Effect of self-care interventions on sleep quality in post-coronary artery bypass grafting patients: A single-center, randomized-controlled study

Sleep quality after autologous breast reconstruction

BACKGROUND

Sleep is a fundamental aspect of human health and well-being, but is often interrupted in a hospital setting. Especially after surgery, poor sleep quality can negatively affect postoperative recovery and quality of life. Therefore, the aim of this study was to gain insights into the quality of sleep in patients after autologous breast reconstruction and evaluate factors associated with the quality of sleep.

MATERIALS AND METHODS

In this single-center observational cohort study, participants completed a sleep diary, including the Pittsburgh sleep quality index (PSQI) and EQ-5D-5L quality of life questionnaire, before surgery, during hospital admission, and two weeks and three months postoperative. Additional variables such as pain and anesthesia duration were collected.

RESULTS

Twenty-nine patients were included. Before the surgery, 58% of them experienced poor quality of sleep, with a median PSQI score of 5.0. During hospital admission, 83% of the patients had poor quality of sleep, with a PSQI score of 6.0. The PSQI score two weeks postoperative increased to 7.0 and decreased three months postoperative to 5.0. Patients with pain scores >4 ("pain" group), had higher median PSQI scores than patients with pain scores ≤4 ("no pain" group) at all postoperative time points previously mentioned. No correlation was observed between anesthesia duration or quality of life.

CONCLUSION

Poor sleep quality was experienced by most women after autologous breast reconstruction, especially in those with higher postoperative pain scores. This knowledge offers an opportunity to improve the postoperative care for such patients.

The Effects of Self-Acupressure on Pain and Sleep Quality in Patients With Coronary Artery Disease: A Randomised Controlled Trial

PURPOSE

The most important cause of death among cardiovascular diseases is Coronary artery disease (CAD). Pain and insomnia symptoms are the most common symptoms in CAD patients. Acupressure is used in patients with CAD as one of the energy-based complementary and alternative methods. This study was conducted to investigate the effects of self-acupressure on pain and sleep quality in patients with coronary artery disease.

DESIGN

This is a randomised controlled trial.

METHODS

This study was conducted between June and August 2021 with a total of 80 participants, 40 in the intervention and 40 in the control group. The participants in the intervention group were asked to perform a total of 16 sessions for 4 weeks, 2 days a week in the morning and afternoon, for a total of 23 minutes, depending on the preparation and compression time to be performed on 5 points. The control group did not receive any intervention during the study. Data were collected by using Descriptive Information Form, Visual Analogue Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

After self-acupressure, the VAS total score of the intervention group decreased significantly compared to the control group (t=-11.861; p<.05). After intervention PSQI total and subscale mean scores of the intervention group decreased significantly compared to the control group (t=-7.767; p<.05). It can be seen that self-acupressure application has a negative and significant effect on PSQI total mean scores and VAS total mean score of patients (p<.05).

CONCLUSION

The results of this study showed that self-acupressure was effective in improving the pain and sleep quality of patients with coronary artery disease.

CLINICAL IMPLICATIONS

Self-acupressure is an accessible and inexpensive method, it is recommended to be supported and maintained in the management of coronary artery disease in nursing practice.

Occupational Therapy Practice Guidelines for Adults With Chronic Conditions

IMPORTANCE

Demand is increasing for occupational therapy practitioners to help the growing population of adults with chronic conditions manage their conditions.

OBJECTIVE

This Practice Guideline, which is informed by systematic reviews of the literature on the use of self-management interventions, is meant to guide occupational therapy practitioners' clinical decision making when working with community-dwelling adults with chronic conditions. The chronic conditions included heart disease, chronic lung conditions, diabetes, and kidney disease. The self-management interventions addressed ADLs and sleep and rest; IADLs; education, work, volunteering, leisure, and social participation; and the caregiver role.

METHOD

We reviewed, discussed, and integrated the clinical recommendations developed from four systematic reviews, supporting literature, and expert opinion to provide recommendations for practice.

RESULTS

A total of 102 articles were included in the systematic reviews, which served as the primary basis for the practice recommendations.

CONCLUSIONS AND RECOMMENDATIONS

Strong to moderate evidence supports clinical recommendations for the use of self-management interventions when working with clients with chronic conditions. We recommend the use of a multimodal approach that includes three components-education, goal setting, and problem solving-over an extended period to assist clients in establishing self-management habits and routines. On the basis of emerging evidence and expert opinion, we recommend that occupational therapy practitioners consider using a prevention approach, helping clients establish habits and routines, and emphasizing shared goal setting when addressing clients' self-management of chronic conditions. What This Article Adds: This Practice Guideline provides a summary of strong to moderate evidence that supports clinical recommendations for the use of self-management interventions with clients with chronic conditions. When guided by this evidence, occupational therapy practitioners are better able to help clients meet their occupational challenges.

Self-Management Interventions to Improve Activities of Daily Living and Rest and Sleep for Adults With Chronic Conditions: A Systematic Review

IMPORTANCE

Chronic conditions often cause functional impairments in activities of daily living (ADLs) and rest and sleep, leading to decreased independence and self-efficacy.

OBJECTIVE

To aid occupational therapy practitioners in making informed decisions regarding self-management interventions to improve ADLs and rest and sleep for community-dwelling adults with chronic conditions.

DATA SOURCES

We identified literature published from 1995 to 2019 through searches of the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract and assess data quality and validity. The review followed American Occupational Therapy Association Evidence-Based Practice Project methodology. Studies addressing self-management interventions for community-dwelling adults ages 18 and older with chronic cardiovascular disease, Type 2 diabetes, heart disease, hypertension, chronic respiratory problems, or kidney disease were included.

FINDINGS

Fifteen articles met inclusion criteria and were categorized into ADLs and sleep. Strong evidence supports education to improve diabetic foot self-care. Low evidence addresses exercise and education to improve ADLs for people with heart disease and chronic obstructive pulmonary disease. Moderate evidence supports mind-body self-care education to enhance sleep.

CONCLUSIONS AND RELEVANCE

Occupational therapy practitioners working with adults with diabetes are encouraged to routinely offer education that includes discussion of risk factors and daily foot inspections and hygiene. When addressing sleep, education that addresses sleep hygiene, nutrition, relaxation techniques, and physical activity should routinely be provided to adults with chronic conditions. Further research is needed to understand the dosage needed. What This Article Adds: This systematic review supports the role of occupational therapy in providing self-management interventions to address ADLs and sleep for adults with diabetes and other chronic conditions.

Diagnostic accuracy and suitability of instruments that screen for obstructive sleep apnoea, insomnia and sleep quality in cardiac patients: a meta-analysis

BACKGROUND

A number of clinical guidelines recommend that all cardiac rehabilitation patients should be screened for potential sleep disorders with a validated screening instrument. There is currently no consensus on what specific tools should be used.

OBJECTIVE

To identify tools that are practical to use in the clinical environment and have high diagnostic accuracy.

METHODS

We systematically searched online databases to identify patient reported outcome instruments that have been used in published research studies to assess the likelihood of obstructive sleep apnoea (OSA) in cardiac patients. In studies that provided diagnostic data, these data were extracted and verified via an evidence-based diagnostic calculator. Where sufficient numbers of studies were available, a meta-analysis was conducted to determine pooled estimates of specificity, sensitivity and diagnostic odds ratios. Selected papers were qualitatively assessed using the Standards for Reporting Diagnostic accuracy studies (STARD).

RESULTS

Of the 21 instruments identified, six detected likelihood of OSA, two assessed daytime sleepiness, five assessed insomnia and eight examined sleep quality. A meta-analysis of 14 studies that assessed diagnostic accuracy of moderate OSA, revealed moderate sensitivity for the Berlin Questionnaire, Sens = 0.49 (95% CI 0.45-0.52) and good sensitivity for the Stop-BANG, Sens = 0.93 (95% CI 0.87-0.96) but poor specificity at standard cut-off criteria.

CONCLUSION

There are promising practical tools available to screen patients with OSA and other sleep disorders in cardiac rehabilitation settings, but specificity could be improved. Additional assessment of sleep quality may enhance prognostic ability with both OSA and insomnia screening.