abstract
STUDY OBJECTIVES Although sleep disturbance is common in acutely ill patients during and after a hospitalization, how hospitalization affects sleep in general medicine patients has not been well characterized. We describe how sleep and activity patterns vary during and after hospitalization in a small population of older, predominately African American general medicine patients. METHODS Patients wore a wrist accelerometer during hospitalization and post-discharge to provide objective measurements of sleep duration, efficiency, and physical activity. Random effects linear regression models clustered by subject were used to test associations between sleep and activity parameters across study days from hospitalization through post-discharge. RESULTS We recorded 404 nights and 384 days from 54 patients. Neither nighttime sleep duration nor sleep efficiency increased from hospitalization through post-discharge (320.2 vs. 320.2 min, p = 0.99; 74.0% vs. 71.7%, p = 0.24). Daytime sleep duration also showed no significant change (26.3 vs. 25.8 min/day, p = 0.5). Daytime physical activity was significantly less in-hospital compared to post-discharge (128.6 vs. 173.2 counts/min, p < 0.01) and increased 23.3 counts/min (95% CI = 16.5 to 30.6, p < 0.01) per hospital day. A study day and post-discharge period interaction was observed demonstrating slowed recovery of activity post-discharge (β 3 = -20.8, 95% CI = -28.8 to -12.8, p < 0.01). CONCLUSIONS Nighttime sleep duration and efficiency and daytime sleep duration were similar in-hospital and post-discharge. Daytime physical activity, however, was greater post-discharge and increased more rapidly during hospitalization than post-discharge. Interventions, both in hospital and at home, to restore patient sleep and sustain activity improvements may improve patient recovery from illness.
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Affiliation(s)
- Riley Kessler
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Kristen L Knutson
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University, Chicago, IL
| | - Babak Mokhlesi
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Monica Shah
- Department of Family Medicine, Carolinas Medical Center, Charlotte, NC
| | | | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
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7
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Mohammad H, Mohammad AI, Saba A. Sleeping pattern before thoracic surgery: A comparison of baseline and night before surgery. Heliyon 2019; 5:e01318. [PMID: 30911690 PMCID: PMC6416731 DOI: 10.1016/j.heliyon.2019.e01318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 03/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Sleep deprivation is considered a stress factor in the perioperative period. There are several studies on sleep disturbance after surgery but very limited literature available on preoperative sleep patterns, predictors of sleep disturbance and its effect on surgical outcome. Methodology Patients scheduled for thoracic surgery were asked to fill out a written Pittsburgh Sleep Quality Index (PSQI) questionnaire. The primary investigator explained this form to all the patients. This was filled out before premedication for subjective assessment of sleeping pattern at two different time point. Only those patients included who spent the previous night at home. Participants were asked to respond to the questions regarding their baseline sleeping pattern and compare it with last night. Results Total eighty-three patients with a mean age of 47.83 ± 17.88 were included in the study. Overall mean PSQI scores were significantly higher (p-value < 0.01) during the night before surgery (6.94 ± 2.115) when compared with baseline (3.88 ± 1.877). Sleep latency was also significantly affected when last night-1 (the night before admission) was compared with usual sleep latency. Twenty patients were unable to sleep more than 5 hrs at night before admission which was significant when compared with their last month status (20 vs 3). Logistic regression model demonstrated the age and Timing of surgery as a strong predictors of poor sleep (defined as PSQI ≥ 5). Conclusion Quality of sleep was profoundly affected at night before thoracic surgery, mainly due to a significant change in sleep latency and sleep duration. Although age and Timing of surgery were strong predictors of poor sleep we were unable to find any association between quality of sleep and type of surgery.
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Affiliation(s)
- Hamid Mohammad
- Anaesthesia Department, Second Floor PW II, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Akhtar Irfan Mohammad
- Anaesthesia Department, Second Floor PW II, Aga Khan University, Stadium Road, Karachi, Pakistan
| | - Ahmed Saba
- Anaesthesia Department, Second Floor PW II, Aga Khan University, Stadium Road, Karachi, Pakistan
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8
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Examination of the Relationship Between Elective Surgical Patients' Methods for Coping With Stress and Sleeping Status the Night Before an Operation. J Perianesth Nurs 2018; 33:855-864. [DOI: 10.1016/j.jopan.2017.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022]
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Sleep Quality During and After Cardiothoracic Intensive Care and Psychological Health During Recovery. J Cardiovasc Nurs 2018; 33:E40-E49. [DOI: 10.1097/jcn.0000000000000499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
RATIONALE Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful. OBJECTIVES This Systematic Review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors. DATA SOURCES PubMed (January 4, 2017), MEDLINE (January 4, 2017), and EMBASE (February 1, 2017). DATA EXTRACTION Databases were searched for studies of critically ill adult patients after hospital discharge, with sleep disturbance measured as a primary outcome by standardized questionnaire or objective measurement tools. From each relevant study, we extracted prevalence and severity of sleep disturbance at each time point, objective sleep parameters (such as total sleep time, sleep efficiency, and arousal index), and risk factors for sleep disturbance. SYNTHESIS A total of 22 studies were identified, with assessment tools including subjective questionnaires, polysomnography, and actigraphy. Subjective questionnaire studies reveal a 50-66.7% (within 1 mo), 34-64.3% (>1-3 mo), 22-57% (>3-6 mo), and 10-61% (>6 mo) prevalence of abnormal sleep after hospital discharge after critical illness. Of the studies assessing multiple time points, four of five questionnaire studies and five of five polysomnography studies show improved aspects of sleep over time. Risk factors for poor sleep varied, but prehospital factors (chronic comorbidity, pre-existing sleep abnormality) and in-hospital factors (severity of acute illness, in-hospital sleep disturbance, pain medication use, and ICU acute stress symptoms) may play a role. Sleep disturbance was frequently associated with postdischarge psychological comorbidities and impaired quality of life. CONCLUSIONS Sleep disturbance is common in critically ill patients up to 12 months after hospital discharge. Both subjective and objective studies, however, suggest that sleep disturbance improves over time. More research is needed to understand and optimize sleep in recovery from critical illness.
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Affiliation(s)
- David R Hillman
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Centre for Sleep Science, University of Western Australia, Perth, Australia.
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12
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Machado FDS, Souza RCDS, Poveda VB, Costa ALS. Non-pharmacological interventions to promote the sleep of patients after cardiac surgery: a systematic review. Rev Lat Am Enfermagem 2017; 25:e2926. [PMID: 28902932 PMCID: PMC5599071 DOI: 10.1590/1518-8345.1917.2926] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/27/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: to analyze evidence available in the literature concerning non-pharmacological interventions that are effective to treat altered sleep patterns among patients who underwent cardiac surgery. METHOD: systematic review conducted in the National Library of Medicine-National Institutes of Health, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycINFO databases, and also grey literature. RESULTS: ten controlled, randomized clinical trials were included in this review. Non-pharmacological interventions were grouped into three main categories, namely: relaxation techniques, devices or equipment to minimize sleep interruptions and/or induce sleep, and educational strategies. Significant improvement was found in the scores assessing sleep quality among studies testing interventions such as earplugs, sleeping masks, muscle relaxation, posture and relaxation training, white noise, and educational strategies. In regard to the studies' methodological quality, high quality studies as established by Jadad scoring were not found. CONCLUSION: significant improvement was found among the scores assessing sleep in the studies testing interventions such as earplugs, sleeping masks, muscle relaxation, posture and relaxation training, white noise and music, and educational strategies. OBJETIVO: analisar as evidências disponíveis, na literatura, sobre as intervenções não farmacológicas, efetivas para o tratamento da alteração do padrão do sono em pacientes submetidos à cirurgia cardíaca. MÉTODO: revisão sistemática realizada por meio de busca nas bases de dados National Library of Medicine National Institutes of Health, Cochrane Central Register of Controlled Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scopus, Embase, Cumulative Index to Nursing and Allied Health Literature e PsycINFO, e na literatura cinzenta. RESULTADOS: dez ensaios clínicos controlados e randomizados foram incluídos na revisão. Constatou-se que as intervenções não farmacológicas agruparam-se em três categorias principais, a saber: técnicas de relaxamento, dispositivos ou equipamentos para minimizar a interrupção do sono e/ou induzir o sono e estratégias educacionais. Houve melhoria significativa nos escores de avaliação do sono entre os estudos que testaram intervenções como tampões de ouvidos, máscara de olhos, relaxamento muscular, treinamento de postura e relaxamento, produção sonora e estratégia educacional. Em relação à qualidade metodológica dos estudos, não foram encontrados estudos considerados de alta qualidade pelo escore de Jadad. CONCLUSÃO: houve melhora significativa nos escores de avaliação do sono em estudos que avaliaram intervenções como tampões de ouvidos, máscara de olhos, relaxamento muscular, treinamento de postura e relaxamento, produção sonora e estratégia educacional. OBJETIVO: analizar las evidencias disponibles en la literatura sobre las intervenciones no farmacológicas, eficientes para el tratamiento de la alteración del patrón del sueño en pacientes sometidos a una cirugía cardíaca. MÉTODO: revisión sistemática realizada mediante búsqueda en las bases de datos de la Librería Nacional de Medicina (National Library of Medicine), de los Institutos Nacionales de la Salud (National Institutes of Health), del Registro Central Cochrane de Ensayos Controlados (Cochrane Central Register of Controlled Trials), de la literatura latinoamericana y del Caribe, en Ciencias de la Salud, Scopus, Embase, Índice Acumulado de Enfermería y Literatura en Ciencias de la Salud, CINAHL (Cumulative Index to Nursing and Allied Health Literature) y PsycINFO, y en la literatura gris. RESULTADOS: se incluyeron en la revisión diez ensayos clínicos controlados y aleatorizados. Se constató que las intervenciones no farmacológicas se agruparon en tres categorías principales: técnicas de relajación, dispositivos o equipos para minimizar la interrupción del sueño y/o inducirlo, y estrategias educativas. Hubo una mejora significativa en las puntuaciones de la evaluación del sueño entre los estudios que probaron las intervenciones como tapón de oídos, máscara de ojos, relajación muscular, entrenamiento de postura y relajación, producción sonora y estrategia educacional. Con respecto a la calidad metodológica de los estudios, no se hallaron los considerados de alta calidad mediante la puntuación de Jadad. CONCLUSIÓN: hubo una mejora significativa en las puntuaciones de la evaluación del sueño en los estudios que evaluaron intervenciones como tapones de oídos, máscara de ojos, relajación muscular, entrenamiento de postura y relajación, producción sonora y estrategia educacional.
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Affiliation(s)
- Fernanda de Souza Machado
- Master’s student, Escola de Enfermagem, Universidade de São Paulo, São
Paulo, SP, Brazil. RN, Hospital Sírio Libanês, São Paulo, SP, Brazil
| | | | - Vanessa Brito Poveda
- PhD, Professor, Escola de Enfermagem, Universidade de São Paulo, São
Paulo, SP, Brazil
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Abstract
Obstructive sleep apnea (OSA) is present in more than 50% of patients referred to cardiac rehabilitation units. However, it has been under-recognized in patients after stroke and heart failure. Those with concurrent OSA have a worse clinical course. Early treatment of coexisting OSA with continuous positive airway pressure (CPAP) results in improved rehabilitation outcomes and quality of life. Possible mechanisms by which CPAP may improve recovery include decreased blood pressure fluctuations associated with apneas, and improved left ventricular function, cerebral blood flow, and oxygenation. Early screening and treatment of OSA should be integral components of patients entering cardiac rehabilitation units.
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Affiliation(s)
- Behrouz Jafari
- Section of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California-Irvine, 333 City Boulevard West, Suite 400, Irvine, CA, USA; Sleep Program, VA Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA.
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Le Grande MR, Neubeck L, Murphy BM, McIvor D, Lynch D, McLean H, Jackson AC. Screening for obstructive sleep apnoea in cardiac rehabilitation: A position statement from the Australian Centre for Heart Health and the Australian Cardiovascular Health and Rehabilitation Association. Eur J Prev Cardiol 2016; 23:1466-75. [DOI: 10.1177/2047487316652975] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/13/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Michael R Le Grande
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
| | - Lis Neubeck
- Sydney Nursing School and Charles Perkins Centre, University of Sydney, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- School of Psychological Sciences, University of Melbourne, Australia
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Dawn McIvor
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- CNC Cardiology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Dianna Lynch
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Ashford Hospital, Australia
| | - Helen McLean
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- Royal Perth Hospital, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health (formerly Heart Research Centre), Melbourne, Australia
- Faculty of Health, Deakin University, Melbourne, Australia
- Australian Cardiovascular Health and Rehabilitation Association, Australia
- University of Hong Kong, Centre on Behavioural Health, Hong Kong
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15
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Affiliation(s)
- Rebecca Shaw
- Rebecca Shaw is a clinical nurse on the orthopedics and trauma acute care unit at the University of North Carolina Medical Center in Chapel Hill, North Carolina
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16
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Lin Y, Xu L, Huang X, Jiang F, Lin F, Ye Q, Lin J. Cardiac Valve Noise Reduction by Non-Drug Interventions Improves the Sleep Quality of Patients after Mechanical Cardiac Valve Implantation. Ann Thorac Cardiovasc Surg 2016; 22:69-75. [PMID: 26853244 DOI: 10.5761/atcs.oa.15-00275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the effects of non-drug interventions on the sleep quality of patients after mechanical cardiac valve implantation. METHODS In this prospective, randomized, controlled trial, 64 patients scheduled for mechanical mitral valve replacement were recruited. Patients underwent cognitive behavioral therapy and wore noise cancelling earplugs and eye mask. Sleep quality was evaluated on the 4th after admission and the 5th days after operation. The primary outcome was the total sleep quality score differences between the 4th day after admission and the 5th day after operation. RESULTS All patients had been suffering from poor sleep quality for a month before admission. There was no difference between both groups on the 4th day after admission. Overall sleep quality in the intervention group was better than in the control group on the 5th day after operation. The subjective sleep quality of the patients in each group was significantly lower on the 5th day after the operation than on the 4th day after admission (P <0.05). CONCLUSION Non-drug intervention could improve the sleep quality of patients after mechanical cardiac valve implantation and help the postoperative recovery of the patients. ( TRIAL REGISTRATION ChiCTR-TRC-14004405, 21 March 2014.).
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Affiliation(s)
- Yanjuan Lin
- Cardiac Surgical Ward of Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
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Yang PL, Huang GS, Tsai CS, Lou MF. Sleep Quality and Emotional Correlates in Taiwanese Coronary Artery Bypass Graft Patients 1 Week and 1 Month after Hospital Discharge: A Repeated Descriptive Correlational Study. PLoS One 2015; 10:e0136431. [PMID: 26291524 PMCID: PMC4546334 DOI: 10.1371/journal.pone.0136431] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022] Open
Abstract
Background Poor sleep quality is a common health problem for coronary artery bypass graft patients, however few studies have evaluated sleep quality during the period immediately following hospital discharge. Purpose The aim of this study was to investigate changes in sleep quality and emotional correlates in coronary artery bypass graft patients in Taiwan at 1 week and 1 month after hospital discharge. Methods We used a descriptive correlational design for this study. One week after discharge, 87 patients who had undergone coronary artery bypass surgery completed two structured questionnaires: the Pittsburgh Sleep Quality Index and the Hospital Anxiety and Depression Scale. Three weeks later (1 month after discharge) the patients completed the surveys again. Pearson correlations, t-tests, ANOVA and linear multiple regression analysis were used to analyze the data. Results A majority of the participants had poor sleep quality at 1 week (82.8%) and 1 month (66.7%) post-hospitalization, based on the global score of the Pittsburgh Sleep Quality Index. Despite poor sleep quality at both time-points the sleep quality at 1 month was significantly better than at 1-week post hospitalization. Poorer sleep quality correlated with older age, poorer heart function, anxiety and depression. The majority of participants had normal levels of anxiety at 1 week (69.0%) and 1 month (88.5%) as measured by the Hospital Anxiety and Depression Scale. However, some level of depression was seen at 1 week (78.1%) and 1 month (59.7%). Depression was a significant predictor of sleep quality at 1 week; at 1 month after hospital discharge both anxiety and depression were significant predictors of sleep quality. Conclusion Sleep quality, anxiety and depression all significantly improved 1 month after hospital discharge. However, more than half of the participants continued to have poor sleep quality and some level of depression. Health care personnel should be encouraged to assess sleep and emotional status in patients after coronary artery bypass surgery and offer them appropriate management strategies to improve sleep and reduce anxiety and depression.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Guey-Shiun Huang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Sung Tsai
- Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Hu RF, Jiang XY, Hegadoren KM, Zhang YH. Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:115. [PMID: 25881268 PMCID: PMC4391192 DOI: 10.1186/s13054-015-0855-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/03/2015] [Indexed: 01/07/2023]
Abstract
Introduction Intensive care unit (ICU) environmental factors such as noise and light have been cited as important causes of sleep deprivation in critically ill patients. Previous studies indicated that using earplugs and eye masks can improve REM sleep in healthy subjects in simulated ICU environment, and improve sleep quality in ICU patients. This study aimed to determine the effects of using earplugs and eye masks with relaxing background music on sleep, melatonin and cortisol levels in ICU patients. Methods Fifty patients who underwent a scheduled cardiac surgery and were expected to stay at least 2 nights in Cardiac Surgical ICU (CSICU) were included. They were randomized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in CSICU. Urine was analyzed for nocturnal melatonin and cortisol levels. Subjective sleep quality was evaluated using the Chinese version of Richards-Campbell Sleep Questionnaire (a visual analog scale, ranging 0–100). Results Data from 45 patients (20 in intervention group, 25 in control group) were analyzed. Significant differences were found between groups in depth of sleep, falling asleep, awakenings, falling asleep again after awakening and overall sleep quality (P < 0.05). Perceived sleep quality was better in the intervention group. No group differences were found in urinary melatonin levels and cortisol levels for the night before surgery, and the first and second nights post-surgery (P > 0.05). The urinary melatonin levels of the first and second postoperative nights were significantly lower than those of the night before surgery (P = 0.01). The opposite pattern was seen with urinary cortisol levels (P = 0.00). Conclusion This combination of non-pharmacological interventions is useful for promoting sleep in ICU adult patients; however, any influence on nocturnal melatonin levels and cortisol level may have been masked by several factors such as the timing of surgery, medication use and individual differences. Larger scale studies would be needed to examine the potential influences of these factors on biological markers and intervention efficacy on sleep. Trial registration Chinese Clinical Trial Registry: ChiCTR-IOR-14005511. Registered 21 November 2014.
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Affiliation(s)
- Rong-Fang Hu
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350108, China.
| | - Xiao-Ying Jiang
- School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350108, China.
| | - Kathleen M Hegadoren
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - You-Hua Zhang
- Department of Nuclear Medicine, Fujian Province Hospital, East Street 134, Fuzhou, 350001, China.
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Pröpper J, van Valen R, van Domburg RT, Brunott M, Bogers AJJC. Quality of Sleep at the Ward after Cardiothoracic Surgery. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.56056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Johansson A, Svanborg E, Edéll-Gustafsson U. Sleep-wake activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample--an actigraphy and questionnaire study. Int J Nurs Pract 2013; 19:390-401. [PMID: 23915408 DOI: 10.1111/ijn.12080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The aim of this study was to explore whether there are gender differences in sleep and health-related quality of life in patients with coronary artery disease (CAD) and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty-seven patients with stable CAD and 47 participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for seven 24-h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses.
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Affiliation(s)
- Anna Johansson
- Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden.
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Madsen MT, Rosenberg J, Gögenur I. Actigraphy for measurement of sleep and sleep-wake rhythms in relation to surgery. J Clin Sleep Med 2013; 9:387-94. [PMID: 23585756 DOI: 10.5664/jcsm.2598] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients undergoing surgery have severe sleep and sleep-wake rhythm disturbances resulting in increased morbidity. Actigraphy is a tool that can be used to quantify these disturbances. The aim of this manuscript was to present the literature where actigraphy has been used to measure sleep and sleep-wake rhythms in relation to surgery. METHODS A systematic review was performed in 3 databases (Medline, Embase, and Psycinfo), including all literature until July 2012. RESULTS Thirty-two studies were included in the review. Actigraphy could demonstrate that total sleep time and sleep efficiency was reduced after surgery and number of awakenings was increased in patients undergoing major surgery. Disturbances were less severe in patients undergoing minor surgery. Actigraphy could be used to differentiate between delirious and non-delirious patients after major surgery. Actigraphy measurements could determine a differential effect of surgery based on the patient's age. The effect of pharmacological interventions (chronobiotics and hypnotics) in surgical patients could also be demonstrated by actigraphy. CONCLUSION Actigraphy can be used to measure sleep and sleep-wake rhythms in patients undergoing surgery.
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Affiliation(s)
- Michael T Madsen
- Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, Herlev, Denmark.
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Abstract
AIM The aim of this study was to determine the sleep quality of the patients hospitalized in surgical units and the factors that influence it. METHOD The research was a randomized descriptive study. It was conducted in the surgical clinics of Sivas Cumhuriyet University Health Services Research Hospital. A total of 411 patients participated in the study. The research data were gathered by means of the Pittsburgh Sleep Quality Index (PSQI) and the Questionnaire aimed at capturing personal information about the participant patients and the factors influencing their sleep. RESULTS The sleep quality score of the patients "during the last week" (8.090 ± 3.504) was higher than their score in the "preadmission" period (4.229 ± 2.726) (p= .000). The sleep quality scores of "the patients with previous hospitalization and operation experience" (p= .000), "those who had undergone a major surgical procedure" (p= .000), "those who had been hospitalized for a week" (p= .022), and "those undergoing medical intervention during sleeping hours" (p= .000) "during the last week" were high. Patients who had a chronic illness history and whose operations were postponed had poor quality of sleep in both the hospitalization and preadmission period (p= .000). CONCLUSIONS It could be suggested that the patients in preoperative and postoperative periods cannot get adequate rest due to low sleep-quality levels. IMPLICATIONS FOR PRACTICE Nurses can prepare an environment aiding sleep as a way to increase surgical patients' sleep quality in hospital.
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Affiliation(s)
- Meryem Yilmaz
- Surgical Nursing Division, Department of Nursing, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey.
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An Exploratory Study of Sleep Quality, Daytime Function, and Quality of Life in Patients with Mechanical Circulatory Support. Int J Artif Organs 2012; 35:531-7. [DOI: 10.5301/ijao.5000109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2012] [Indexed: 11/20/2022]
Abstract
Purpose: To identify and describe: (1) characteristics of sleep quality, daytime sleepiness, and quality of life (QOL) pre and post implantation of a left ventricular assist device (LVAD); (2) changes in sleep quality, daytime sleepiness, and QOL at baseline and 6 months post implant; and (3) relationships among the sleep quality, daytime sleepiness, and QOL variables. Methods: We employed an exploratory research design. Fifteen patients with continuous/non-pulsatile flow LVAD consented to partake in the study. However, only 12 patients completed the baseline and 6-month post-LVAD implant data. We used the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) to measure study variables. Data were analyzed using IBM SPSS 19.0 software. Results: Patients reported worse sleep quality accompanied by daytime sleepiness particularly at baseline, and persisting up to 6 months post LVAD implant. A significant improvement in QOL was observed at 6 months post implant, but remained at poor levels. Correlations among sleep disturbance and daytime dysfunction components of PSQI and global daytime sleepiness (ESS) with QOL were strong (Pearson's correlations r>.60; p values <.05). Conclusions: We report the first empirical data describing the characteristics and correlations among sleep quality, daytime sleepiness, and QOL in patients with LVADs. Our findings offer beginning evidence about the sleep-QOL connection in this population which warrants attention in clinical practice and research. Further research is required to clearly elucidate these phenomena in patients with mechanical circulatory support and other implantable artificial organs.
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Zimmerman L, Barnason S, Hertzog M, Young L, Nieveen J, Schulz P, Tu C. Gender differences in recovery outcomes after an early recovery symptom management intervention. Heart Lung 2011; 40:429-39. [PMID: 21501872 DOI: 10.1016/j.hrtlng.2010.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/15/2010] [Accepted: 07/23/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite known gender differences in recovery, few studies have examined symptom management (SM) interventions or responses by gender after coronary artery bypass surgery (CABS). OBJECTIVE The purpose of this subanalysis was to describe and evaluate differences in response by gender to an SM intervention on the presence and burden of symptoms, physical activity, and physical functioning in elderly CABS patients during the early discharge period (3 and 6 weeks after CABS, and 3 and 6 months after CABS). METHODS The parent study whose data were analyzed to examine gender differences involved a two-group, randomized clinical trial design. The 6-week early recovery SM telehealth intervention was delivered by the Health Buddy. Measures included the Cardiac Symptom Survey, a Modified 7-Day Activity Interview, an RT3 accelerometer, an Activity Diary, and the Medical Outcomes Study Short Form 36. This study was not powered for a gender × group analysis, and we used descriptive statistics, χ(2) tests, t tests, and analysis of variance for statistical analyses. RESULTS Subjects (n = 232) included 192 men and 40 women, with a mean age of 71.2 SD, 7 years. The intervention group consisted of 86 men and 23 women, and the usual care (UC) group consisted of 106 men and 17 women. Data trends suggest that the SM intervention exerted greater impact on women than on men for symptoms such as fatigue, depression, sleep problems, and pain. Again, men exhibited higher levels of physical activity than did women. However, women in the SM group generally had higher scores than did women in the UC group. CONCLUSION Although the parent study found no effect of an early recovery SM intervention, this exploratory secondary analysis indicated that women in the intervention group demonstrated more improvement in measures of physical activity than did those in the UC group. Further study, using a larger sample, is necessary to test these preliminary results.
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Affiliation(s)
- Lani Zimmerman
- College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska 68588-0220, USA.
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Affiliation(s)
- Carol A Landis
- Department of Biobehavioral Nursing and Health System, University of Washington, Seatle, WA 98195-7266, USA.
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Schulz P, Lottman DJ, Barkmeier TL, Zimmerman L, Barnason S, Hertzog M. Medications and associated symptoms/problems after coronary artery bypass surgery. Heart Lung 2010; 40:130-8. [PMID: 20561878 DOI: 10.1016/j.hrtlng.2010.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 03/02/2010] [Accepted: 03/09/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this secondary analysis was to describe medication use and examine the relationship between medications and postoperative symptoms/problems in the first 3 months after coronary artery bypass surgery (CABS). METHODS The sample consisted of older (≥65 years) men and women (n = 232) who had undergone CABS. Medication data were collected through self-report 3 and 6 weeks and 3 months after surgery. RESULTS Most patients reported taking aspirin (88.2%-85.7%), statins or cholesterol-lowering drugs (88.6%-87%), and beta-blockers (68%-55.6%). No significant differences were found between the proportion of patients taking and not taking beta-blockers, antiarrhythmics, cholesterol-lowering drugs, or angiotensin-converting enzyme inhibitor medications for common medication-specific symptoms/problems. CONCLUSION Patients experience symptoms after surgery, but these symptoms did not seem to be side effects from medications. Nursing assessments and interventions targeting postoperative symptoms, symptom management, and medication side effects can enhance recovery and reinforce medication adherence.
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Affiliation(s)
- Paula Schulz
- UNMC College of Nursing-Lincoln Division, Lincoln, Nebraska 68588-0220, USA.
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Suleiman KH, Yates BC, Berger AM, Pozehl B, Meza J. Translating the Pittsburgh Sleep Quality Index into Arabic. West J Nurs Res 2009; 32:250-68. [PMID: 19915205 DOI: 10.1177/0193945909348230] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This descriptive correlational study describes the translation process and the psychometric testing of the Pittsburgh Sleep Quality Index (PSQI). The PSQI has been successfully translated into Arabic and back-translated into English by 10 Arabic bilingual translators. Then the PSQI is tested in a sample of 35 healthy Arabic bilinguals.The internal consistency reliability for the Global PSQI demonstrates borderline acceptability (Cronbach's alpha = .65). The reliability is further supported by moderate to high correlations between five PSQI components and the global PSQI score (r = .53 to .82, p < .01). Convergent validity is supported by the global PSQI correlating strongly with the Insomnia Severity Index (r = .76) and moderately with the related construct of the Medical Outcome Study Short Form-36 vitality subscale (r = -.33). Further testing of the PSQI is needed in a larger Arabic population, both clinical and healthy populations, living in their native countries.
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Caldwell BA, Redeker NS. Sleep patterns and psychological distress in women living in an inner city. Res Nurs Health 2009; 32:177-90. [PMID: 19086035 DOI: 10.1002/nur.20308] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Psychological distress, including symptoms of anxiety, depression, and psychological trauma, is common in women living in inner cities and can be associated with disturbed sleep. The purposes of the study of 115 women were to examine: (a) objective and subjective sleep patterns; (b) extent of psychological distress; and (c) the relationship between objective and subjective sleep patterns and psychological distress. Wrist actigraphs were worn. High levels of life stress, sleep pattern disturbance, and psychological distress were common. Self-reported sleep patterns, but not objective sleep pattern variables, explained 12.5% to 44% of the variance in psychological distress, suggesting the importance of screening for sleep and psychological distress. These findings suggest that interventions focusing on sleep or psychological distress may reduce symptoms.
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Affiliation(s)
- Barbara A Caldwell
- School of Nursing, University of Medicine and Dentistry of New Jersey, 65 Bergen Street, Newark, NJ, USA
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Figueroa-Ramos MI, Arroyo-Novoa CM, Lee KA, Padilla G, Puntillo KA. Sleep and delirium in ICU patients: a review of mechanisms and manifestations. Intensive Care Med 2009; 35:781-95. [PMID: 19165463 DOI: 10.1007/s00134-009-1397-4] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Accepted: 11/12/2008] [Indexed: 12/27/2022]
Abstract
Sleep deprivation and delirium are conditions commonly encountered in intensive care unit patients. Sleep in these patients is characterized by sleep fragmentation, an increase in light sleep, and a decrease of both slow wave sleep and rapid eye movement sleep. The most common types of delirium in this population are hypoactive and mixed-type. Knowledge about the mechanisms of sleep and delirium has evolved over time, but these phenomena are not yet well understood. What is known, however, is that different areas in the brainstem transmit information to the thalamus and cortex necessary for sleep-wake regulation. Delirium is related to an imbalance in the synthesis, release, and inactivation of some neurotransmitters, particularly acetylcholine and dopamine. The relationship between sleep deprivation and delirium has been studied for many years and has been viewed as reciprocal. The link between them may be ascribed to shared mechanisms. An imbalance in neurotransmitters as well as alteration of melatonin production may contribute to the pathogenesis of both phenomena. A better understanding of the mechanisms and factors that contribute to sleep deprivation and delirium can guide the development of new methods and models for prevention and treatment of these problems and consequently improve patient outcomes.
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Affiliation(s)
- Milagros I Figueroa-Ramos
- School of Nursing, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, Puerto Rico 00936-5067.
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Abstract
Disturbances in sleep associated with sleep deprivation, disorders in circadian rhythms, and sleep-disordered breathing are common in critical care settings and may have a significant impact on physiologic, behavioral, and functional outcomes, as well as patient satisfaction and utilization of healthcare resources. Despite growth in awareness of the potential importance of sleep in the critical setting over the past 30 years, many questions about the nature of sleep, the predictors and consequences of sleep disturbance, and the efficacy of sleep promotion interventions in critically ill patients remain unanswered. Most of the studies of sleep in critical care settings have used small, nonrandom samples and descriptive or explanatory designs; many have not considered multifactorial explanatory variables; and clinical trials are rare. These gaps in quantity and quality of research findings are barriers to the delivery of evidence-based sleep promotion interventions and may be partially explained by conceptual and methodological challenges associated primarily with the nature of sleep measurement and characteristics of critically ill patients and the critical care environment. This article will explore these concerns and propose strategies to deal with them. Research exemplars from the literature will be used to illustrate key points.
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Hedges C, Redeker NS. Comparison of Sleep and Mood in Patients After On-Pump and Off-Pump Coronary Artery Bypass Surgery. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.2.133] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Off-pump coronary artery bypass surgical procedures have been advocated to reduce the adverse effects of cardiopulmonary bypass on the brain.
Objective To examine differences in objective and subjective characteristics of sleep and mood disturbance between patients after on-pump and off-pump coronary artery bypass surgery.
Methods In a secondary analysis of pooled data from 2 previous studies, sleep characteristics and mood disturbance on postoperative night 2 after transfer to the cardiac surgery step-down unit were compared in patients who had on-pump and off-pump cardiac surgery. The sample included 129 coronary artery bypass patients: 48 on-pump patients from one hospital and 81 off-pump patients from another hospital. Data were obtained with wrist actigraphs. Subjective characteristics of sleep were determined by using the Pittsburgh Sleep Quality Index and a sleep diary; mood disturbance was evaluated by using the short form of the Profile of Mood States.
Results Off-pump surgery was associated with better objective sleep continuity (decreased percentage of wake time after sleep onset and fewer awakenings) but not longer sleep duration after controlling for age and sex. The 2 groups of patients did not differ overall in subjective sleep characteristics, mood disturbance, or preoperative sleep quality.
Conclusion Use of off-pump coronary artery bypass surgery may improve sleep continuity during the early postoperative period. Prospective longitudinal studies are needed to evaluate the potential long-term benefits of this procedure during the different phases of recovery.
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Affiliation(s)
- Christine Hedges
- Christine Hedges is a nurse researcher at Ann May Center for Nursing, Meridian Health, Neptune, New Jersey. Nancy S. Redeker is a professor and associate dean for scholarly affairs at the School of Nursing, Yale University, New Haven, Connecticut
| | - Nancy S. Redeker
- Christine Hedges is a nurse researcher at Ann May Center for Nursing, Meridian Health, Neptune, New Jersey. Nancy S. Redeker is a professor and associate dean for scholarly affairs at the School of Nursing, Yale University, New Haven, Connecticut
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Abstract
In this study, I examined sleep, memory, and learning in off-pump coronary artery bypass (OPCAB) patients. Sixty-six men and women aged >or=60 years wore actigraphs to record sleep and completed sleep diaries for two 24-hour periods following OPCAB surgery. Prior to discharge from the hospital, participants completed the Pittsburgh Sleep Quality Index (PSQI) and Rey Auditory Verbal Learning Test. No significant correlations were found between habitual sleep, sleep time, efficiency, number, and duration of awakenings, daytime napping, or memory and learning. Nighttime sleep was short with frequent disturbances, and daytime sleep accounted for half the daily sleep time. Participants scored low in learning and delayed recall. These findings suggest the need to assess sleep and cognition in patients recovering from OPCAB surgery.
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Affiliation(s)
- Christine Hedges
- Ann May Center for Nursing, Meridian Health, Jersey Shore University Medical Center, Rosa I, 1945 Route 33, Neptune, NJ 07754, USA
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